OECD Health Care Quality Reviews provide a toolkit to improve the quality of health care
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.
The reviews will cover around 10 to 12 country reports. Each report highlights best practices and offers recommendations for improvement. A final report on policies to drive improvements in health care quality across countries will be produced in 2015.
Why review health care quality policies?
- OECD countries spent nearly a tenth of their GDP on health. As spending rises, there is pressure to ensure that resources help people live healthier lives.
- Most OECD countries have seen increased public interest in ensuring that patients receive care that is safe, effective, and responsive to their needs.
- OECD Health Care Quality Indicators show wide variations in quality across OECD countries, yet little is known about the policies that sit behind the numbers.
Some lessons learnt
- Korea’s substantial policy reforms over the past decades have equipped it with an ideal institutional architecture from which to pursue further reforms.
- Governments ought to take early action to develop primary care infrastructure and establish gate-keeping by primary care professionals.
- There are risks of oversupply of hospital services at the expense of quality. Strong budgetary or regulation on supply, and payments that reward providers for doing better rather than doing more are important to avoid this.
- Governments and purchasers should demand accountability for the quality of health care for the substantial payments they make to health care providers.
- Israel has a world class primary care system based on teams of professionals working in community clinics that are held to account by extensive data collection and strong after hours services.
- The government ought to address the relatively poor information on quality of care in hospitals by encouraging better hospital quality reporting and improvement programmes.
- Improving the flow of clinical information will help coordination between primary care and hospitals.
- Dedicated health programmes for the disadvantaged have helped address inequalities though renewed efforts are needed along with tackling the social determinants of health and avoiding further increases in co-payments.
- Denmark's impressive health care quality initiatives have been developed over more than 20 years; linkages across them must now be built so as to improve quality of the system as a whole, and not just focusing on individual initiatives.
- Special focus ought to be on measuring and maximising the contribution of the primary care sector, including on the co-ordination between the primary, secondary, and community care sector.
- To exploit the full potential of the hospital reform, Danish authorities should support the diffusion of good practices, strengthen pre-hospital care services and track data on individual physicians performance to stimulate continuous improvement by clinicians.
- Better use of data from quality registers and other rich data sets would help documenting the extent of inequalities in health and health care and would leave Denmark better equipped to address inequalities in health.
- Sweden has developed a care infrastructure that allows seven out of ten dependent elderly people to receive most health and social care in their homes. Compared to the hospital sector though, there is still a relative lack of standards, guidelines and indicators to measure and assure the quality of community-based care.
- Sweden has a long-established and extensive set of quality registers for many areas of health and social care. Open comparison of municipality-level results has been instrumental in developing an ambitious quality-improvement culture across the country. More needs to be done though to build links between quality registers, in order to build up a picture of the complete pathway of care for patients with complex needs.
- Sweden is pioneering the issue of data linkage by linking individual patient data across its Senior Alert, Dementia, Behavioural Symptoms and Palliative Care registers. This will allow a comprehensive assessment of the quality of care for patients with dementia starting from early detection, through to diagnosis and management, deterioration and end of life.
- Sweden is expanding the role of non-traditional care providers (such as private sector providers or community organisations) in an attempt to expand patient choice and encourage quality-based competition. Close evaluation of these reforms will be needed to ensure that other objectives, such as coordinated care and equity of access, are not compromised.
- Through the 2012 ‘Coordination Reform’ Norway set out a strategic vision for its health system, seeking to increase the role of primary and community services, including through a number of financial penalties and incentives.
- The Coordination Reform’s financial incentives should be a strong driver for municipalities to strengthen care in the community and support early discharge from hospital, but may be working less well to promote good management of chronic conditions and prevent avoidable hospital admissions.
- The core incentives of the Coordination Reform were directed at service delivered by municipalities, meaning that key players in reducing hospital admissions and promoting coordination of care, e.g. GPs and the mental health sector, have much weaker incentives for change.
- Under-developed data infrastructures in primary care have limited progress towards securing better quality, and a lack of electronic patient records that are portable across care settings may impede smooth patient pathways across service settings.
- The Czech Republic’s data infrastructure is weak and fragmented, and there is little information for patients on hospital performance. More solid infrastructure and data collection would make it easier to monitor quality, and make patients better informed.
- The Czech Republic takes a voluntary approach to quality assurance, which enables hospitals to escape scrutiny. A shift to mandatory accreditation would give hospitals stronger incentives to improve performance.
- The Czech Republic’s primary care system is failing to prevent chronic disease. Focusing more on evidence-based prevention and screening programmes would help reduce the incidence of these conditions.
- GPs aren’t playing an active role in managing complex patients with diabetes. Giving GPs incentives and training to adopt a leading role in diabetes treatment would improve quality and co-ordination of care.
The country reports, published in English or French, are available below for download. All reports are also available on the OECD iLibrary.
For a description of the health system in these countries and many others, visit the European Observatory's Health Systems in Transition (HiT) series.
Ms. Francesca Colombo (tel: +33 1 45 24 93 60 or email@example.com)
Permanent URL: http://www.oecd.org/health/qualityreviews
Health Care Quality Indicators