HEALTH - OECD

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OECD WORK ONHEALTH OECD 2017OECD WORK ONHealth1

OECD WORK ON HEALTH3The Organisation for Economic Co-operation and Development4Towards people-centred health systems6OECD work on health8Patient-Reported Indicators Survey – PaRIS10Quality of care12OECD Health Statistics and Health at a Glance14Health spending16Value for money18Ensuring financial sustainability of health systems20Ageing and long-term care22Public health24Pharmaceuticals and new technologies26Health workforce policies28Health inequalities and inclusive growth30Global health – Health system strengthening32The structure of the Health Committee33Health organigram34Key health contacts36Key publications and databases

OECD WORK ONHealthThe Organisation for EconomicCo-operation and DevelopmentThe OECD, which traces its roots to the Marshall Plan, groups 35 member countries committed to democraticgovernment and the market economy. It provides a forum where governments can compare and exchange policyexperiences, identify good practices and promote decisions and recommendations. Dialogue, consensus and peer revieware at the very heart of OECD.The OECD continues to actively engage with countries beyond the 35 member states. Accession talks with Colombia andLatvia began in 2013, and with Costa Rica and Lithuania in 2015. Latvia became a member in 2016. We work closely withthe major emerging economies – Brazil, China, India, Indonesia and South Africa – as they seek to improve their healthsystems, as well as with a number of programme countries, including Kazakhstan, Morocco and Peru. The launch ofthe Southeast Asia Regional Programme by the Secretary-General in May 2014 marked the elevation of long-standingengagement with the region to a higher level.The OECD is working for a stronger, cleaner and fairer world economy. The principle aim of the Organisation is to promotepolicies for sustainable economic growth and employment, and rising standards of living. By “sustainable economicgrowth” the OECD means growth that balances economic, social and environmental considerations. At the heart of theOECD’s mission is to promote policies that will improve the economic and social well‑being of people around the world.The OECD is one of the world’s most reliable sources of comparable statistical, economic and social data. It monitorstrends, collects data, analyses and forecasts economic development and investigates evolving patterns in a broad rangeof public policy areas, including agriculture, development co-operation, education, employment, environment, taxationand trade, science, technology and industry. The OECD family of organisations also includes the International EnergyAgency, the Nuclear Energy Agency, the International Transport Forum, the Development Centre and the Club du Sahel. OECD 20173

4Towards people-centred health systemsH“Today, OECD countries devote on averagearound 10% of their gross domestic product tohealth. At OECD, we have become very goodat measuring what health systems do and howmuch they spend. But we have so far neglectedto measure their true impact on the lives ofpeople they serve – their effect on comfort andpain, physical and mental function, mobility orindependence. The Patient-Reported IndicatorsSurvey (PaRIS) initiatve will provide newindicators of health system performance asreported by patients themselves. PaRIS has thepotential to be a game changer in our assessmentof health systems. It will help build a truly peoplecentred view of health system performance toraise health care quality further, reduce wasteand improve health and well being for all.”Stefano Scarpetta, Directorealth is essential for the well-being of individuals and for fosteringinclusive and sustainable growth. The health sector is also a keygenerator of job opportunities and driver of innovation.Health spending accounts for almost 10% of GDP on average in the OECD areaand health systems are struggling to demonstrate value for money andto deliver good care aligned to the needs of ageing populations. Newtreatments and improved public health mean that people are living longerthan ever, although not necessarily healthily for longer. As living standardsrise, people expect better access to safe and high-quality care that meetstheir needs. At the same time the pace of technological innovation is drivingcost increases.In response, OECD Health Ministers, at their meeting in January 2017, haveasked the OECD to help them reorient health systems to become morepeople-centred. Shifting the focus of care from providers towards theneeds of individuals will have important implications for the way healthsystems are structured and how their performance is measured in thefuture. This is why we are developing new metrics to assess health systemperformance based on what people need, not what providers can do.The Patient Reported Indicator Survey (PaRIS) initiative will help policymakers understand how health systems best meet people’s needs. OECD 2017

