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The German health system is characterised by high levels of human and physical resources guaranteeing good access to care with a low direct financial burden for patients. Nevertheless, the changing demographic situation with a rapidly ageing society creating new demand for health services will pose a challenge for Germany’s health system.
How health providers are paid is one of the key policy levers that countries have to drive health system performance. The 2012 HSC Survey analyses the payment modes currently in use in OECD countries to remunerate primary care, outpatient specialist care and inpatient care, the price regulations for health services and identifies new innovative modes of payments in more detail.
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Denmark has a strong and high-performing healthcare system. However, challenges remain when it comes to primary care and prevention. Harmful alcohol consumption and rising overweight and obesity rates among adults suggest a need for targeted public health policies in Denmark.
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The Netherlands has seen remarkable improvements in the health of its population but also faces several challenges. The burden of cardiovascular diseases has declined but cancer prevalence is relatively high. Financial sustainability is of concern, while reforms in mental and long-term care that aim to improve efficiency must be monitored carefully.
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.
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Although increasing, life expectancy in the Czech Republic, at 78.3 years, was still below the OECD average of 80.5 years in 2013. The Czech Republic presents above average levels of risk factors such as tobacco, alcohol consumption and obesity. To cope with the expected rise in chronic diseases, the Czech Republic will have to shift care from the hospital sector and strengthen preventive health care.
At the OECD, we have calculated that about 50% of all the antimicrobials prescribed by healthcare facilities in our member countries do not meet prescription guidelines. In healthcare services such as long-term care facilities and general practices up to 70% and 90% respectively of antibiotics may be prescribed for inappropriate reasons.
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In the past 30 years Korea has gone from having a limited medical infrastructure, fragmented financing and limited population coverage, to a health care system characterised by universal coverage, one of the highest life expectancies in the world while still having one of the lowest levels of health expenditure among OECD countries.
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Israel has built a universal health system at relatively low-cost. Health spending was 7.5% of GDP in 2013, below the OECD average of 8.9% although the health spending share of GDP has been increasing rapidly, particularly in recent years. Israel has developed a sophisticated programme to monitor quality of primary care.
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Norway has an impressive and comprehensive health system, but it is facing several challenges over the coming years. The shift in the need for care from an ageing population will weigh heavily on the Norwegian health care system, demanding for more skilled health care personnel as well as strengthening of community care.