Governments must make their health care systems more efficient if they are to maintain quality of care without putting further stress on public finances, according to a new 200 page OECD report, ‘Health Care Systems: efficiency and policy settings. The OECD warns that cash-strapped governments no longer have the option of boosting spending to improve health outcomes, as they have done over the past several decades.
Angel Gurria of OECD says, "Healthcare is now one of the largest government spending items, representing on average 15% of government spending across the OECD, and costs are still rising. The economic and financial crisis has weighed heavily on public finances, reinforcing the need to improve health care efficiency."
The OECD report recognises that the sharp rise in healthcare spending - which has grown by more than 70% per capita in real terms since the early-1990s - led to steady improvements in health outcomes across the OECD. Life expectancy has increased by one year every four years, survival rates from diseases like cancer are up, and premature births and infant mortality have dropped dramatically.
Cross-country comparative analysis highlights the uneven healthcare efficiency performance across the OECD countries. Australia, Japan, Korea, Switzerland and Iceland get the best health outcomes for money spent. Denmark, Greece, Hungary, the Slovak Republic and the United States have the widest margin for improving health outcomes without increasing spending.
The report says that exploiting efficiency gains would allow countries to continue improving the quality of care while holding costs constant. Adoption of best practices could reduce costs by nearly 2% of GDP by 2017 across the OECD, as compared to a no-reform scenario, while savings could be above 3% of GDP in Greece, Ireland and the United Kingdom. If all countries were to become as efficient as the best performers, life expectancy at birth could be raised by more than two years on average across the OECD area, without any increased health care spending. A 10% increase in health care spending would only increase life expectancy by three to four months, if the extent of inefficiency remains unchanged.
The new report is based on unique healthcare policy data gathered from 29 OECD countries, grouped into six newly-defined types of health care systems, ranging from those that rely principally on private insurance and markets to those where governments take the lead. The report investigates the links between policy choices and health system efficiency and makes specific suggestions for improvements on a country-by-country basis.
It seeks to compare quality of healthcare between the countries. It uses many criteria but admits that comparing quality is far from easy. Every country has minuses and pluses. What it does highlight is that simplistic comparisons such as healthcare/hospitals/doctors in country A are better than country B, are statistically unprovable and dangerous; you can suggest that country A has a higher admissions or lower fatality rate on a specific chronic disease such as heart failure than country B, but this is a very rough and ready comparison as there may be specific country factors other than healthcare that affect outcomes.
It says that increasing patient choice on where and when they can be treated enhances customer empowerment and stimulates competition. It highlights the increased patient choice in the UK, Norway and Sweden. It shows the many different ways countries seek to improve and regulate healthcare- some offering a free market, and others with highly controlled pricing. What it does highlight is the very different ways that countries offer healthcare, state v private, private insurance v state insurance, compulsory insurance v voluntary insurance etc. The message to any destination or healthcare provider marketing medical tourism, is that each of the target country markets has its own unique mechanisms on providing healthcare, and unique advantages/ disadvantages on price and care; you cannot lump all of Europe or all of Asia together and market to each country in that group in exactly the same way.