Satisfaction guaranteed (at a high price)

Euro Health Consumer Index 2016

The survey has a clear message: the more you have choice on healthcare, the more you are satisfied (in general). The Netherlands leads the ranking every year in the last decade. The european countries that spend most on health per capita are Luxembourg (6.023€), Germany (4.003€) and Netherlands (3.983€). Luxembourg lies behind in satisfaction, while Switzerland (choice) is in the second position and the third is for Norway (not so strong in choice).
Choice may provide satisfaction, but you have to agree on a model that supports it, and be able to pay the bill. Personally, I'm not so sure about choice as a general construct to support decision making and satisfaction, a former post explains my doubts.
Long time ago the European Union made surveys on satisfaction, and decided to stop, because it was an easy policy tool for the opponents. Right now we do have only the Euro Health Consumer Index 2016. Unfortunately you'll not find data on Catalonia, it will appear in a next edition.

Superbe!
Andrea Motis and her new album

A prescription for “high-need, high-cost” patients

David Blumenthal presented at the recent  OECD health conference the Commonwealth Fund report: Designing a High-Performing Health Care System for Patients with Complex Needs: Ten Recommendations for Policymakers
These are the recommendations:

1. Make care coordination a high priority for patients with complex needs
2. Identify patients at greatest need of proactive, coordinated care
3. Train more primary care physicians and geriatricians
4. Improve communication between providers, e.g. integrated clinical records
5. Engage patients in decisions about their care
6. Provide better support for carers
7. Redesign funding mechanisms for patients with complex needs
8. Integrate health and social care, and physical and mental healthcare
9. Engage clinicians in change, train and support clinical leaders
10.Learn from experience; scale up successful projects

Once again, the issue is not about what, but about how, according to the specific setting. This is the reason why change implies modify incentives and coordination mechanisms. This is the hardest part, with cost and benefits uneven distributed over time and people. And this is the reason why recommendations fail so often in its implementation.

At Tate Britain, righ now, David Hockney

Common challenges and responses to improve healthcare quality

Caring for quality in health: Lessons learnt from 15 reviews of health care quality

Towards actionable international comparisons of health system performance:expert revision of the OECD framework and quality indicators

Key messages from the last OECD report on quality:

Systemic changes on where and how health care is delivered will optimise both quality and efficiency
Lesson 1: High-performing health care systems offer primary care as a specialist service that provides comprehensive care to patients with complex needs
Lesson 2: Patient-centred care requires more effective primary and secondary prevention in primary care.
Lesson 3: High-quality mental health care systems require strong health information systems and mental health training in primary care
Lesson 4: New models of shared care are required to promote co-ordination across health and social care systems

Health care systems need to engage patients as active players in improving health care, while modernising the role of health professionals
Lesson 5: A strong patient voice is a priority to keep health care systems focussed on quality when financial pressures are acute
Lesson 6: Measuring what matters to people delivers the outcomes that patients expect
Lesson 7: Health literacy helps drive high-value care
Lesson 8: Continuous professional development and evolving practice maximise the contribution of health professionals

Health care systems need to better employ transparency and incentives as key quality-improvement tools
Lesson 9: High-performing health care systems have strong information infrastructures that are linked to quality-improvement tools
Lesson 10: Linking patient data is a pre-requisite for improving quality across pathways of care
Lesson 11: External evaluation of health care organisation needs to be fed into continuous quality-improvement cycles
Lesson 12: Improving patient safety requires greater effort to collect, analyse and learn from adverse events

It may sound as a dejà-vu, and the difficult part is how, not what to do to improve quality. However if you want to read an article on health care quality comparisons, check this one. Comparing quality is crucial because we are used to compare expenditure without a detailed knowledge of quality achievement. We'll have to follow next reports on the issue.

The coverage of health risk and the extent of generosity

The Right to Health A Multi-Country Study of Law, Policy and Practice

If we look at European Union, the right to health is heterogeneous. The size of the difference among countries depends on many factors, and path dependence explains mostly such diversity. If you want to check beyond EU, a new book explains how countries define health risck coverage under different arrangements.