OECD WORK ONHealthThe OECD offers tools to assess the impact of policies to prevent chronic diseases and helps governments reducewaste in health systems. Reorienting health systems towards primary and community care and shifting spending tocheaper equivalent treatment add value to patients. Personalised medicine and digital tools offer the potential for greatimprovements in care and outcomes but also require new governance models.The OECD is also contributing to the international health agenda, including responding to requests from the UN, G7 andG20. We are leading strands of work on health workforce skills, contributing to efforts to tackle antimicrobial resistanceand supporting countries achieve universal health coverage. With the international spotlight turning to how the 2015Sustainable Development Goals are implemented at country level, the importance of building and maintaining stronghealth systems has never been greater.The OECD helps policy makers develop strategies to address the significant challenges that lie ahead. By publishing robustmeasures of comparative health system performance, identifying and sharing good practices across our member andpartner countries, and responding to country-specific demands for tailored analyses and recommendations on particularpolicy problems, we help countries develop policies for better and healthier lives on issues such as: Developing a people-centred care policy framework Developing a new generation of health indicators – the PaRIS initiative Strengthening primary care and the prevention of illness Improving the quality of care Tackling waste and helping tight resources go further Effectively exploiting new technologies and ensuring effective integration into health systems Adapting health care to address the complex needs of the frail elderly Improving health workforce skills Contributing to the global health agenda OECD 20175

6OECD work on healthWithin the OECD, most of the work on health is carried out by the Health Division of the Directorate for Employment,Labour and Social Affairs. Beyond health issues, the Directorate leads the Organisation’s work on employment, socialpolicies and international migration.What we doWe help countries achieve high-performing health systems by measuring healthoutcomes and health system resource use and by analysing policies that improveaccess, efficiency, and quality of health care.What we areAn advisor to OECD member countries and a number of non-member emergingeconomies, providing policy analysis and statistical information on health policies.A forum for governments, business, workers, academics and other representativesof civil society to engage in a constructive dialogue on how best to develop policiesthat ensure utilisation of human capital at the highest possible level, improve the qualityand flexibility of working life and promote social cohesion.Who we serveOECD has 35 member countries: Australia, Austria, Belgium, Canada, Chile,Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland,Ireland, Israel, Italy, Japan, Korea, Latvia, Luxembourg, Mexico, the Netherlands,New Zealand, Norway, Poland, Portugal, Slovak Republic, Slovenia, Spain, Sweden,Switzerland, Turkey, the United Kingdom and the United States. The OECD is in accessiondiscussions with Colombia, Lithuania and Costa Rica, and works closely with Brazil,the People’s Republic of China, India, Indonesia, Russia and South Africa as well asa number of programme countries, including Kazakhstan and Peru. OECD 2017

OECD WORK ONOur priority areas OECD 2017 Measuring health system outcomesQuality of health careValue for moneyFinancial sustainability and health system financingEconomics of disease preventionPharmaceuticals and new technologiesAgeing and long-term careHealth workforceGlobal healthPublic healthHealth inequalitiesHealth7

8Patient-Reported Indicators Survey – PaRISWe provide international leadership to developnew indicators of health system performance –as reported by patients themselvesMonitoring these indicators internationally providesnew tools to improve health care policy and practice.IrelandFranceUnited Kingdom200150100OECD 004202002032001020 People also report on their experience of being treated –whether the treatment was properly explained,for example, or if they felt involved in decisionsabout their care.Austria25020 Patients report on outcomes that matter to them –whether treatment reduces their pain, for example,or helps them live more independentlyPer100 000population00Cure and survival give only a partial picture of healthsystem performance. It is when we measure outcomesreported by patients themselves that importantdifferences in the outcomes of care emerge.Trends in knee replacement surgery, 2000-1420The success of health systems is typically measuredby survival rates, or rates of cure, after treatment.Often, though, differences in clinical outcomesbetween the best- and worst-performing providersof care are small.Rates of knee replacement vary hugely across OECDhealth systems. Is this justified? asking the peoplewho have had the operation is the way to find out.Source: OECD Health Statistics 2017. OECD 2017

