1. HOW DO WE MEASURE EFFICIENCY IN BELGIUM HSPA REPORT 1 P.Meeus MD, MPH,MHA, Pascal.meeus@inami.fgov.be OECD 23/10/2014

2. 1.Introduction 2.Efficiency indicators within Be HSPA 3.Other (in) efficiency indicators within Be HSPA ? 4.Discussion 2

3. 1.Introduction 2.Efficiency indicators within Be HSPA 3.Other (in) efficiency indicators within Be HSPA ? 4.Discussion 3

4. (Financial) Sustainability Quality (Financial) Accessibility Health system objectives Equitable system ? Efficiency ?

5. Conceptual model (be) 5 Quality = appropriateness, safety, efficacy, continuity, patient centerdness

6. Dimensions 6

7. Criteria for indicators 74 (120) indicators International indicators Literature screening 60 external experts 7 Base for international benchmark: EU-15

8. 1.Introduction 2.Efficiency indicators within Be HSPA 3.Other (in)efficiency indicators within Be HSPA 4.Discussion 8

9. HSPA Belgium: list of indicators: Efficiency 9

10. 10

11. PRICE PER CASE 2012: surgical conditions (ONE DAY /CLASSIC ) (PPP hospital OECD) 11 One day is more efficient than classic hospitalisation. Day surgery is usually cheaper in Belgium, (-20%--40%) …. Except for cataract surgery (+25%- 40%)

12. HSPA Belgium: list of indicators: Efficiency 12

13. ALOS 2012: GYNECOLOGY 13

14. HSPA Belgium: list of indicators: Efficiency 14

15. 15 Low cost medicines % low cost (DDD/ inh /year )

16. 16 Low cost medicines targets and results (Belgium 2013) Low cost medicines by medical specialities % of target (2013)

17. 17 Low cost medicines % low cost ( DDD) versus Expenses (EUR) expenses

18. 18 Low cost medicines: DDD /inh evolution Quality expenses

19. HSPA Belgium: list of indicators: Efficiency 19

20. Breast cancer screening (50-69) 20 MISUSE

21. 1.Introduction 2.Efficiency indicators within Be HSPA 3.Other (in)efficiency indicators within Be HSPA 4.Discussion 21

22. HSPA Belgium: list of indicators: Efficiency 22

23. HSPA Belgium: list of indicators: What about efficiency in other dimensions ? 23

24. Bed days / inhabitant 24 Source: OECD Health data 2012 International comparaison: Nb acute bed days high in B. = based on RCM/MKG, (exclude one day + RPM / MPG) OVERUSE: Inefficiency + Sustainability issues

25. Breast cancer screening outside target group (40-49) & (70-80) Mammographies réalisées chez les femmes de moins de 50 ans ou de plus de 72 ans Figure 9.Figure 10. OVERDIAGNOSIS : (In) Appropriateness & safety issues = Waste -> inefficiency

26. Knee Arthroscopy 26 Unexplained geographical variations in diagnosis consumption UNDERUSE, OVER USE, MISUSE ? -> inefficiency

27. 1.Introduction 2.Efficiency indicators within Be HSPA 3.Other (in)efficiency indicators within Be HSPA 4.Discussion 27

28. Discussion (1/3) 28

29. Discussion (2/3) 29

30. 30