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  • Lorenzoni, Luca  (9)
  • Paris : OECD Publishing  (9)
  • Cambridge [u.a.] : Cambridge Univ. Press
  • Social Issues/Migration/Health  (9)
  • 1
    Language: English
    Pages: 1 Online-Ressource (52 p.) , 21 x 28cm.
    Series Statement: OECD Health Working Papers no.154
    Keywords: Finance and Investment ; Social Issues/Migration/Health
    Abstract: Innovative providers’ payment models represent an important policy lever that could be used to promote value-based health systems. By bundling services across the continuum of care or to target acute events or chronic conditions, innovative payment models set financial incentives for providers to increase efficiency in service delivery, improve health outcomes and enhance patient experience with care. This paper offers insights on value-based payment models, a type of innovative payment model implemented in several OECD countries and reviews the publicly available evidence on the impact of those payment models on value. Innovative payment models tend to be exceptional and small-scale compared to activity-based payment models and have been extensively piloted in the United States while implementation and evaluation in other countries is limited. The publicly available empirical evidence points to modest efficiency and quality gains from value-based payment models. Impact on healthcare spending, outcomes and patient experience varies across programmes. Given the significant variation in the key features of value-based payment models and the context-specific issues they address, those models do not offer a one-size-fits-all solution. This paper outlines several intervention points that policy makers need to consider when designing and implementing value-based payment models to maximise their positive outcome.
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  • 2
    Language: English
    Pages: 1 Online-Ressource (76 p.) , 21 x 28cm.
    Series Statement: OECD Health Working Papers no.152
    Keywords: Gesundheitskosten ; OECD-Staaten ; Schwellenländer ; Entwicklungsländer ; Social Issues/Migration/Health
    Abstract: The COVID-19 pandemic has highlighted that access to timely health spending data is crucial for informed policy-making. This Health Working Paper summarises and compares the methodologies applied in around half of OECD countries to estimate public and private health spending for the most recent year (i.e., t-1) as well as the approaches taken by the OECD Secretariat to fill existing data gaps for the remaining OECD countries. For the first time, the paper also explores the feasibility of nowcasting health spending for the current year (i.e., t) and examines data sources that could be potentially useful in such an exercise. While this review should help OECD countries that do not yet have experience in estimating health spending for year t-1 to improve the timeliness in their data reporting, the paper also analyses the applicability of the methods in low- and middle-income countries.
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  • 3
    Language: English
    Pages: 1 Online-Ressource (50 p.) , 21 x 28cm.
    Series Statement: OECD Health Working Papers no.161
    Keywords: Gesundheitskosten ; Öffentliche Ausgaben ; Finanzpolitik ; Irland ; Social Issues/Migration/Health
    Abstract: This working paper uses a new method to assess the fiscal sustainability of the Irish health system by considering the effects of population change and income growth on both government revenue and health spending over time. Spending on healthcare is comparatively high in Ireland, accounting for 8.4% of GNI in 2019. Health spending from public sources is projected to account for 24% of government revenues in 2040 (up from 20% in 2019). The fiscal balance is projected to slightly deteriorate in Ireland by 2040. Population change is projected to be a much greater driver of future health spending in Ireland over the next 20 years as compared to the OECD average. By coupling health spending projections with government revenue projections, our approach provides policymakers with a broader set of whole-of-government policies to consider when addressing financing shortfalls.
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  • 4
    Language: English
    Pages: 1 Online-Ressource (37 Seiten) , 21 x 28cm.