OECD WORK ONPaRIS will Accelerate and standardise international monitoringin population groups where patient-reported indicatorsare already used. Priority groups are patients who have experiencedstroke, heart attack, cancer, hip and knee surgery,and mental illness. Close collaboration with international partners suchas the Commonwealth Fund and the InternationalConsortium for Health Outcomes Measurementensures state-of-the-art indicators and surveys.Develop new patient-reported indicators in critical areasof health care, where none currently exist. Priority groups are patients with chronic conditionssuch as diabetes, COPD or depression and – inparticular – patients with several conditions.We will survey these patients and carers directly, andpublish new international benchmarks of healthsystem performance.WHO WILL PaRIS HELP? Patients, by having their sayon which treatments work best for them Clinicians, by betterunderstanding how to improve the quality of the care theyprovide . Policy makers, by having better information on whereto focus quality improvement efforts and prioritise spending.The share of patients who feel that doctors involve themin decisions about care and treatment varies two-foldacross health systems Belgium95.1Portugal90.9United Kingdom88.9Australia87.9New .5United States84.6Canada84.3OECD 1583.1Korea81.8Estonia79.5Sweden79.0NorwayKey statistics.pdf OECD sex standardised rates per 100 patientsSource: Commonwealth Fund International Health Policy Survey 2016; national sources.9

10Quality of careEnsuring effective health careWe continue to refine and develop measures of effectivehealth care. Moving beyond our existing nationalcomparisons, new insights are being generated from thedevelopment of new measures of the variation in outcomesof care within countries at the hospital level.Providing patients with care that is safe, effectiveand responsive to patient needs is now recognisedas the foremost objective of health systems in allOECD countries. We measure quality of care and helpgovernments identify the drivers of high-quality careas the cornerstone of quality improvement.Work on extending patient-reported measures of careexperiences is also building our capacity to monitor systemresponsiveness to patient needs and people-centred care.Improving patient enlanFinedomelIsraSwevents is equivalent to that of 3 500 hospital nurses. Preventingadverse events in US Medicare hospitals saved USD 28 billionin just five years.KinDID YOU KNOW . In some health systems, the cost of adverse35302520151050dIn addition to hospital care, we are now focusingattention on ways to measure and report patient safetyin primary and long-term care.Dispersion of hospital acute myocardial infarction death ratesDeath rateUniteSafety remains a policy priority for all OECD countries.Efforts to measure and monitor preventable patientharm are central to strategies to improve patientsafety, including people-centred measures based onself reporting of patient experiences of unsafe events.gdMeasuring quality to improve standards of careNote: Diagram shows range and frequency of death rates, with each dot representing a hospital.Source: OECD Hospital Performance Data Collection 2017. OECD 2017

HealthOECD WORK ONUnderstanding differences in quality where care is providedWhile progress has been made in collecting indicatorsof health care quality, too little is known aboutthe reasons behind differences in performance acrossand within countries.Our work focuses on analyses and country reviews toadvise policy makers on what policies and approacheswork best in improving quality of edenCanadaGermanyNorwayalanZewFrance0Ne How to reconcile the need for individual data privacy withsocially valuable uses, such as health care research.Source: OECD Health Statistics 2017.” OECD Health Care Quality Indicators indicators.htm43% OECD 2017 How to design and use personal Electronic Health Records;Key links and publications%5010 How to make better use of individuals’ data that existacross several databases;Patient medical records are all too often not shared between doctors, jeopardising the quality of carePercentage of patients where the specialist lackeda medical history or the regular doctor was not informedabout specialist care20We also help countries strengthen the informationinfrastructure to better track quality of care: The Economics of Patient Safety s-of-patient-safetyMarch-2017.pdf OECD Reviews of Health Care iews.htm Cardiovascular Disease and Diabetes: Policies for Better Health andQuality of Care ase-and-diabetes.htm Health Data Governance: Privacy, Monitoring and Research 789264244566-en.htm11

