Colombia’s record in extending health insurance and health services to its population is impressive. In 1990, around 1 in 6 of the population had health insurance. Now, nearly 97% do, with greatest expansion occurring amongst poorer households. Likewise, in 1993 out-of-pocket spending made up 52% of total national expenditure on health. By 2006, this had fallen to less than 15%. Although Colombia has high rates of income inequality (with a Gini coefficient of 53.5 in 2012, compared to the OECD average of 32.2), access to health care services is much more equal. In urban populations, for example, 1.8% of children aged less than two years of age are recorded as having received no routine vaccinations, compared to 1.0% of rural children. Colombia nevertheless faces important challenges to maintain and improve the performance of its health system. This report looks at Colombia’s health care system in detail and offers recommendations on what Colombia can do to ensure accessibility, quality, efficiency and sustainability.
Australia’s health system functions remarkably well, despite operating under a complex set of institutions that make coordinating patient care difficult. Complications arising from a split in federal and state government funding and responsibilities are central to these challenges. This fragmented health care system can disrupt the continuity of patient care, lead to a duplication of services and leave gaps in care provision. Supervision of these health services by different levels of government can manifest in avoidable impediments such as the poor transfer of health information, and pose difficulties for patients navigating the health system. Adding to the Australian system’s complexity is a mix of services delivered through both the public and private sectors. To ease health system fragmentation and promote more integrated services, Australia should adopt a national approach to quality and performance through an enhanced federal government role in steering policy, funding and priority setting. The states, in turn, should take on a strengthened role as health service providers, with responsibility for primary care devolved to the states to better align it with hospital services and community care. A more strategic role for the centre should also leave room for the strategic development of health services at the regional level, encouraging innovation that is responsive to local population need, particularly in rural and remote areas.
This new edition of Health at a Glance presents the most recent comparable data on the performance of health systems in OECD countries. Where possible, it also reports data for partner countries (Brazil, China, Colombia, Costa Rica, India, Indonesia, Latvia, Lithuania, Russian Federation and South Africa). Compared with the previous edition, this new edition includes a new set of dashboards of health indicators to summarise in a clear and user-friendly way the relative strengths and weaknesses of OECD countries on different key indicators of health and health system performance, and also a special focus on the pharmaceutical sector. This edition also contains new indicators on health workforce migration and on the quality of health care.
Too many lives are still lost in OECD countries because healthcare quality is improving too slowly to cope with ageing populations and the growing number of people with one or more chronic diseases, according to a new OECD report.
The book presents a background study of DRG-based payment systems, drawing on the experience of implementing such hospital funding arrangements internationally, including an overview of developments in the Asia and Pacific region. It underscores the need for countries to be clear about their purpose and objective for introducing Diagnosis Related Groups, as well as their place in health-care financing reform, and for policy-makers to reflect on the importance of country-specific starting points, objectives and context in which the hospital payment reforms are being implemented. Chapter 4 – written by Yuki Murakami and Luca Lorenzoni – investigates the evidence regarding the impact on cost, quality and efficiency of the introduction of a DRG-based payment system.
All countries are investing in health data. There are however significant cross-country differences in data availability and use. Some countries stand out for their innovative practices enabling privacy-protective data use while others are falling behind with insufficient data and restrictions that limit access to and use of data, even by government itself. Countries that develop a data governance framework that enables privacy-protective data use will not only have the information needed to promote quality, efficiency and performance in their health systems, they will become a more attractive centre for medical research. After examining the current situation in OECD countries, a multi-disciplinary advisory panel of experts identified eight key data governance mechanisms to maximise benefits to patients and to societies from the collection, linkage and analysis of health data and to, at the same time, minimise risks to the privacy of patients and to the security of health data. These mechanisms include coordinated development of high-value, privacy-protective health information systems, legislation that permits privacy-protective data use, open and transparent public communication, accreditation or certification of health data processors, transparent and fair project approval processes, data de-identification and data security practices that meet legal requirements and public expectations without compromising data utility and a process to continually assess and renew the data governance framework as new data and new risks emerge.
The health systems we enjoy today, and expected medical advances in the future, will be difficult to finance from public resources without major reforms. Public health spending in OECD countries has grown rapidly over most of the last half century. These spending increases have contributed to important progress in population health: for example, life expectancy at birth has increased, rising on average by ten years since 1970. The challenge now is to sustain and enhance these achievements in a context of tight fiscal constraints in many countries combined with upward pressure on health spending from factors such as new technological advances and demographic changes. Finding policies that can make health spending more sustainable without compromising important achievements in access and quality requires effective co-operation between health and finance ministries. Sound governance and co-ordination mechanisms are therefore essential to ensure effective policy choices. Prepared by both public finance and health experts, this report provides a unique detailed overview of institutional frameworks for financing health care in OECD countries. One of the main features of this book is a comprehensive mapping of budgeting practices and governance structure in health across OECD countries.
This report reviews the quality of health care in Japan, and seeks to highlight best practices, and provides a series of targeted assessments and recommendations for further improvements to quality of care. One of Japan’s foremost policy challenges is to create an economically-active ageing society. Excellent health care will be central to achieving this. A striking feature of the Japanese health system is its openness and flexibility. In general, clinics and hospitals can provide whatever services they consider appropriate, clinicians can credential themselves in any speciality and patients can access any clinician without referral. These arrangements have the advantage of accessibility and responsiveness. Such light-touch governance and abundant flexibility, however, may not best meet the health care needs of a super-ageing society. Japan needs to shift to a more structured health system, separating out more clearly different health care functions (primary care, acute care and long-term care, for example) to ensure that peoples’ needs can be met by the most appropriate service, in a coordinated manner if needed. As this differentiation occurs, the infrastructure to monitor and improve the quality of care must simultaneously deepen and become embedded at every level of governance –institutionally, regionally and nationally.
Specific country notes have been prepared using data from the database OECD Health Statistics 2015, July 2015 version. The notes are available in PDF format.
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This new brochure presents the OECD Work on Health for 2015-2016, including all recent and forthcoming major publications and databases.