    Series Statement: OECD Working Papers on Fiscal Federalism no.38
    Keywords: Social Issues/Migration/Health ; Economics ; Taxation
    Abstract: OECD economies are undergoing a seemingly inevitable process of population ageing that has been changing income and consumption patterns. Notably, the demand for health services is expected to increase, while labour forces are projected to shrink. Both factors are projected to negatively impact the sustainability of health systems – the former through an increase in government expenditures on health and the latter through a decrease in government revenues. As health systems and their funding streams tend to be at least partially decentralised in most OECD countries, this fiscal pressure is expected to be asymmetric across levels of government. The objective of this paper is to provide order-of-magnitude estimates of the possible effects of population ageing on government finances across OECD countries, and to discuss reforms to fiscal federalism and intergovernmental relations with the purpose of funding expenditures at all levels of government.
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  • 5
    Language: English
    Pages: 1 Online-Ressource (circa 53 Seiten) , Illustrationen
    Series Statement: OECD health working papers no. 95
    Keywords: Gesundheitskosten ; Trend ; Prognose ; Vergleich ; OECD-Staaten ; Social Issues/Migration/Health ; Arbeitspapier ; Graue Literatur
    Abstract: Across the OECD, healthcare spending has typically outpaced economic growth in recent decades. While such spending has improved health outcomes, there are concerns about the financial sustainability of this upward trend, particularly as healthcare systems are predominantly funded from public resources in most OECD countries. To better explore this financial sustainability challenge, many countries and international institutions have developed forecasting models to project growth in future healthcare expenditure. Despite methodological differences between forecasting approaches, a common set of healthcare spending drivers can be identified. Demographic factors, rising incomes, technological progress, productivity in the healthcare sector compared to the general economy (Baumol’s cost disease) and associated healthcare policies have all been shown to be key determinants of healthcare spending.
    Note: Zusammenfassung in französischer Sprache
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  • 6
    Language: English
    Pages: 1 Online-Ressource (circa 43 Seiten) , Illustrationen
    Series Statement: OECD health working papers no. 94
    Keywords: 2012 - 2014 ; Krankenhaus ; Dauer ; Krankenhauskosten ; Kanada ; Frankreich ; Irland ; Israel ; Social Issues/Migration/Health ; Arbeitspapier ; Graue Literatur
    Abstract: Hospitals are the most expensive component of OECD health care systems, accounting for around one third of total health care expenditure. Given growing pressures on government budgets, this is an area of expenditure that has already been, and will continue to be, thoroughly scrutinised for potential increases in efficiency. One way to assess hospital efficiency is to measure the amount of resources each hospital uses to treat specific conditions. A care delivery process may be seen as more efficient – after accounting for broader health system and market factors that may constrain the hospital from operating at an efficient level – if it consumes fewer resources while delivering adequate care for the same condition, the dimension of efficiency under review here. In this light, measuring hospital length of stay and costs for a given condition helps the understanding of how efficient (better performing) hospitals are relative to each other. Through international comparative work, this paper helps policy makers understand the scope and nature of length of stay/costs variation across hospitals in OECD countries. It also explores whether characteristic of hospitals or of countries' regulatory and operating environments can explain differences in efficiency. Data on length of stay and costs to treat patients admitted to hospitals for nine tracing conditions/treatments were collected and analysed for Canada (Alberta province), France, Ireland and Israel for 2012-2014. Our analysis shows that hospitals with a number of beds ranging between 200 and 600, and not-for-profit hospitals report shorter length of stay and lower costs for several conditions/treatments. It also shows that variations in efficiency are more likely to exist at the hospital level for cardiac surgery (acute myocardial infarction with percutaneous transluminal coronary angioplasty and coronary artery bypass graft), and at country level for hysterectomy, caesarean section and normal delivery. These results shed some light on the importance of hospital payment system in fostering efficiency in care delivery for standard/high volume treatments such as normal delivery, whereas hospital management and organisation seem to drive efficiency for more complex/technology driven treatments such as bypass surgery.
