Health reform, a lost chance (once again)

30 MESURES PER ENFORTIR EL SISTEMA DE SALUT

In the midst of covid crisis, our government created a Comitè d’Experts per a la Transformació del Sistema Públic de Salut. It gave them 2 months to solve such a complex issue, and this is the result. The message is clear, the implementation fuzzy. My impression is that if the Parliament asked for a reform and we delivered a report 6 years ago and nothing happened, now that the government is leaving it is not the best moment to think about it. Nevertheless, health reform, public and private, is as relevant as it was 6 years ago, but unfortunately nobody is taking charge.

PS. Someday I'll explain what really happened, the enablers and the blockers, and why all this has still impact in the current situation.

Integrated care as organizational innovation

Innovative Integrated Health And Social Care Programs In Eleven High-Income Countries 

High-income countries face the challenge of providing effective and efficient care to the relatively small proportion of their populations with high health and social care needs. Recent reports suggest that integrated health and social care programs target specific high-needs population segments, coordinate health and social care services to meet their clients’ needs, and engage clients and their caregivers. We identified thirty health and social care programs in eleven high-income countries that delivered care in new ways. We used a structured survey to characterize the strategies and activities used by these programs to identify and recruit clients, coordinate care, and engage clients and caregivers. We found that there were some common features in the implementation of these innovations across the eleven countries and some variation related to local context or the clients served by these programs.

Needs segmentation, Patient coordination and Engagement are the crucial topics. More details inside the article.

 

Specialty pharmaceuticals regulation

SPENDING REVIEW FASE II. ESTUDIO GASTO HOSPITALARIO EN EL SISTEMA NACIONAL DE SALUD 

Airef has release a report on specialty pharmaceuticals in the National health service. This is a crucial issue to understand health expenditure, and the report helps a lot.

The ppt, here.

Private health insurance landscape

 Private health insurance: history, politics and performance

This is  a collection of comparative case studies analysing the history, politics and performance of private health insurance globally and its implications for universal health coverage. An essential reading.

And these are the contents:

1 Why private health insurance?

2 Private finance publicly subsidized: the case of Australian health insurance

3 Private health insurance in Brazil, Egypt and India

4 Private health insurance in Canada

5 Regulating private health insurance: France’s attempt at getting it all

6 Statutory and private health insurance in Germany and Chile: two stories of coexistence and conflict

7 Uncovering the complex role of private health insurance in Ireland

8 Integrating public and private insurance in the Israeli health system: an attempt to reconcile conflicting values

9 Private health insurance in Japan, Republic of Korea and Taiwan, China

10 The role of private health insurance in financing health care in Kenya

11 Private health insurance in the Netherlands

12 The challenges of pursuing private health insurance in low- and middle-income countries: lessons from South Africa

13 Undermining risk pooling by individualizing benefits: the use of medical savings accounts in South Africa

14 Consumer-driven health insurance in Switzerland, where politics is governed by federalism and direct democracy

15 Regression to the increasingly mean? Private health insurance in the United States of America

16 Health savings accounts in the United States of America

Patients are not consumers

 Patient-Centered Care, Yes; Patients As Consumers, No

There are numerous calls for building health care delivery systems that are more patient centered. The focus on patient-centered care has increasingly begun to rely upon, and even merge with, the concept of patients as consumers. Early references to patients as consumers were made by patient advocates who were attempting to challenge professional and corporate dominance in health care. Today, “consumer-driven” health care has become associated with neoliberal efforts to emphasize market factors in health reform and deemphasize government regulation and financing. In our view, a narrow focus on consumerism is conceptually confused and potentially harmful. The consumer metaphor wrongly assumes that health care is a market in the usual understanding of that term, that the high cost of US health care is a function of excessive consumer demand, and that price transparency and competition can deliver on the promise of reducing costs or ensuring quality. Furthermore, a consumer metaphor places disproportionate burdens on patients to reduce health care costs, and it could erode professional obligations to provide appropriate and effective care.

So, all said.

Episode based payment systems (2)

The Impact Of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review

THE CURRENT STATE OF EVIDENCE ON BUNDLED PAYMENTS

The topic has already been explained in this blog. Now you may find a systematic review of what is going on in US:

We performed a systematic review of the impact of three CMS bundled payment programs on spending, utilization, and quality outcomes. The three programs were the Acute Care Episode Demonstration, the voluntary Bundled Payments for Care Improvement initiative, and the mandatory Comprehensive Care for Joint Replacement model. Twenty studies that we identified through search and screening processes showed that bundled payment maintains or improves quality while lowering costs for lower extremity joint replacement, but not for other conditions or procedures.

 While bundled payment programs maintain or improve quality while lowering costs for Lower extremity joint replacement, our systematic review suggests that the effects of the payment model on health care spending and utilization varied considerably—particularly by clinical episode type.

So what?. The drivers for success still have to be found. But there is one that is mandatory: payment systems need to be holistic, any partial design will fail. 

Social distance

When voting is useless in our country

 Inside the Mind of a Voter

A great book for a democracy, a useless book for our dictatorship. What's next?