Friday, April 9, 2010

[EQ] The Netherlands Health system review

The Netherlands Health system review

Willemijn Schäfer, NIVEL, Netherlands Institute for Health Services Research

Madelon Kroneman, NIVEL, Netherlands Institute for Health Services Research

Wienke Boerma, NIVEL, Netherlands Institute for Health Services Research

Michael van den Berg, RIVM, National Institute for Public Health and the Environment

Gert Westert, RIVM, National Institute for Public Health and the Environment

Walter Devillé, NIVEL, Netherlands Institute for Health Services Research

Ewout van Ginneken, Berlin University of Technology


World Health Organization April 2010, on behalf of the European Observatory on Health Systems and Policies

Available online PDF [267p.] at: http://www.euro.who.int/Document/OBS/NEThit2010.pdf

"……..The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of health systems and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems. They also describe the institutional framework, process, content, and implementation of health and health care policies, highlighting challenges and areas that require more in-depth analysis.

Undoubtedly the dominant issue in the Dutch health care system at present is the fundamental reform that came into effect in 2006. With the introduction of a single compulsory health insurance scheme, the dual system of public and private insurance for curative care became history. Managed competition for providers and insurers became a major driver in the health care system. This has meant fundamental changes in the roles of patients, insurers, providers and the government. Insurers now negotiate with providers on price and quality and patients choose the provider they prefer and join a health insurance policy which best fits their situation.

To allow patients to make these choices, much effort has been made to make information on price and quality available to the public. The role of the national government has changed from directly steering the system to safeguarding the proper functioning of the health markets.

With the introduction of market mechanisms in the health care sector and the privatization of former sickness funds, the Dutch system presents an innovative and unique variant of a social health insurance system…."

Content
Preface

Executive summary
1. Introduction
               
1.1 Geography and sociodemography

1.2 Economic context

1.3 Political context

1.4 Health status

2. Organizational structure
                                
2.1 Overview of the health

2.2 Historical background

2.3 Organizational overview

2.4 Concentration and (de)centralization

2.5 Patient empowerment

3. Financing

3.1 Health expenditure

3.2 Population coverage and basis for entitlement

3.3 Revenue collection/sources of funds

3.4 Pooling of funds

3.5 Purchasing and purchaser–provider relations

3.6 Payment mechanisms

4. Regulation and planning

4.1 Regulation

4.2 Planning and health information management

5. Physical and human resources

                6. Provision of services
                               
6.1 Public health services

6.2 Patient pathways

6.3 Primary health care

6.4 Secondary care, specialized ambulatory care/inpatient care

6.5 Emergency care

6.6 Pharmaceutical care

6.7 Long-term care

6.8 Services for informal carers

6.9 Palliative care

6.10 Mental health care

6.11 Dental care

6.12 Complementary and alternative treatments

7. Principal health care reforms

7.1 Analysis of recent reforms

7.2 Future developments

8. Assessment of the health care system

8.1 The stated objectives of the health system

8.2 The distribution of the health system's costs and benefits across the population

8.3 Efficiency of resource allocation in health care (across services, across inputs)

8.4 Technical efficiency in the production of health care

8.5 Quality of care

8.6 The contribution of the health system to health improvement

9. Conclusions

10. Appendices

10.1 References

10.2 Further reading
10.3 Useful web sites

10.4 HiT methodology and production process
10.5 The review process

 

*      *     *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

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and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
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[EQ] Public financing of health in developing countries: a cross-national systematic analysis

Public financing of health in developing countries:
a cross-national systematic analysis

Chunling Lu PhD a, Matthew T Schneider BA b, Paul Gubbins BA b, Katherine Leach-Kemon MPH b, Dean Jamison PhD b, Prof Christopher JL Murray MD b
a Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

b Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

Lancet 2010; published online April 8. 2010 - DOI:10.1016/S0140-6736(10)60233-4

Website: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960233-4/fulltext#

“…….Government spending on health from domestic sources is an important indicator of a government's commitment to the health of its people, and is essential for the sustainability of health programmes. We aimed to systematically analyse all data sources available for government spending on health in developing countries; describe trends in public financing of health; and test the extent to which they were related to changes in gross domestic product (GDP), government size, HIV prevalence, debt relief, and development assistance for health (DAH) to governmental and non-governmental sectors.

