Professor Peter smith
•Transferir como PPT, PDF•
0 gostou•442 visualizações
Peter Smith, Professor of Health Policy at Imperial College London 'Healthcare in Europe – a macroeconomic viewpoint'
Recomendados
Recomendados
Mais conteúdo relacionado
Destaque
Destaque (20)
Semelhante a Professor Peter smith
Semelhante a Professor Peter smith (20)
Mais de Investnet
Mais de Investnet (20)
Último
Último (20)
Professor Peter smith
- 1. Healthcare in Europe – a macroeconomic viewpoint Peter C. Smith Imperial College Business School and Centre for Health Policy peter.smith@imperial.ac.uk
- 2. Investing in Health Systems A Conceptual Framework Health Systems Societal Well-being Health Wealth Source: McKee, M. and Figueras, J. (2011), Health systems, health, wealth and societal well-being: assessing the case for investing in health systems, Maidenhead: Open University Press.
- 3. How do health systems contribute to wellbeing? • Through their impact on wealth – Health services as a core part of the economy – Helping improve productivity • Through their impact on health – Increasingly recognized as an important determinant of health – Many health technologies are very good value for money • Directly through their impact on social protection
- 4. Health Systems Societal Well-being Health Wealth 1. HEALTH SYSTEMS AND THE ECONOMY
- 5. Total spending on healthcare % of GDP 18 Australia Austria Belgium 16 Canada Chile Czech Republic 14 Denmark Finland France 12 Germany Greece 10 Hungary Iceland Italy 8 Japan Korea Luxembourg 6 Mexico Netherlands New Zealand 4 Norway Poland Portugal 2 Slovak Republic Spain Sweden 0 Switzerland Turkey 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 United Kingdom United States Ireland
- 6. Future healthcare spending • The US Congressional Budget Office (2007) estimates that – with no policy change – total spending on health care will rise from 16 percent of the US economy in 2007 to – 25 percent in 2025 – 37 percent in 2050 – 49 percent in 2082. • Congressional Budget Office. 2007. The Long-Term Outlook for Health Care Spending. Washington DC: Congress of the United States.
- 7. Public spending on healthcare % of total 120 Australia Austria Belgium Canada 100 Chile Czech Republic Denmark Finland France 80 Germany Greece Hungary Iceland 60 Italy Japan Korea Luxembourg Mexico 40 Netherlands New Zealand Norway Poland 20 Portugal Slovak Republic Spain Sweden Switzerland 0 Turkey 0 3 6 9 2 5 8 1 4 7 0 3 6 9 2 5 8 United Kingdom 6 6 6 6 7 7 7 8 8 8 9 9 9 9 0 0 0 United States 9 9 9 9 9 9 9 9 9 9 9 9 9 9 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 Ireland
- 8. RAND projections for US (2005) • Reductions in spending resulting from better health will be outweighed by the costs of new technologies, and by additional health expenditure during the additional years of life that the technologies make possible. • Although highly socially desirable, tackling chronic diseases will not in general save money. • The one exception may be obesity. • RAND Health. 2005. Future Health and Medical Care Spending of the Elderly. Santa Monica: RAND.
- 9. Estimates of NHS expenditure growth drivers, 2002-2022 , optimistic scenario Wanless, D., Appleby, J., Harrison, A., Patel, D. (2007), Our Future Health Secured? A review of NHS funding and performance, London: King’s Fund 250 200 n150 o i l l i b £100 50 0
- 10. Health Systems Societal Well-being Health Wealth 2. HEALTH SYSTEMS AND HEALTH
- 11. Life expectancy at birth 90 Australia Austria 85 Belgium Canada Chile 80 Czech Republic Denmark Finland 75 France Germany Greece 70 Hungary Iceland 65 Italy Japan Korea 60 Luxembourg Mexico Netherlands 55 New Zealand Norway 50 Poland Portugal Slovak Republic 45 Spain Sweden Switzerland 40 Turkey 0 3 6 9 2 5 8 1 4 7 0 3 6 9 2 5 8 United Kingdom 6 6 6 6 7 7 7 8 8 8 9 9 9 9 0 0 0 United States 9 9 9 9 9 9 9 9 9 9 9 9 9 9 0 0 0 Ireland 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2
- 12. OECD Rankings • Determinants of life expectancy – Health care spending – Education – GDP – Pollution – Alcohol – Tobacco – Diet • Residual is health system efficiency Joumard, I., C. Andre, C. Nicq and O. Chatal (2008) Health status determinants: lifestyle, environment, health care resources and efficiency. Economics Department Working Paper 627. Paris: OECD.
