Driving Improvements in Health Systems with Data
Mark Pearson discusses leveraging data to enhance health systems, exploring international measures of inputs/outputs, efficiency analysis, and potential gains in health outcomes. The talk emphasizes the importance of data-driven decision-making for optimizing healthcare performance.
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Presentation Transcript
HOW DATA CAN DRIVE IMPROVEMENTS IN HEALTH SYSTEMS Mark Pearson Head, OECD Health Division Japanese Health Economics Association 21 July, 2012
Structure of my talk 1. A cautionary tale: don t ask me which health system is the best 2. Getting better international measures of health inputs 3. Getting better international measures of health outputs 4. Prices and volumes of activity
1. WHICH SYSTEM IS BEST?
Efficiencyof the health sector DEA analysis Output 84 82 Efficiency frontier inefficiency 80 Output 78 Input inefficiency 76 74 72 Source: OECD, 2010 70 0 1000 2000 3000 4000 5000 6000 Input 4
If we spent better, what would we get? Years Potential gains in 2007 (DEA) Increase over 1997-2007 6 5 4 3 2 1 0 United Turkey Korea Belgium Sweden Luxembourg Greece Portugal Iceland Australia France Finland Mexico Hungary Canada Poland Denmark Germany Spain Austria Czech Republic Norway Ireland New Zealand United States Netherlands Japan Italy Switzerland Slovak Republic
Groups of countries sharing broadly similar institutions
Efficiency varies more within groups of countries than across them Potential gains in life expectancy (years, DEA) 5 HUN SVK DNK 4 GRC LUX FIN GBR IRL 3 CZE BEL DEU NLD OECD average AUT NZL NOR POL CAN 2 ESP SWE TUR ITA PRT FRA MEX JPN KOR 1 ISL CHE AUS 0 0 1 2 3 4 5 6
. BETTER INTERNATIONAL MEASURES OF INPUTS
Three dimensions of health accounting What types of health goods and services are consumed? Healthcare Consumption SHA Who Accounting Framework provides the service? Who pays? Service Provision Health Financing Source: Adapted from IHAT for SHA 2011
SHA 2011: What is new and improved? Consistent labelling and categories introduced: Link to intl. standards - SNA 2008, provider classifications (e.g. ISIC) Larger compatibility between functions of care and providers Closer correspondence to financing functions of revenue raising, pooling and purchasing Refined boundary setting Continuity facilitated: Functions, Providers, Financing New health care classifications: Factors of provision Financing revenues Introduction of capital classification Separate reporting for current and capital
A need to clarify the boundaries of LTC Long Term Care, as a share of GDP, 2009 (or nearest year) LTC (Health) General government LTC (Health) Private sector LTC (Social) General government LTC (Social) Private sector 4 Different division between health and social care 3.5 3 Restricted boundary of LTC in health 2.5 2 1.5 1 0.5 0
Policy use of internationally comparable data USD PPP USA 800 In 2007, per capita spending on pharmaceuticals in Greece was second only to the US GREECE CAN IRELAND FRA BEL DEU 600 JPN ITA ESP PRT AUT AUS CHE SWE HUN SVK ISL FIN SVN LUX NOR KOR GBR 400 CZE DNK POL NZL MEX EST 200
3. BETTER INTERNATIONAL MEASURES OF OUTPUTS
Increasing life expectancy, but in good health? Healthy life years (HLY) at age 65, by gender, 2008-10 Females Males Sweden Denmark United Kingdom Ireland Netherlands France Spain EU-27 Greece Italy Germany Hungary Portugal Japan (2004) 20 Years 15 10 5 0 0 5 10 15 20 Years Source: Eurostat Statistics Database; Cabinet White Paper, 2007.
What factors account for increases in life expectancy? Contributions to changes in life expectancy Women 1.14 0.00 0.06 0.02 0.15 0.50 0.11 Men 1.34 0.12 0.07 0.02 0.29 0.49 0.63 Health care spending Smoking Alcohol Diet Pollution Education GDP Observed changes 2.49 3.45
Cancer Breast cancer five-year relative survival 1995-2000 2004-2009 or nearest period United States Japan Canada Finland Germany OECD United Kingdom Korea 0 10 20 30 40 50 60 70 80 90 100 Age-standardised rate (%)
Care for acute exacerbation of chronic conditions Ischemic stroke 30 day in-hospital mortality 2000 2009 (or nearest year) Australia OECD Sweden United States Finland Korea Japan 0 1 2 3 4 5 6 7 8 Age-sex standardised rate (%)
Care for acute exacerbation of chronic conditions AMI 30 day in-hospital mortality 2000 2009 (or nearest year) Japan Korea OECD Finland United States Australia Sweden 0 2 4 6 8 10 Age-sex standardised rate (%)
Care for chronic conditions Uncontrolled diabetes admissions, 2009 (or nearest year) Korea Finland Germany OECD (24) United Kingdom United States Canada Australia 0 20 40 60 80 100 120 140 Age-sex-standardised rate per 100 000 population
Patient safety Foreign body left in during procedure, 2009 (or nearest year) Canada United Kingdom OECD (17) France United States Finland Germany 0 2 4 6 8 10 Crude Rate per 100,000 patients
Where the Japanese health system does MORE than other countries Japan Rank compared with OECD countries 1st OECD average 13. 1 per capita 10.1 6.8 Doctor consultations per capita 8.7 Practising nurses 11th per 1000 population 8.1 per 1000 population 43.1 per million population 97.3 per million population per 1000 population 3.4 per 1000 population 12.5 per million population 22.8 per million population Hospital beds 1st MRI units 1st CT scanners 1st Source: OECD Health Data 2012.
Widespread availability of medical technology Per million population Per million population CT scanners MRI machines 120 50 100 40 80 30 60 20 40 10 20 0 0 Source: OECD Health Data 2012.
Where the Japanese health system does LESS than other countries Japan Rank compared with OECD countries OECD average 2.2 3.1 Practising physicians 29th per 1000 population per 1000 population 107.1 151.6 Hospital discharges 28th per 1000 population per 1000 population Source: OECD Health Data 2012.
Comparative hospital price level, 2009 250 208205 197 200 185 172 148147145141 150 135 130126 119116 108105 104100 100 93 100 83 79 44 50 38 32 30 24 0
Per capita volumes of hospital services, 2009 USD Hospital PPP 4000 3332 3500 2705 3000 2684 2667 2584 2531 2510 2462 2423 2359 2353 2336 2248 2239 2500 2136 2110 2046 1996 1939 1933 1777 2000 1620 1532 1524 1512 1420 1394 1500 1000 500 0 Portugal Canada Sweden Estonia Spain Norway United States Germany Belgium Finland Australia Poland Austria OECD (mean) Luxembourg Czech Republic France Slovak Republic Italy Israel Hungary Denmark Slovenia Ireland Switzerland United Kingdom Netherlands
Service levels were maintained in Ireland Key Metrics 2006 2007 2008 2009 2010 Patients treated as inpatients (% change over previous year) Patients treated as day cases (% change) Attendances as out patients (% change) 2.3 3.9 -2.0 -1.2 -0.7 9.2 4.8 9.6 4.4 8.2 7.5 10.7 5.9 2.5 6.0 Health expenditure 2006 2007 2008 2009 2010 Gross current expenditure (% change) 9.1 10 10.7 1.6 -4.1 Gross pay (% change) 8.1 6.7 5.7 2.1 -6.6
while growth in health prices continued in the United States Factors Accounting For Growth In Personal Health Care Spending, Selected Periods 2000 10. Source: Martin et at, Health Affairs (2012)
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