Elizabeth Docteur European Health Forum Gastein 7 October 2004 Towards High-Performing Health Systems: Challenges and Opportunities for Reform

2 Gains in life expectancy at birth, total population,1960–2000 Source: OECD Health Data 2003.

3 Infant mortality, 2000 and average annual declines in infant mortality,

4 Factors driving health improvements Economic expansion and related factors –e.g. increased educational attainment Improvements in health care and health systems –Advances in medicine and technical capability –Improvements in access to care and health care systems (e.g., universal coverage attained in most OECD countries) –Successful public health initiatives (vaccination, initiatives and policies to reduce tobacco consumption)

5 “Health systems are victims of their own success.” Julio Frenk Health Minister, Mexico OECD Health Ministerial Meeting, May 2004

6 Growing health spending as a share of GDP,1970 and 2002 Source: OECD Health Data 2004, 2 nd edition.

7 Is spending growth a problem? Some evidence to suggest that benefits from medical advances exceed costs, at least for some conditions (e.g. Cutler and McClellan 2001) Health is a vibrant economic sector providing good employment, high-tech industry But…spending must be financed!

8 Pressures on public budgets and private resources THE by source of funding, 2001 Note: Countries are ranked from left (highest) to right (lowest) according to level of per capita health expenditure. THE = total health expenditure. Source: OECD Health Data 2004, 2 nd edition.

9 Countries should expect continued cost and financing pressure in the health sector.

10 Cost pressures due to ageing Growing proportion of over 80 Ageing populations expected to raise demand for care Long-term care costs relatively low but growing

11 Health expenditure linked to GDP, although spending varies for given income level, 2002 Source: OECD Health Data 2004, 2 nd edition.

12 There are very great opportunities to further improve health and the performance of health systems.

13 Further health gains are possible Life expectancy at age 65, 2002 FemalesMales Source: OECD Health Data 2004, 1st edition

14 Increasing obesity rates among the adult population in OECD countries Source: OECD Health Data 2003.

15 Increasing awareness of serious problems with health care quality Needed services not always provided –Aspirin and beta blockers after a heart attack Services are provided that are not clinically appropriate for a patient –Antibiotics for colds Errors in health-care delivery are not uncommon –Wrong-site surgeries, wrong medicine or dosage

16 Cross-country differences in care Immunisation against influenza, 2000 Source: OECD Health Data 2004 % of population 65+

17 One-year case-fatality rates for ischaemic stroke, 1998 Note: Canadian data are from Alberta and Ontario, United Kingdom data are from the Oxford region, and United States data are from Medicare data only. Source: OECD (2003), A Disease-Based Comparison of Health Systems. % of patients who died within the first year following admission

18 Other pressures to improve health- system performance Excessive waiting times for elective surgery are a policy issue in about ½ of OECD countries Disparities in access to care, service use, or health status across population groups

19 Efficiency of OECD health systems: what do we know? Complexity, market failures, extent of government intervention suggest potential for distortions that reduce efficiency Very large cross-country variation in resources, activity and health system performance –Highest spending and activity levels do not always translate into best results (e.g. health-care outcomes, waiting times, patient and consumer satisfaction, equitable access to care) –This suggests that it is not just how much you spend, but how you spend it that matters –Suggests that there is opportunity to learn from comparison

20 The Challenges Improving performance without increasing cost pressure Finding ways to reduce spending that do not hurt performance Reducing financing pressure while maintaining equity

21 Some Lessons International comparisons provide valuable guidance –Monitoring and benchmarking are essential Even armed with knowledge, improving health-system performance is never easy Trade-offs across policy goals are inevitable Making real change can be difficult –Need to involve stakeholders –Reform is an iterative process

22 OECD Health Project products Towards High-Performing Health Systems Final Report to Ministers Summary Report Policy Studies compendium Private Health Insurance in OECD Countries Health Technologies and Decision Making Long-Term Care for Older People New OECD Health Working Papers series (16 releases to date)

23 For more information: