Payers for health care are pursuing a variety of policies as part of broader efforts to improve the quality and efficiency of care. Payment reform is but one policy tool to improve health system performance that requires supportive measures in place such as policies with well-developed stakeholder involvement, information on quality, clear criteria for tariff setting, and embedding evaluation as part of the policy process. Countries should not, however, underestimate the significant data challenges when looking at price setting processes. Data access and ways to overcome its fragmentation require well-developed infrastructures. Policy efforts highlight a trend towards aligning payer and provider incentives by using evidence-based clinical guidelines and outcomes to inform price setting. There are signs of increasing policy focus on outcomes to inform price setting. These efforts could bring about system-wide effects of using evidence along with a patient-centred focus to improve health care delivery and performance in the long-run.
Base de données Statistiques de l'OCDE sur la santé 2015 - Notes par pays
The Portuguese National Health Service has responded well to financial pressure, successfully balancing the twin priorities of financial consolidation and continuous quality improvement, according to a new OECD report.
This report reviews the quality of health care in Portugal, seeks to highlight best practices, and provides a series of targeted assessments and recommendations for further improvements to quality of care. The Portuguese National Health Service has responded well to financial pressure, successfully balancing the twin priorities of financial consolidation and continuous quality improvement. Even in the post-crisis years when GDP fell and health spending declined, improvements in quality of care continued. The need to reduce health spending has been met through a combination of structural reforms, and a well-designed suite of quality initiatives. Reforms around the purchasing and use of pharmaceuticals and medical devices have helped drive down costs, and Portugal has been innovative in how public funds are used to pay providers, increasingly basing payments on quality and efficiency. Important priorities for further work in the Portuguese health system do remain. Portugal will need to improve clinical processes and pathways, particularly in the acute sector. There is still room to improve efficiency, for instance increasing the share of generic drug consumption, and using the Portuguese health workforce more effectively, especially through expanded roles for nurses. Further structural reform is needed with an emphasis on shifting care out of hospitals into less-expensive community settings, and Portugal will also need to reflect on the strategic direction of the primary care system which, following an impressive reform, now risks developing into a two-tiered system with increasingly divergent levels of care quality.
In Portugal, health spending has been reduced from 10.8% of GDP in 2009 to 10.2% now. This has been achieved by rationalising spending on pharmaceuticals, promoting the use of generic drugs, moderating salaries; cutting the fees paid to hospitals, and increasing user charges, while still protecting those in most need, said OECD Secretary-General.
The mortality amenable to health care is defined as a possible indicator to measure the health care systems performance in preventing premature deaths that can be avoided by appropriate health care intervention. This paper assesses the feasibility of using this indicator in OECD countries.