Transcript Document

-Thailand
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Health Policy
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-Thailand
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Policy
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International
Mirror, Mirror on the Wall:
How the Performance of the US Health Care
System Compares Internationally
Phusit Prakongsai
International Health Policy Program (IHPP)
Ministry of Public Health, Thailand
29 July 2010
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Background
• The US health system is the most expensive in the world.
• Comparative analyses consistently show the US underperforms
relative to other countries on most dimensions of performance.
• The Commonwealth Fund Commission on a High Performance
Health System employed the National Scorecard to measure
and monitoring health care outcomes, quality, access,
efficiency, and quality in the US in 2006 and 2008.
• This 2010 report includes information on:
– health care outcomes in the 2008 US health system scorecard,
– Most recent three Commonwealth Fund surveys of patients and
primary care physicians in 2007-2009.
Healthcare spending as % of GDP
OECD countries, 2008
Growth in personal health care expenditures in the US
from 1990 to 2007
Core dimensions of Commonwealth National Scorecard
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Health Policy
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International
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Measuring and monitoring health system performance
Long, healthy,
and productive lives
• Effective care
• Safe care
Efficiency
Quality care
• Coordinated care
• Patient-centered
care
Commonwealth
National
Scorecard
Equity
Access
• Cost-related
access problems
• Timeliness care
1. Quality care
1.1 Effective care
Source
AUS
CAN
GER
NETH
NZ
UK
US
Physicians reporting it is easy
to print out a list of patients
who are due or overdue for
tests or preventive care
2009
63
(3)
18
(7)
37
(5)
65
(2)
57
(4)
90
(1)
24
(6)
Patients sent computerized
reminder notices for
preventive or follow-up care
2009
82
(2)
10
(7)
17
(6)
48
(4)
92
(1)
76
(3)
18
(5)
Receive reminders for
preventive/ follow-up care
2007
44
(6)
40
(7)
57
(4)
58
(2.5)
48
(5)
58
(2.5)
70
(1)
Doctor asked if emotional
issues were affecting health
2007
37
(2)
36
(3)
25
(6.5)
27
(5)
31
(4)
25
(6.5)
46
(1)
Received advice from doctors
on weight, nutrition, and
exercise
2007
41
(3)
46
(2)
37
(4)
24
(7)
36
(5)
29
(6)
56
(1)
2
7
6
3
5
1
4
Prevention
Overall benchmark ranking
1. Quality care
1.1 Effective care
Source
AUS
CAN
GER
NETH
NZ
UK
US
Diabetics receiving all four
recommended services*
2008
36
(7)
39
(6)
40
(5)
59
(2)
55
(3)
67
(1)
43
(4)
Practice routinely uses written
guidelines to treat diabetes
2009
87
(4)
82
(5.5)
77
(7)
98
(1)
93
(3)
96
(2)
82
(5.5)
Patients with HT who have
had cholesterol checked in
past year
2008
82
(4)
83
(3)
88
(1)
78
(6)
75
(7)
81
(5)
85
(2)
Practice routinely uses written
guidelines to treat HT
2009
83
(3)
81
(4)
75
(6.5)
90
(2)
75
(6.5)
96
(1)
78
(5)
Practice routinely uses written
guidelines to treat depression
2009
71
(2)
45
(5)
26
(7)
31
(6)
65
(3)
80
(1)
49
(4)
Has chronic condition and did
not follow recommended care
because of cost
2007
11
(6)
7
(3)
0
(1)
1
(2)
9
(4)
10
(5)
24
(7)
Primary care practices that
routinely provide chronic dis
patients written instructions
2007
24
(3)
16
(6)
23
(4)
22
(5)
15
(7)
33
(1)
30
(2)
Chronic care
* Four recommended services include HbA1C checked in the past six months, feet examined, eye exam, and cholesterol
checked in the past year.
1. Quality care
1.2 Safe care
Source
AUS
CAN
GER
NETH
NZ
UK
US
Believed a medical mistake
was made in your treatment
or care in past 2 years
2008
17
(7)
16
(5.5)
12
(3)
9
(2)
15
(4)
8
(1)
16
(5.5)
Given the wrong medication
or wrong dose by a doctor,
nurse, hospital, or pharmacist
in past 2 years
2008
13
(5.5)
10
(4)
7
(2)
6
(1)
13
(5.5)
9
(3)
14
(7)
Given incorrect results for a
diagnostic or lab test in past 2
years
2008
7
(6.5)
1
(1)
3
(2.5)
3
(2.5)
7
(6.5)
Experienced delays in being
notified about abnormal test
results in past 2 years
2008
13
(6)
5
(1.5)
10
(4)
8
(3)
16
(7)
Hospitalized patients
reporting infection in hospital
2008
7
(4.5)
5
(1)
11
(7)
10
(6)
7
(4.5)
Doctors routinely receives a
computerized alert or prompt
about potential problem with
drug dose or interaction
2009
92
(3)
95
(1)
90
(4)
93
(2)
37
(5)
5
5
(4.5) (4.5)
12
(5)
5
(1.5)
6
6
(2.5) (2.5)
20
(7)
24
(6)
2. Access to care
Source
AUS
CAN
GER
NETH
NZ
UK
US
25
(3)
26
(4)
7
(1)
31
(5)
13
(2)
54
(7)
5
(4)
8
(5.5)
1
(1)
19
(7)
Cost-related access problems
Did not fill the prescription:
skipped recommended
medical test, RX or follow-up
in the past 2 years due to
