Health Equity: 01/22/09

Thursday, January 22, 2009

[EQ] A retrospective analysis of health systems in Denmark and Kaiser Permanente

A retrospective analysis of health systems in Denmark and Kaiser Permanente

Anne Frølich1§, Michaela L Schiøtz2, Martin Strandberg-Larsen2, John Hsu3, Allan Krasnik2, Finn Diderichsen4, Jim Bellows5, Jes Søgaard6, Karen White7

1. Copenhagen Hospital Corporation, Copenhagen NV, Denmark

2 Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark

3 Center for Health Policy Studies, Kaiser Permanente, Oakland, CA , USA

4 Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark

5 Care Management Institute, Kaiser Permanente, Oakland, CA USA

6. Danish Institute for Health Services Research, Copenhagen , Denmark

7 Institute for Global Health, University of California/San Francisco, San Francisco, CA USA

BMC Health Services Research – December 2008

Available online at: http://www.biomedcentral.com/content/pdf/1472-6963-8-252.pdf

Background

To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy.

Methods

Retrospective analysis of secondary data in the Danish Health Care System (DHS) with 5.3 million citizens and the Kaiser Permanente integrated delivery system (KP) with 6.1 million members in California. We used secondary data to compare population characteristics, professional staff, delivery structure, utilisation and quality measures, and direct costs. We adjusted the cost data to increase comparability.

Results

A higher percentage of KP patients had chronic conditions than did patients in the DHS: 6.3% vs. 2.8% (diabetes) and 19% vs. 8.5% (hypertension), respectively. KP had fewer total physicians and staff compared to DHS, with134 physicians/100,000 individuals versus 311 physicians/100,000 individuals. KP physicians are salaried employees; in contrast, DHS primary care physicians own and run their practices, remunerated by a mixture of capitation and fee-for-service payments, while most specialists are employed at largely public hospitals. Hospitalisation rates and lengths of stay (LOS) were lower in KP, with mean acute admission LOS of 3.9 days versus 6.0 days in the DHS, and, for stroke admissions, 4.2 days versus 23 days. Screening rates also differed: 93% of KP members with diabetes received retinal screening; only 46% of patients in the DHS with diabetes did. Per capita operating expenditures were PPP$1,951 (KP) and PPP $1,845 (DHS).

Conclusions

Compared to the DHS, KP had a population with more documented disease and higher operating costs, while employing fewer physicians and resources like hospital beds. Observed quality measures also appear higher in KP. However, simple comparisons between health care systems may have limited value without detailed information on mechanisms underlying differences or identifying translatable care improvement strategies. We suggest items for more in-depth analyses that could improve the interpretability of findings and help identify lessons that can be transferred. ….”

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[EQ] Global Action for Health System Strengthening: Policy Recommendations to the G8

Global Action for Health System Strengthening: Policy Recommendations to the G8

Task Force on Global Action for Health System Strengthening, January 16, 2009
Japan Center for International Exchange

The final report of the Working Group on Challenges in Global Health and Japan's Contributions was submitted to the Japanese and Italian governments in January 2009 for consideration for the 2009 G8 Summit agenda.

English: PDF file Full report [131p] at: http://www.jcie.org/researchpdfs/takemi/full.pdf

· Download full report ( Japanese | Italian) [2.4 MB PDF]

· Download by chapter:

· Table of Contents [56 KB PDF]

· The G8 and Global Health: Emerging Architecture from the Toyako Summit (overview), Keizo Takemi and Michael R. Reich [376 KB PDF]

· Opportunities for Overcoming the Health Workforce Crisis, Masamine Jimba 644 KB PDF]

· Strengthening Health Financing in Partner Developing Countries, Ravindra P. Rannan-Eliya [996 KB PDF]

· Toward Collective Action in Health Information, Kenji Shibuya [652 KB PDF]

· Appendices (report background, team members, & acknowledgements) [176 KB PDF]