Methods

We did a systematic analysis of all data sources available for government expenditures on health as agent (GHE-A) in developing countries, including government reports and databases from WHO and the International Monetary Fund (IMF). GHE-A consists of domestically and externally financed public health expenditures. We assessed the quality of these sources and used multiple imputation to generate a complete sequence of GHE-A. With these data and those for debt relief, and development assistance for health DAH to governments, we estimated government spending on health from domestic sources. We used panel-regression methods to estimate the association between government domestic spending on health and GDP, government size, HIV prevalence, debt relief, and DAH disbursed to governmental and non-governmental sectors. We tested the robustness of our conclusions using various models and subsets of countries.

Findings

In all developing countries, public financing of health in constant US$ from domestic sources increased by nearly 100% (IMF 120%; WHO 88%) from 1995 to 2006. Overall, this increase was the product of rising GDP, slight decreases in the share of GDP spent by government, and increases in the share of government spending on health. At the country level, while shares of government expenditures to health increased in many regions, they decreased in many sub-Saharan African countries. The statistical analysis showed that debt relief, and development assistance for health DAH to government had a negative and significant effect on domestic government spending on health such that for every US$1 of DAH to government, government health expenditures from domestic resources were reduced by $0·43 (p=0) to $1·14 (p=0).

However, debt relief, and development assistance for health DAH to the non-governmental sector had a positive and significant effect on domestic government health spending. Both results were robust to multiple specifications and subset analyses. Other factors, such as debt relief, had no detectable effect on domestic government health spending.

Interpretation

To address the negative effect of debt relief, and development assistance for health DAH on domestic government health spending, we recommend strong standardised monitoring of government health expenditures and government spending in other health-related sectors; establishment of collaborative targets to maintain or increase the share of government expenditures going to health; investment in the capacity of developing countries to effectively receive and use DAH; careful assessment of the risks and benefits of expanded DAH to non-governmental sectors; and investigation of the use of global price subsidies or product transfers as mechanisms for debt relief, and development assistance for health DAH.

Funding

Bill & Melinda Gates Foundation…..”

Supplementary webappendix:
http://download.thelancet.com/mmcs/journals/lancet/PIIS0140673610602334/mmc1.pdf?id=3d35b1b5aa0ec416:-335b6fc1:127e27f00da:229b1270819215738

“….This Webappendix is divided into three components. The first component provides more detail on data sources, descriptive statistics, and country and regional groupings. The second component presents a detailed and extensive sensitivity analysis that strengthens the basis for the conclusions drawn in the main body of the text. The third component provides the fully-imputed government health expenditure as agent data, which are based on data reported to WHO and the IMF by countries.
These imputed data should serve as an improved source for future analyses….”

VIEWPOINT:

Crowding out: are relations between international health aid and government health funding too complex to be captured in averages only?

Gorik Ooms, Kristof Decoster, Katabaro Miti, Sabine Rens, Luc Van Leemput, Peter Vermeiren, Wim Van Damme
www.thelancet.com Published online April 9, 2010 DOI:10.1016/S0140-6736(10)60207-3

URL:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60207-3/fulltext

“…..In today’s Lancet, Lu and colleagues1 show that for every dollar of international health aid provided to governments, government health funding falls by US$0·43–1·14. Irrespective of whether this outcome is named fungibility or crowding out,2 mean estimates from many countries suggest a pattern. Without questioning the mean findings of today’s study, we argue that explicit policy choices are behind crowding-out effects, unfolding very differently dependent on the individual countries’ situations. To try to understand why some countries make these choices that result in crowding-out effects, and not only whether they do, is of importance…..”

*      *     *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
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Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
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confidential information. If you are not the intended
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transmission to the intended recipient, you may not
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any action in reliance on it. If you received this
transmission in error, please notify us immediately by
email to infosec@paho.org, and please dispose of and
delete this transmission. Thank you.