12OECD Health Statistics and Health at a GlanceComparative measurement of health and healthsystem performanceOECD Health Statistics and Health at a Glance are,respectively, the leading statistical database andpublication for international comparisons of health andhealth systems. They help policy makers, researchers,journalists and citizens compare the performance ofhealth systems across OECD and partner countries.We produce standardised and comparable healthstatistics and indicators on health status, healthrisk factors, physical and human resources of healthsystems, health service utilisation, quality of care,pharmaceutical markets, long-term care, and healthexpenditure and financing.We fill important data gaps and respond to emergingissues in health systems by disseminating key datafor all OECD countries and partner countries in ourflagship publication Health at a Glance. Its regionaleditions Health at a Glance: Europe is produced incollaboration with the European Commission(now part of the State of Health in the EU cycle).Health at a Glance: Asia/Pacific is prepared incollaboration with the two WHO regional officesin that region.Improving how we measure health systemsPopulation health has improved greatly over the pastdecades, with women and men living longer than everbefore, although the pace of growth in life expectancyhas varied across OECD countries and there continueto be large inequalities by socioeconomic status withincountries. Population ageing and changing risk factorsto health are leading to a growing number of peopleliving with chronic conditions, and this is particularlythe case among disadvantaged groups. We providestatistics to monitor the evolution of health and healthsystems over time.We are developing better measures of patientexperience and outcomes, hospital-level performance,disparities in health and access to health care, andefficiency in health service delivery to allow for morecomplete assessments of health system performance. OECD 2017

OECD WORK ONLife expectancy has been rising in OECD countriesby about 3 months each year, but gains have been slowerin some countriesYears86JapanKoreaFranceHealthKey links and publications OECD Health Statistics (annual database), available on OECD.Stator throughwww.oecd.org/health/healthdataUnited States Health at a Glance: OECD Indicators, 2015 and 2017 editionswww.oecd.org/health/healthataglance84 Health at a Glance: Europe, 2018 and 2020 editions (in collaborationwith the European europe-23056088.htm8280OECD average7876747270199019952000200520102015Source: OECD Health Statistics 2017.DID YOU KNOW that mortality rates from heart attack,stroke and other diseases of the circulatory system have beenreduced by over 50% on average across OECD countries since1990, thanks to reductions in risk factors (notably smoking)and improvements in medical treatments, but the growingprevalence of obesity threatens these earlier gains. OECD 2017 Health at a Glance: Asia/Pacific, 2018 and 2020 editions(in collaboration with the OECD Korea Policy Centre and WHORegional Offices for the Western Pacific and South-East acific-23054964.htm13

14Health spendingHealth spending growth has slowed downIn 2015, OECD countries saw health spending growthincrease slowly, albeit still below the growth ratesseen in the years before the economic crisis. Healthspending growth has more closely followed economicgrowth since 2013. The latest rise is driven by renewedgrowth in government and compulsory insurancespending. Moreover, growth of pharmaceuticalspending increased again for many countries in 2014.We provide accurate, reliable and timely data onhealth spending that are comparable across OECD andpartner countries and over time, and we analyse thefactors behind the trends. Since 2005, OECD, Eurostatand WHO have been jointly collecting expenditure andfinancing information from OECD and EU countries.A global standard in health accountingWe work with international partners (Eurostatand WHO) to define and extend standards forinternationally consistent and comparable reporting ofhealth financing and expenditure data. The frameworkoffered by A System of Health Accounts 2011 meets theneeds of public and private sector health analysts.Prices and volumes of careOur wor

Health spending accounts for almost 10% of GDP on average in the OECD area and health systems are struggling to demonstrate value for money and to deliver good care aligned to the needs of ageing populations. New treatments and improved public health mean that people are living longer than ever, although not necessarily healthily for longer.

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