Transcript ws6_Westert_final

Designing a national health care performance
system in the Netherlands: ZORGBALANS
prof dr Gert Westert
Basics
• Ministry of Health
Carefully assess the performance of
the Dutch health care system
• Why performance /why now?
-
Lissabon 2000 agenda
EU market in 2010: strong and attractive
‘healthy’ public sector
Less input more output!
• Performance in terms of what?
- Performance in terms of health OR in terms of health care
- Health = f (…, Care)
- Care = f (Quality, Access, Costs)
Performance framework for the Dutch healthcare,
phase 1
Lalonde model
Balanced scorecard
Environmental
factors
Financial
perspective
Performance:
Genetic
layout
Health
Health Care†
Internal
Processes
perspective
Consumer
Perspective
Innovation
perspective
Lifestyle
• Health performance of the system
versus health care performance of
the system
• ‘Steering the oil tanker’
• Balanced score card: health
system management (2003-2004)
-
Consumer
Financial
Internal processes
Innovation
• Cockpit signals:
Population Health Information
Management Information
†Health care includes all sectors: prevention, cure, care and welfare
- 26 baskets with indicators:
- 2 year interactive process
• Performance framework for
healthcare, phase 2
HEALTH
How healthy are the Dutch?
NON-HEALTHCARE DETERMINANTS OF HEALTH
Are the non-healthcare factors that also determine health as well as if/how healthcare is
used changing favorably?
E
Q
U
I
HEALTHCARE SYSTEM PERFORMANCE
How does the healthcare system perform? What is the level of care across the range of patient care needs? What does this
performance cost?
Dimensions of Healthcare Performance
Quality
Healthcare
Needs
Effectiveness
Safety
Access
Patientcenteredness
Cost
Accessibility
Staying
healthy
Getting better
X
X
Living with
illness or
disability
End-of-life
care
Efficiency
(Value for money)
HEALTH SYSTEM DESIGN AND CONTEXT
What are the important design and contextual information that may be specific to the Dutch health system and which are
necessary for interpreting the quality of healthcare?
T
Y
• Health needs: 4x
• Change from BSC perspectives to
system goals: quality, accesibility
and costs
• OECD HCQI framework
• Baskets with indicators ‘adopted’
from phase 1
- Health impact
- Susceptibility to being influenced by
health care system
- Policy importance
• Rearranged merging of baskets:
- QA€
Quality
• Effectiveness
• PatientCenteredness (satisfaction, trust)
• Safety
• Innovativeness
Costs
• System costs
• Productivity
• Financial position
suppliers
• Health care market
• Contracting
Access
• Choice
• Concentration
• Waiting
• Personell
• Cost for citizens
State of Dutch health care 2006/ ZORGBALANS 2006
• Reference year 2004, published in April 2006
• MACRO-level report 100 pages
• 15 chapters with 125 indicators and results
• Max. 5 key messages per chapter
• Executive summary describing the overall state, including trade-off
issues for quality, access and costs
• Chapter on information needs for 2008
• Zorgbalans team: 12 researchers
• Two examples:
- Effectiveness cure
- Waiting list in health care
Effectiveness of curative healthcare in the Netherlands is
at best ‘average’
• GP’s are not prescribing medications that should not be prescribed as
recommended.
• GP’s refer less to hospitals that 15 year ago.
• Hospital-related mortality rates for pneumonia have been fluctuating around 1012% over the last several years.
• Hospital-related mortality rates for heart failure have also been stable with only
slight improvements from 14% to 12% in the last 2 years.
• In-hospital AMI and stroke mortalities within 30 days of hospital admission
are within the OECD average.
• Breast cancer mortality, which is improving slowly, is still high in the Netherlands
compared to many other European countries.
• Five-year survival rates for cervical and colorectal cancers compare well to
OECD averages.
• Asthma mortality is improving and is better than the OECD average.
• About 80% of all hip fractures are operated within 48 hours.
Number of people on a waiting list still considerable
• In 2003 218.000 were waiting on waiting list for health care
• Waiting list for hospital inpatient care simular as the year before (64,000
naar 62,500)
• Waiting list for mental health care increased slightly in the periode 20012003 (14,100 naar 15,600)
• Waiting list in care much shorter (nursing homes from 11,400 to 6.900);
home care from 39,600 to 19,500.
To conclude…
JIGSAW PUZZLE of 1000 pieces,
but we have only 100 pieces
It is all about:
• Selection of indicators
• Representativeness
• Interpretation of results: norms
and points of reference
- Time and space comparisons
- Within the Netherlands
(benchmarking; small area
variations; best practices)
- International indicator sets: OECD
(HCQI)