The Lancet Features the Takemi Working Group Report (January 15, 2009)
"G8 and strengthening of health systems: follow-up to the Toyako summit," by Michael R. Reich and Keizo Takemi (free registration required)

· Also online at the The Lancet—excerpts from keynote speeches at November 3–4, 2008, International Conference on Global Action for Health System Strengthening:

· "Primary Health Care as a route to health security," by Margaret Chan, Director General, World Health Organization

· "Strengthening health systems to promote security," by Julio Frenk, Dean, Harvard School of Public Health

On January 16, 2009, a high-level working group on global health convened by the Japan Center for International Exchange (JCIE) released a report to the Japanese government outlining measures that the G8 countries should take to set them on a path toward fulfilling their existing commitments to contributing to an overall improvement in the health of individuals and communities around the world.

The Working Group on Challenges in Global Health and Japan’s Contributions (the “Takemi Working Group”) is chaired by Japan’s former Senior Vice Minister for Health, Labour and Welfare Keizo Takemi and directed by JCIE President Tadashi Yamamoto. The Japanese government will pass the report to the Italian government, encouraging them to put these recommendations on the agenda of the 2009 G8 Summit in Italy.

The report includes chapters by an international team of researchers and advisors on three specific building blocks of health systems—health financing, health information, and the health workforce—that are generally acknowledged to be critical components of any strong health system. While each paper offers specific recommendations for improvements that can be made in each individual building block, they also come to several common conclusions:

1. While there is still a dire need for more resources—financial, human, and knowledge resources—in the global health field, there is also a critical need to use existing resources more efficiently and more effectively. Recognizing that the current global financial environment will make it even more difficult to secure the resources needed to make health systems work better for everyone, the paper writers recommend complementing the quest for more resources with creative thinking on ways to achieve better health outcomes with the resources we already have.

2. The human security concept, which has become a pillar of Japan’s foreign policy, is identified as a promising approach that can be adopted globally for strengthening health systems. Human security’s emphasis on the wellbeing of individuals and communities is very much in line with the ultimate goal of health system strengthening: improving people’s health and making health services available to all so that they can be healthy, productive members of society. Human security also responds to the complexity of health system strengthening with its focus on integrating community empowerment with protection strategies and its recognition of the dynamic way in which health is interconnected with many other human security challenges.

3. In all areas of health system strengthening, donor countries tend to tell their partners in developing countries how they should behave and make decisions. This can lead to confusion, with contradicting instructions often coming from multiple donors and even from single donors, and loss of motivation for stakeholders in partner countries to take ownership of processes to improve their own health sectors. Contributing to this challenge, capacity for making informed decisions on health is often weak, further discouraging domestic decision making in planning and management of health systems. The paper writers all recommend that donor countries invest in capacity building for health sector decision making at the national and local levels and, at the same time, encourage stakeholders in partner countries to drive their own planning and implementation processes.

4. Finally, the paper writers all recommend that the G8 follow through on its commitment to accountability by establishing an annual review of its activities and accomplishments within each of these three building blocks.

The Takemi Working Group was launched in September 2007 as Japan was preparing to host the 2008 G8 Summit and the Fourth Tokyo International Conference on African Development. The working group is unique in Japan and is the first major initiative to bring together global health experts from the relevant government ministries (foreign affairs; health, labor, and welfare; and finance) as well as those from Japan’s aid agencies, NGOs, research institutes, and academia to discuss strategies for keeping global health high on the G8 agenda. Following the Toyako G8 Summit in July 2008, the working group answered the Japanese government’s call for clear recommendations for following up on the G8 commitments to global health and launched a task force to develop the current report. An earlier version of the papers in the report appeared online in the Lancet :

Reich MR, Takemi K. G8 and strengthening of health systems: follow-up to the Toyako summit.
Lancet 2008; published online January 15. DOI:10.1016/S0140-6736(08)61899- http://www.jcie.org/japan/j/pdf/gt/cgh-jc/lancetarticle090115.pdf

