Efficiency of Health Care Delivery: co-ordination of care

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During 2006 and 2007, work in the area of efficiency has focused on coordination-of-care policies as a tool for improving both cost and quality outcomes. The OECD Health Division  has now released a Health Working Paper "Improved health system performance through better care coordination", Health Working Paper No. 30.  This report covers OECD countries and those EU members that are not members of the OECD.

What is the purpose of this study?

The main objective of this study was to assess the potential for higher efficiency through better care coordination policies, and to identify how governments in OECD countries promote coordination of care.

Why look at coordination of care?

Many OECD countries see coordination of care as a key policy response to improve efficiency and effectiveness of health care delivery, in the context of changes in the patterns of demand and supply of health care. Technical progress and increased specialisation in medicine are  leading to greater fragmentation in supply while rising numbers of chronically-ill patients are consuming a growing share of total health care spending. Where care coordination leads to more appropriate care, for example, through fewer medical errors, more appropriate medication and less re-hospitalisation, cost efficiency and cost effectiveness will be enhanced as well.  To the degree that this leads to higher workforce productivity – e.g. through reduced sick leave – overall economic efficiency will also improve.

Approach

The OECD Secretariat has defined coordination of care as system-wide efforts and/or formal policies to ensure that patients receive services that are appropriate to their needs and integrated across care settings and over time. Specifically, this study attempts to identify:

• the importance of coordination problems within individual health care systems and sectors;
• existing coordination policies, their scope and any evidence of measured impact;
• institutional and managerial barriers to improved coordination; and
• experience with coordination programmes such as case and disease management for selected countries. 
  

The results of this study are based on replies to a detailed questionnaire from 26 countries, supplemented by a review of the literature on the impact of such programmes. The broad result is that, while coordination of care policies seems likely to improve the quality of care (and are therefore valuable in their own right), there is less evidence that they will lead to substantive cost savings.

Contact

Mr Howard Oxley: howard.oxley@oecd.org