Monday, April 6, 2009

[EQ] The Finnish Health Care System: A Value-Based Perspective

The Finnish Health Care System: A Value-Based Perspective

 

 

Michael E. Porter, Bishop William Lawrence University Professor, Harvard Business School

Juha Teperi, Medical doctor and health services researcher at the University of Helsinki

Lauri Vuorenkoski, senior researcher at Finland  National Institute for Health and Welfare (THL)

Jennifer F. Baron, Senior Researcher, Institute for Strategy and Competitiveness, Harvard Business School

The Sitra Reports - Helsinki 2009

 

Available online as PDF file [117p.] at:

http://www.isc.hbs.edu/pdf/Finnish_Health_Care_System_SITRA2009.pdf

 

“….This report applies a value-based framework of health care delivery in order to provide a holistic view of the current state of Finnish health care. This report consists of three parts. Section 2 presents a brief overview of the general principles of value-based care delivery. Sections 3 to 7 then utilize these principles to analyze the Finnish health care system as it looks today. While the text aims to cover the essential features of the Finnish system, special attention is paid to aspects that are crucial from a value-based perspective. Finally, Section 8 proposes a set of general conclusions and recommendations for Finland….”

 

 

“……..In only a few decades, Finnish health care has developed from a somewhat rudimentary health care system into one that is internationally acclaimed. Every permanent resident in the sparsely populated country has access to an extensive set of services, yet total per capita health care costs remain lower than in most comparable countries. Despite recent concerns about equity issues, Finns are generally very satisfied with their health care services.

 

However, as in any country, Finland cannot rest on its laurels. Advancing medical science raises a new bar for quality in terms of the outcomes achieved in the treatment of illness. An aging population and rising public expectations threaten to increase costs and impede timely access to care, thus jeopardizing sustainability.

 

One challenge in particular, the aging Finnish workforce, affects not only patient demographics but also the availability of clinicians. The upcoming wave of retiring health care professionals will occur at just the time when Finland will need more of them. To overcome these challenges, every health care system will have to use its resources more effectively; the achievements of past decades are to be maintained and built upon. Access and equity will remain necessary characteristics

of optimal health care systems, but they are insufficient goals in terms of improving quality and achieving financial sustainability.

 

Instead, the value created by the system as a whole must be continuously improved; for each euro spent, more health needs to be achieved. The large variations in health care quality and costs have been described and documented in many advanced economies, signaling a lack of consensus concerning best practices, not only in individual care processes but also in the organization of care delivery itself. Finnish researchers, for example, have shown that outcomes like disease-specific mortality rates vary across and even within providers in a way that cannot be explained by the severity of the condition or other initial patient conditions…..”

 

Content:

 

I Introduction


II Principles of value-based delivery

The fundamental goal is value for patients

The only way to truly contain cost and increase value is to improve health outcomes

Care should be organized around medical conditions over the full cycle of care

Value is increased by provider experience, scale, and learning at the medical condition level

Value must be universally measured and reported 3

Reimbursement should be aligned with value and reward innovation

Competition should occur for patients based on value, while encouraging the restructuring of care

Electronic medical records must enable the restructuring of care delivery, support integrated care and produce outcome measures

Health plans or funding agencies should contribute to value, rather than act as passive payers


III Overview of the Finnish health care system


IV Access and standards for coverage

Municipal health care system

National health insurance system

Private insurance

Occupational health care system

Assessment


V Structure of health care delivery

Providers

Employers

Patients

Suppliers

Clinical guidelines


VI Health information technology

Assessment


VII Results measurement

Use of measurement data in health care management Assessment


VIII Overall assessment and recommendations

Intensify outcome measurement and link it to incentives and management

Create integrated practice units

Strengthen primary health care

Create true health plans

Reimburse full cycles of care

Increase value by service consolidation combined with competition

Encourage innovation in care delivery and its structures

Invest in health information technology

Increase the role of patients in health care

Moving to action


References

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] A Human Rights Approach to Neglected Tropical Diseases

A Human Rights Approach to Neglected Tropical Diseases

 

World Health Organization - Health & Human Rights team

Department of Ethics, Equity, Trade and Human Rights - 2009

 

Available online at: http://www.who.int/hhr/activities/factsheets/en/index.html

 

Neglected tropical diseases (NTDs) affect one billion people in the world, often the most vulnerable  populations living in poor rural areas in low-income countries. NTDs  can result in lifelong disabilities and even death. They constitute a  source of social stigma, discrimination and poverty. Affected  populations often do not have access to treatment and preventive measures, and research and development has been insufficient.

 

In  recent years, there is growing attention to NTDs as both a public health, and human rights issue. This WHO Information sheet, available in English, French and Spanish) on a human rights-based approach to neglected tropical diseases, aims to raise understanding and knowledge  among health planners, human rights groups, development partners and civil society organisations.

 

English : http://www.who.int/hhr/activities/NTD%20information%20sheet%20-%20English.pdf

 

French: http://www.who.int/hhr/activities/NTD%20information%20sheet%20-%20French.pdf

 

Spanish: http://www.who.int/hhr/activities/NTD%20information%20sheet%20-%20Spanish.pdf

 

 

 

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.  

[EQ] Coordination and management of chronic conditions in Europe: the role of primary care

Co-ordination and management of chronic conditions in Europe: the role of primary care
- position paper of the European Forum for Primary Care

 Greß, Stefan1; Baan, Caroline A.2; Calnan, Michael3; Dedeu, Toni4; Groenewegen, Peter5; Howson, Helen6; Maroy, Luc7; Nolte, Ellen8; Redaèlli, Marcus9; Saarelma, Osmo10; Schmacke, Norbert11; Schumacher, Klaus12; van Lente, Evert Jan13; Vrijhoef, Bert14

Quality in Primary Care, Volume 17, Number 1, February 2009 , pp. 75-86(12)

Abstract website at: http://www.ingentaconnect.com/content/rmp/qpc/2009/00000017/00000001/art00011

“……Healthcare systems in Europe struggle with inadequate co-ordination of care for people with chronic conditions. Moreover, there is a considerable evidence gap in the treatment of chronic conditions, lack of self-management, variation in quality of care, lack of preventive care, increasing costs for chronic care, and inefficient use of resources. In order to overcome these problems, several approaches to improve the management and co-ordination of chronic conditions have been developed in European healthcare systems.

These approaches endeavour to improve self-management support for patients, develop clinical information systems and change the organisation of health care. Changes in the delivery system design and the development of decision support systems are less common. Almost as a rule, the link between healthcare services and community resources and policies is missing. Most importantly, the integration between the six components of the chronic care model remains an important challenge for the future.

We find that the position of primary care in healthcare systems is an important factor for the development and implementation of new approaches to manage and coordinate chronic conditions. Our analysis supports the notion that countries with a strong primary care system tend to develop more comprehensive models to manage and co-ordinate chronic conditions. …..”

 

Diederik Aarendonk, Forum Coördinator, European Forum for Primary Care
Visiting address: Otterstraat 118 – 124, 3513 CR Utrecht
Postal address: PO Box 1568, 3500 BN Utrecht, The Netherlands
e-mail: d.aarendonk@euprimarycare.org Web-site: http://www.euprimarycare.org/

 

                                                                                                                                                                                    

 EFPC conference in Cyprus on the 7th & 8th of May 2009 - Nicosia Cyprus

In close collaboration with the University of Nicosia and the Cyprus Ministry of Health

The URL for the conference is: http://www.nivel.nl/oc2/page.asp?PageID=12258

 

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.