The National Health Service in the United Kingdom takes health care quality seriously and makes great effort to be a system that learns. The current NHS Outcomes Framework is entirely built around quality and patient-centredness is the system’s focal point. The drive to provide high quality care means that the United Kingdom has internationally pioneered many initiatives, including clinical guidelines, continuing professional development and use of patient surveys and patient-reported outcomes. Professionalism was for many years the trusted base upon which quality monitoring and improvement activities rested. In recent years, though, this governance model has progressively shifted toward a quality management approach, more reliant upon regulation and control. There has been a proliferation of national agencies, reviews and policies that address quality, leading to a somewhat congested and fragmented field of actors, particularly in the fields of inspection and performance monitoring. A tension, perhaps more pronounced than in other OECD health systems, is now evident between top-down quality management approaches and bottom-up quality improvement techniques. What should the United Kingdom do to resolve this tension and ensure that its quality architecture remains one that is studied and emulated by other OECD health systems? This report recommends three key actions. First, greater emphasis on professionalism should be reinstated as a key driver of excellence. As the same time there is scope to simplify the range of institutions and policies regulating health care quality. Finally, renewed focus on the quality at the interfaces of care, as well as on community-based services, is needed.
The objective of the HCQI Project is to develop a set of indicators based on comparable data and which can be used to raise questions for further investigation on quality differences across countries.
Les personnels de santé sont essentiels pour assurer l'accès à des soins de qualité et rentables. Le travail de l'OCDE examine les tendances et les priorités en ce qui concerne les politiques en matière de personnels de santé dans les pays de l'OCDE.
OECD Health Care Quality Reviews seek to examine what works and what does not work in different countries – both to benchmark the efforts of countries and to provide advice on reforms to improve their health system.
Those in-depth studies of the health system of member countries focus on economic issues. They assess the performance of health systems in a comparative context, identify the main challenges faced by the country health system and put forward policy options to better meet them. Reviews are initiated at the request of the country to be examined and emphasis is placed on specific issues of key policy interest.
The OECD Health Division is releasing a new series to highlight its work on health policies and data. A new graph will be available each month.
Publications sur la santé
Ten years after the introduction of publically-funded universal health insurance, the Mexican health system finds itself at a critical juncture. Unquestionably, some measures of health and health system performance have improved: those previously uninsured now use health services more often, whilst numbers reporting impoverishing health expenditure having fallen from 3.3% to 0.8%. Other indicators, however, remain worrying. Rates of survival after heart attack or stroke are markedly worse than in other OECD countries. Prevention is a particular concern: with 32% of the adult population obese, Mexico ranks as the second most obese nation in the OECD and almost 1 in 6 adults are diabetic. Other key metrics imply deep-rooted inefficiencies in the system: administrative costs, at 8.9% of total health spending, are the highest in the OECD and have not reduced over the past decade. Likewise, out-of-pocket spending has stuck at nearly 50% of total health spending - the highest in the OECD - and implies that individuals feel the need to visit private clinic despite having health insurance. In short, Mexico’s massive public investment in its health system has failed to translate into better health and health system performance to the extent wished and a programme of continued, extensive reform is needed. This report sets out the OECD’s recommendations on the steps Mexico should take to achieve this.
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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.