cost
2008
36
(6)
Patient had serious problems
paying or was unable to pay
medical bills
2007
8
(5.5)
Physicians think their patients
often have difficulty paying
for medications or OOP costs
2009
23
(2)
27
(4)
28
(5)
33
(6)
25
(3)
14
(1)
58
(7)
OOP expenses for medical
bills more than 1000 USD in
the past year
2008
25
(6)
20
(5)
13
(3)
8
(2)
14
(4)
4
(1)
41
(7)
6
3.5
3.5
2
5
1
7
Overall benchmark
ranking
4
4
(2.5) (2.5)
3. Efficiency measures
Source
AUS
CAN
GER
NETH
NZ
UK
US
Total exp on health as percent
of GDP
2007
8.9
(2)
10.1
(5)
10.4
(6)
9.8
(4)
9.0
(3)
8.4
(1)
16.0
(7)
% of national health
expenditure spent on health
administration and insurance
2007
2.6
(1)
3.6
(3)
5.3
(5)
5.2
(4)
7.4
(7)
3.4
(2)
7.1
(6)
Medical records/test results
did not reach MD office in
time for appointment
2008
16
(4)
19
(6)
12
(2)
11
(1)
17
(5)
15
(3)
24
(7)
Sent for duplicate tests by
different health care
professionals in past 2 years
2008
12
(5)
11
(4)
18
(6)
4
(1)
10
(3)
7
(2)
20
(7)
Visited ED for a condition that
could have been treated by a
regular doctor
2008
17
(5)
23
(7)
6
(1.5)
6
(1.5)
8
(3.5)
8
(3.5)
19
(6)
Hospitalized patients went to
ER or re-hospitalized for
complications from discharge
2008
11
(3.5)
17
(5.5)
9
(1)
17
(5.5)
11
(3.5)
10
(2)
18
(7)
2
6
5
3
4
1
7
Overall benchmark ranking
4. Health equity
Source
AUS
CAN
GER
NETH
NZ
UK
US
Rated doctor fair/poor
2007
5
(5)
5
(5)
3
(2.5)
5
(5)
0
(1)
3
(2.5)
9
(7)
Had medical problem but did
not visit doctor because of
costs in the past year
2008
0
(3)
8
(5)
-2
(1.5)
1
(4)
20
(6)
-2
(1.5)
24
(7)
Did not get recommended
test or treatment or follow-up
because of cost in the past
year
2008
15
(6)
3
(1.5)
10
(5)
6
(3.5)
19
(7)
Did not fill prescription or
skipped doses because of cost
in the past year
2008
6
(2)
9
(5)
7
(3.5)
0
(1)
16
(6)
7
(3.5)
18
(7)
Need dental care but did not
see dentist because of cost in
past year
2008
13
(5)
20
(6)
6
(3)
2
(2)
7
(4)
-5
(1)
28
(7)
Last time needed medical
attention had to wait 6 or
more days for appointment
2009
3
(4)
11
(6)
6
(5)
-1
(1.5)
1
(3)
-1
(1.5)
13
(7)
4
5
3
1
6
2
7
Overall ranking
6
3
(3.5) (1.5)
5. Long, healthy, and productive lives measures
Source
AUS
CAN
GER
NETH
NZ
UK
US
Mortality amenable to health
care (deaths per 100,000)
2003
71
(1)
77
(2)
90
(4)
82
(3)
96
(5)
103
(6)
110
(7)
Infant mortality
2006
4.7
(3)
5.0
(4.5)
3.8
(1)
4.4
(2)
5.2
(6)
5.0
(4.5)
6.7
(7)
Healthy life expectancy at age
60 (average of women and
men)
2006
24.6
(1)
23.8
(2)
23.0
(4)
22.8
(5)
23.7
(3)
22.5
(7)
22.6
(6)
1
2
3
4
5
6
7
Overall ranking
Overall ranking of health systems among
seven countries
Summary key findings
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• Quality
– The US was best on provision and receipt of preventive and
patient-centered care,
– However, its low scores on chronic care management, and safe and
coordinated care which pull its overall quality score down,
• Access
– Without universal coverage, costs related access problems in the
US were higher than other countries,
• Efficiency
– The US ranks last among the seven countries, while the UK and
Australia ranking first and second, respectively.
• Equity
– The US ranks a clear last on nearly all measures of equity.
• Long, healthy and productive lives
– The US ranks last overall with poor scores on all three indicators of
long, healthy, and productive lives.
Efficiency analysis
Per capita THE at inter dollar with Life expectancy
USA
Monitoring & Evaluation of health systems reform /strengthening
A general framework for HSPA
Inputs & processes
Financing
Indicator
domains
Governance
Infrastructure
/ ICT
Health
workforce
Supply chain
Information
Data
sources
Administrative sources
Financial tracking system; NHA
Databases and records: HR,
infrastructure, medicines etc.
Policy data
Outputs
Outcomes
Impact
Intervention
access &
services
readiness
Coverage of
interventions
Improved
health outcomes
& equity
Prevalence risk
behaviours &
factors
Social and financial
risk protection
Intervention
quality, safety
and efficiency
Responsiveness
Facility assessments
Population-based surveys
Coverage, health status, equity, risk protection, responsiveness
Clinical reporting systems
Service readiness, quality, coverage, health status
Vital registration
Analysis &
synthesis
Communication
& use
Data quality assessment; Estimates and projections; In-depth studies; Use of research results;
Assessment of progress and performance of health systems
Targeted and comprehensive reporting; Regular country review processes; Global reporting
Health Systems
Assessment
Approach of
HS 20/20
Sub-national HSPA
Immunization coverage <1 year by district in SA 2007-2008
Source: District Health Barometer 2007-08
20
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