    Note: Zusammenfassung in französischer Sprache
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  • 7
    Language: English
    Pages: 1 Online-Ressource (circa 72 Seiten) , Illustrationen
    Series Statement: OECD health working papers no. 104
    Keywords: 2000 - 2015 ; Gesundheitsversorgung ; Dienstleistungsqualität ; Gesundheitskosten ; OECD-Staaten ; Social Issues/Migration/Health ; Arbeitspapier ; Graue Literatur
    Abstract: The incentive structures produced by different institutional arrangements in health systems are important determinants of their performance, and can explain some of the differences in cross-country performance patterns. This paper proposes an approach and quantitative method to investigate how different policies and institutions helped achieving better value for money across 26 OECD countries for the period of 2000-2015. To this aim, it uses a panel of health system characteristics indicators - derived from questionnaires sent to countries by OECD in 2008, 2012 and 2016 - that describes primarily health financing and coverage arrangements, health care delivery systems, and governance and resource allocation.
    Note: Zusammenfassung in französischer Sprache
    URL: Volltext  (lizenzpflichtig)
    URL: Volltext  (lizenzpflichtig)
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  • 8
    Language: English
    Pages: 1 Online-Ressource (circa 40 Seiten) , Illustrationen
    Series Statement: OECD health working papers no. 92
    Keywords: Gesundheitsfinanzierung ; Gesundheitskosten ; OECD-Staaten ; Social Issues/Migration/Health ; Arbeitspapier ; Graue Literatur
    Abstract: Health care expenditure per person, after accounting for changes in overall price levels, began to slow in many OECD countries in the early-to-mid 2000s, well before the economic and fiscal crisis. Using available estimates from the OECD’s System of Health Accounts (SHA) database, we explore common trends in health care expenditure since 1996 in a set of 22 OECD countries. We assess the extent to which the trends observed are the results of cyclical economic influences, and the respective contributions of changes in relative prices, health care volumes and coverage to the slowdown in health care expenditure growth. Our analysis suggests that cyclical factors may account for a little less than one half of the estimated slowdown in health care spending since the crisis, suggesting that structural changes have contributed to the trends. Before the crisis the slowdown in health care expenditure growth was accounted for by health care prices growing less than general prices and a reduction in care volumes, whereas the latter accounts for most of the steeper deceleration after the crisis. Although both privately and publically financed health care expenditure grew at a reduced pace during the study period, the sharp post-crisis deceleration happened mostly in the public component. When examined by function, the slowdown in publicly-financed expenditure has been largest in curative and rehabilitative care (particularly after the crisis) and in medical goods (especially pharmaceuticals), whereas the deceleration in the privately financed component is largely in medical goods (including pharmaceuticals). We conclude that structural changes in publicly financed health care have constrained the growth of care volumes (especially) and prices leading to a marked reduction in health care expenditure growth rates, beyond what could be expected based on cyclical economic fluctuations. We examine a range of government policies enacted in a selection of OECD countries that likely contributed to the structural changes observed in our analysis.
    Note: Zusammenfassung in französischer Sprache
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  • 9
    Language: English
    Pages: 1 Online-Ressource (circa 70 Seiten) , Illustrationen
    Series Statement: OECD health working papers no. 85
    Keywords: Krankenhauskosten ; Krankenhaus ; Privatwirtschaft ; Vergleich ; OECD-Staaten ; Südafrika ; Social Issues/Migration/Health ; South Africa ; Arbeitspapier ; Graue Literatur
    Abstract: The health system in South Africa is unique in many ways. South Africa spends 41.8% of total health expenditures on private voluntary health insurance – more than any OECD country – but only 17% of the population – mostly high income citizens - can afford to purchase private insurance. Given the magnitude of private health expenditures, the activities in the private health care market have an important impact on the functioning of the health care system as a whole. Medical schemes (private health insurance) in South Africa mainly finance care that is predominantly delivered by private providers (i.e., private hospitals, specialists, general practitioners, pharmacies). Therefore, these schemes primarily finance an alternative to seeking care in the public sector and offer services that duplicate those available in the public sector.
    Note: Zusammenfassung in französischer Sprache
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