Hard Copies & Information

To request a hard copy of the report or for more information on the working group’s activities, please contact the secretariat:

Website: http://www.jcie.or.jp/thinknet/takemi_project/

In Asia: JCIE Attn: Tomoko Suzuki Program Officer

4-9-17 Minami Azabu Minato-ku, Tokyo 106-0047 Japan

Tel: +81-3-8403-7781 Fax: +81-3-3443-7580

Outside of Asia: JCIE/USA Attn: Susan Hubbard Senior Associate

274 Madison Avenue, Suite 1102 New York, NY 10016 USA

Tel: +1-212-679-4130 Fax: +1-212-679-8410 shubbard@jcie.org

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[EQ] Healthy Societies: Addressing 21st Century Health Challenges

Healthy Societies: Addressing 21st Century Health Challenges

Prepared by Professor Ilona Kickbusch, Adelaide Thinker in Residence Department of the Premier and Cabinet

May 2008 - State of South Australia

Available online PDF [62p.] at: http://www.thinkers.sa.gov.au/images/Kickbusch_Final_Report.pdf

“……..Discussing the state of health at the beginning of the 21st century is not dissimilar to discussing the state of the environment. Both are in crisis and run counter to the notion of sustainable wellbeing, both focus around the ways of life that have developed in our societies and both indicate that significant changes are required at the level of policy and of society. As regards the environment we have begun to realise that our way of life and use of energy is endangering the planet and its resources, and that it can endanger our health by destroying life support systems such as water.

What we have yet to fully understand is how our way of life and use of energy in the 21st century is counterproductive to our health and wellbeing in a very direct way. We are at a turning point in health policy. It has become increasingly clear that changes in the existing health care system will not be sufficient to maintain and improve our health. Both our extensive knowledge about what creates health, as well as the exponentially rising rates of chronic disease, obesity and mental health problems, indicate that we need to shift course and apply a radically new mindset to health.

Speed is essential, and if we do not take rapid action to invest in health and human wellbeing our societies will face a double jeopardy: we will not be able to afford the rising health care expenditure and we will not be able to guarantee the coming generations a healthier life. As a consequence, health inequalities will increase significantly and undermine the democratic promise of health as a right of citizenship. Some warning voices state that the present generation of children – born at the turn of the century – might be the first to have a lower life expectancy than their parents. After the extraordinary gains in health and longevity over the last 100 years, such a development would indeed represent a phenomenal failure.

My challenge was to turn this broad concern with societal change and health determinants into manageable policy principles and approaches. After listening and learning during my residency I chose to concentrate the strategic vision on three interconnected priority principles: health sustainability, health equity and health in all policies………”

Content:

Introduction The process of ‘Thinking’ together 7

Ten key directions forward

Wellbeing: a central challenge for 21st century societies

Healthy people – healthy economy

Health and medical tourism

Changing mindsets: addressing the determinants of health

The classic determinants of health

Determinants of Aboriginal health

21st century health determinants

The key health sustainability challenges of 21st century societies

Health in All Policies

The South Australian Health in All Policies approach

A health lens on South Australia’s Strategic Plan

Policy learning April–November 2007

Health in All Policies Conference – November 2007

The Health in All Policies Forum – February 2008

Health in All Policies: the ten principles

The next step: taking Health in All Policies to the local level

Generation H!SA: investing in children

The Generation H!SA model: a strategic approach

The strategy: developing synergies and strengthening policy mechanisms

Healthy public policy for children: a Children’s Health Act

Generation H: their voice

Health literacy: addressing the double inequity

Health and wellbeing partnerships

Mobility, health and equity

Health, wellbeing and equity: Aboriginal health

Body image and eating disorders

Health research in South Australia: future directions

Health research priorities

Centre for Intergenerational Health

Glossary of terms

Source: Ilona Kickbusch

Healthy Societies: Addressing 21st Century Health Challenges, 2008

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