Looking at health through a human rights lens tells us something about the nature of illness that epidemiology and biology cannot: it encourages us to consider to what extent illness is unjust. It also frames illness and disease within the political, social, cultural, and economic conditions that surround it; considers the power dynamics that perpetuate illness and disease; and focuses the attention on marginalized and vulnerable groups that may exist outside of medical research priorities or beyond the target demographics of political decisions, at greatest risk of becoming invisible. Worse still, history has shown us that in extreme situations medical professionals can be used as tools of the state to cover up or even inflict abuse. Considering the complex relationship between justice and health, using the international framework for the right to health offers the possibility of mitigating some of the effects of deeply embedded inequalities and discrimination and promoting environments in which anyone can achieve their highest level of health.

There is a major misunderstanding about the frame of the right to health. Somebody should specify that we are talking mostly of right to health care and state at the same time about the individual duties on health. Anyway, let's imagine a country that close to 2% of population are il.legal immigrants that have the right to health care accepted as any citizen, this is my country.  Unfortunately such unique level of generosity and solidarity you'll not find it in this book:

PS. Somebody should ask at the same time if going beyond such level of generosity is financially sustainable. However this is an inconvenient question, a politically incorrect one.

PS. Good post.This Economic Phenomenon Is Making Government Sick and this one

The future of health statistics

RECOMMENDATIONS TO OECD MINISTERS OF HEALTH FROM THE HIGH LEVEL REFLECTION GROUP ON THE FUTURE OF HEALTH STATISTICS

You may find information on quality of healthcare in many websites. Catalonia has developed a broad strategy in this topic. You may check "Central de Resultats", and you'll find details about it. However, what about patients perspectives on quality?.
OECD has started an approach known as Patient Reported indicators survey. We'll have to wait for more details, but this initiative will cover a range of topics that provider led information forgets.
And this approach is only a tool from a wide set of recommendations about the future of health statistics. Sounds good.

Miró- Projecte per Catalunya

 Don't miss the next auction in Sotheby's, it could be yours

The endogenous democide of Spain

From Theorising Democide: Why and How Democracies Fail:

Ko Maeda has made the case that ‘research on the determinants of democratic durability can be advanced by paying closer attention to the manner by which democracies are terminated.’ Specifically for Maeda, we need to pay closer attention to two distinct types of democratic breakdowns: endogenous termination and exogenous termination

Exogenous termination: when democracy and its popularly elected government are overthrown by forces external to the democracy and government. Spain suffered a coup d'état in February 23rd, 1981.

Endogenous termination:‘where democratically elected leaders ended the democratic process themselves’,endogenous terminations occur most frequently as the result of acts ‘suspending the constitution, arresting the opposition politicians, restricting the activities of the mass media, or rigging electoral results’. Against the conventional assumption that democracies do not self-immolate, there has been little or at least a great deal less attention paid to breakdowns of democracies whose source stems from democratic practices and institutions themselves. But as Maeda is quick to identify, this assumption has been problematic given the empirical data, which suggests that some 40 per cent of all democratic breakdowns which occurred between 1950 and 2004 were due to  endogenous factors. Democracies fail, and they do so not because of some extrinsic or exogenous factor. Indeed, almost half of all democracies that have collapsed during the last half century have done so as a result of endogenous causes: that is, democratic  reasons and processes. In other words, there is something intrinsic to democracy that makes it prone to self-destruct.

When incapable of redressing the political crises they have manufactured  themselves,whether because of individual freedoms, bureaucratic morass or the sluggishness of democratic politics, the claim is that democracies can die by their own hand. They have, in Keane’s words, ‘suffered and died under several bad moons’, another of which he claims ‘is now rising over all democracy’ In contrast to its more common meaning – the murder of a person or people by their government – the theory of democide put forward in this book focuses instead on a people who elect, by more or less democratic means, to murder their democracy.

This is precisely what will begin tomorrow. The indictment of our former president and 4 ministers confirms the process of democide of Spain.

SOS Santé

ARTE documentary, in french