Health Equity: 06/12/12

Tuesday, June 12, 2012

[EQ] Dimensions of health care system quality in Finland

Dimensions of health care system quality in Finland

Pääkkönen, Jenni ; Seppälä, Timo

VATT Working Papers 31 - May 2012 - Valtion taloudellinen tutkimuskeskus

Government Institute for Economic Research - Helsinki 2012

Available online PDF [40p.] at: http://bit.ly/KlzFqA

“……This paper evaluates the determinants of quality - cost relationship in primary health care. We first summarize information from various indicators of care by principal component analysis (PCA), effectively producing quality of care indicators: accessibility, coverage and allocative efficiency.

We then regress the costs of care against these indicators to evaluate their relationship. Our results suggest that PCA may be used to produce quality of care indicators. Furthermore, the relationship between the costs and quality of care is complex. Better accessibility is reflected in higher costs, whereas the efficient allocation of resources will bring some cost savings. …”

“……….The main task of a public health care system is to maintain and yield health among the citizens. However, government budgets are tight and the increase in health care expenses together with aging does not help to consolidate the budgets.

Decision makers may be able to minimize the increase in health care expenses by allocating resources efficiently. However, policies are not alike: some cost-saving policies may harm the quality of care, while other policies may leave quality intact.

To evaluate the influence of cost-savings on quality, one needs first a measurement of quality, and second, the relationship between costs and quality should be verified.

Most health economic research focusing on quality-cost issues has concentrated on fragments of health care (e.g. cardiac diseases, diabetes treatments), whereas given the weak economic prospects of governments, one should rather study the possibility of revealing a link between quality and costs at the system level. In this paper, we attempt to measure the quality of care at the system level. We also evaluate whether costs are systematically associated with quality. Finnish data from primary health care facilitate the contemplation of these issues empirically……..”

Contents

1 Introduction

2 Quality of care indicators

3 Methods

4 Results

5 Discussion

A Appendix: data

B Appendix: results

KMC/2012/HSS
Twitter http://twitter.com/eqpaho

* * *
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]
Washington DC USA

“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”.
------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho

IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission.

Thank you.

[EQ] Priority-Setting in Health: Building Institutions for Smarter Public Spending

Priority-Setting in Health:
Building Institutions for Smarter Public Spending

A report of the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group

Amanda Glassman and Kalipso Chalkidou, Co-chairs – 2012

Available online PDF [101p.] at: http://bit.ly/LYHE9Z

“…….Health donors, policymakers, and practitioners continuously make life-and-death decisions about which type of patients receive what interventions, when, and at what cost. These decisions—as consequential as they are—often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. The result is perverse priorities, wasted money, and needless death and illness.

Examples abound: In India, only 44 percent of children 1 to 2 years old are fully vaccinated, yet open-heart surgery is subsidized in national public hospitals. In Colombia, 58 percent of children are fully vaccinated, but public monies subsidize treating breast cancer with Avastin, a brand-name medicine considered ineffective and unsafe for this purpose in the United States.

Reallocating a portion of public and donor monies toward the most cost-effective health interventions would save more lives and promote health equity. The obstacle is not a lack of knowledge about what interventions are best, but rather that too many low- and middle-income countries lack the fair processes and institutions needed to bring that knowledge to bear on funding decisions.

With that in mind, the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group recommends creating and developing fair and evidence-based national and global systems to more rationally set priorities for public spending on health. The group calls for an interim secretariat to incubate a global health technology assessment facility designed to help governments develop national systems and donors get greater value for money in their grants…”

Content:

Executive summary

Chapter 1 Finite resources, unlimited demand

A framework of de facto rationing mechanisms

The timing of rationing: ex ante and ex post

The rationing implications of allocation between areas and within levels of the health system

In a practical sense, however, priority is often revealed by action and spending

Rationing is constrained by historical and political processes

Why the Priority-Setting Institutions in Health Working Group?

Chapter 2 The opportunity: evidence, economies, and donor agendas converge to make explicit rationing necessary and possible

Force 1: A growing body of evidence suggests huge health gains are possible

Force 2: Public spending on health is growing in low- and middle-income countries

Force 3: Donors are beginning to restrict health aid flows, putting renewed emphasis on impact, co-financing, and value for money

Chapter 3 Considering cost-effectiveness: the moral perspective

The cost-effectiveness landscape in global health 1

The moral case

Challenges addressed

Chapter 4 Progress on policy instruments for explicit priority setting

Essential medicines lists

Health benefits plans

National Immunization Technical Advisory Committees

Health technology assessment agencies

Case studies

Chapter 5 Donors and decisions

Development assistance partners’ support to recipient country priority-setting processes

GAVI Alliance prioritization mechanisms

Global Fund prioritization mechanisms

Chapter 6 Building institutions for explicit priority setting

Institutionalizing health technology assessment systems in low- and middle-income countries

Chapter 7 Recommendations for action

Looking ahead

Appendix A – B

Appendix C Current international support to priority setting in low- and middle-income countries

Appendix D Sources for low- and middle-income countries with health benefits plans

References

Thank you.