The detailed analysis of these 10 case studies together with the rest of the analytical text highlight the realities of P4P programs and their potential impact on the performance of health systems in a diversity of settings. This book provides critical insights into the experience to date with P4P and how this tool may be better leveraged to improve health system performance and accountability.
L’utilisation des soins de santé varie d’un pays à l’autre mais peut aussi varier tout autant, voire plus, au sein même des pays. Les gouvernements devraient redoubler d’efforts pour améliorer leurs systèmes de santé afin d’éviter les interventions superflues, et pour que chacun, où qu’il vive, ait le même accès à des soins de santé de qualité, selon un nouveau rapport de l’OCDE.
Variations in health care use within a country are complicated. In some cases they may reflect differences in health needs, in patient preferences or in the diffusion of a therapeutic innovation; in others they may not. There is evidence that some of the observed variations are unwarranted, signalling under- or over-provision of health services, or both. This study documents geographic variations for high-cost and high-volume procedures in select OECD countries. It finds that there are wide variations not only across countries, but within them as well. A mix of patient preferences and physician practice styles likely play an important part in this, but what part of the observed variations reflects over-provision, or whether there are unmet needs, remain largely unexplained. This report helps policy makers better understand the issues and challenges around geographic variations in health care provision and considers the policy options.
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Selon un rapport de l'OCDE, les variations dans le recours à différents types de services de santé entre les zones géographiques à l’intérieur des pays est une source de préoccupation. Ces variations indiquent que la probabilité de recevoir un service de santé dépend fortement du lieu de résidence du patient dans le pays.
Rapports techniques sur la santé
Despite the enormous burden that mental ill-health imposes on individuals, their families, society, health systems and the economy, mental health care remains a neglected area of health policy in too many countries. Mental disorders represent a considerable disease burden, and have a significant impact on the lives of the OECD population, and account for considerable direct and indirect costs. This report argues that even in those OECD countries with a long history of deinstitutionalisation, there is still a long way to go to make community-based mental health care that achieves good outcomes for people with severe mental illness a reality. The disproportionate focus on severe mental illness has meant that mild-to-moderate mental illnesses, which makes up the largest burden of disease, have remained overwhelmingly neglected. This book addresses the high cost of mental illness, weaknesses and innovative developments in the organisation of care, changes and future directions for the mental health workforce, the need to develop better indicators for mental health care and quality, and tools for better governance of the mental health system. The high burden of mental ill health and the accompanying costs in terms of reduced quality of life, loss of productivity, and premature mortality, mean that making mental health count for all OECD countries is a priority.
The USA has exceptional levels of health-care expenditure, but growth slowed dramatically in recent years, amidst major efforts to close the coverage gap with other OECD countries.
Les dépenses de santé ont recommencé à augmenter, après avoir stagné, voire reculé, dans de nombreux pays de l'OCDE pendant la crise, mais à un rythme qui reste bien inférieur au taux avant la crise, notamment en Europe, selon les Statistiques de l’OCDE sur la santé 2014.
This book presents a comprehensive review of health care quality in the Czech Republic. It finds that over the past 20 years, the Czech Republic witnessed the unprecedented gains in quality of health care and life expectancy and successfully transferred its Semaschko system into the modern accessible health care system with private-public mix of providers. Nevertheless the health care system in the Czech Republic still has some way to go to achieve the outcomes of the best performing OECD members. While some of the gap might be caused by the one of the lowest levels of health care expenditures among OECD countries (7.2% GDP in 2011) there are possibilities to improve the outcomes without incurring much of the additional costs.
The Czech authorities should reach a consensus on the development of quality of care and data infrastructure and aim for sustainable long-term initiatives undisturbed by the political cycles in both of these areas. While the adverse events reporting and voluntary accreditation are the good steps towards the accountability of the providers, the government should do more in this area, undertake the effort to broaden the accreditation process and include outpatient care and link public health authorities to the quality agenda of inpatient care. In the area of data infrastructure more data should be gathered, the process of data gathering should be streamlined and administrative burden for the providers lowered primarily via the merging the data-collecting agencies. Finally, without the active participation of health insurance funds and proper reimbursement mechanisms in place the quality agenda will not be perceived as the priority.
The 2012 HSC Survey identifies policy responses to tackle possible issues with problems of physician supply in OECD countries and takes stock of the employment status of doctors, their training and various issues concerning regulations of this medical profession.