- 13. Joumard et al (2008): Country-specific effects (life years) relative to OECD average Iceland Australia New Zealand Korea Greece Canada Finland Poland Sweden France Belgium Ireland United Kingdom Czech Republic Netherlands Switzerland Austria Germany Turkey Denmark Norway Hungary United States -5 -4 -3 -2 -1 0 1 2 3
- 14. Programme budgeting expenditure England 2010/11 £per capita http://www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/Programmebudgeting/index.htm
- 15. Estimates of marginal costs of saving a life year, by disease programme, England 2005/6 • Cancer £13,900 • Circulatory disease £12,600 • Respiratory problems £7,400 • Gastro-intestinal £19,000 • Diabetes £26,500 Martin, S., Rice, N. and Smith, P. (2012), “Comparing costs and outcomes across programmes of health care”, Health Economics, 21(3), 316-337.
- 16. The Effects of Health Coverage on Population Outcomes: A Country-Level Panel Data Analysis by Rodrigo Moreno-Serra and Peter C. Smith (2011) • Examines the link between health spending and health outcomes in 153 countries over a 14 year period • Results strongly indicate that higher government health spending per capita reduces both child and adult mortality rates. • The estimated gains are larger for low and middle income countries than in the full sample. • The implied marginal cost of saving a year of life is around US$1,000 in the full sample of countries. • Public spending seems more effective in reducing mortality than prepaid private insurance • Investing in broader health coverage can generate significant gains in terms of population health. http://resultsfordevelopment.org/projects/transitions-health-financing
- 17. Health Systems Societal Well-being Health Wealth 3. HEALTH SYSTEMS AND SOCIAL PROTECTION
- 18. 5 July 1948 th • “...there are no charges, except for a few special items. There are no insurance qualifications. But it is not a ‘charity’. You are all paying for [the NHS], mainly as taxpayers, and it will relieve your money worries in times of illness.”
- 19. Out-of-pocket spending on healthcare: % of total 80 Australia Austria Belgium 70 Canada Chile Czech Republic 60 Denmark Finland France Germany 50 Greece Hungary Iceland 40 Italy Japan Korea Luxembourg 30 Mexico Netherlands New Zealand 20 Norway Poland Portugal 10 Slovak Republic Spain Sweden Switzerland 0 Turkey 0 3 6 9 2 5 8 1 4 7 0 3 6 9 2 5 8 United Kingdom 6 6 6 6 7 7 7 8 8 8 9 9 9 9 0 0 0 United States 9 9 9 9 9 9 9 9 9 9 9 9 9 9 0 0 0 Ireland 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2
- 20. 20 Cost-Related Access Problems in the Past Year Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Did not fill prescription or 12 10 7 6 3 7 6 7 4 2 21 skipped doses Had a medical problem but did not visit 13 4 6 16 2 9 6 5 6 2 22 doctor Skipped test, treatment, or 14 5 6 10 3 8 5 4 4 3 22 follow-up Yes to at least one of the 22 15 13 25 6 14 11 10 10 5 33 above THE COMMONWEALTH FUND 20 Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
- 21. 21 Overall Views of Health Care System, 2010 Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Only minor changes 24 38 42 38 51 37 40 44 46 62 29 needed Fundamental changes 55 51 47 48 41 51 46 45 44 34 41 needed Rebuild completely 20 10 11 14 7 11 12 8 8 3 27 THE COMMONWEALTH FUND Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
- 22. Very strong link between % reporting cost problems and opinions of health system UK NLSWIZ FR SWE NOR NZ CAN GER USA AUS Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
- 23. Health Systems Societal Well-being Health Wealth
- 24. Concluding comments • Growth of publicly funded health services one of the major social policy successes on twentieth century • Expenditure on health services yields many gains in social welfare in terms of health, wealth and social protection • Many reasons for seeking to protect publicly funded health services as a priority
- 25. ... but if expenditure control becomes an imperative: • Supply side – Little evidence globally that there is scope for step changes in productivity – But potential for gains from (eg) better information, carefully regulated competition etc – Care with incentive effects of provider payment mechanisms • Demand side – Ageing population not intrinsically problematic, but it is if citizens live longer sicker lives – Some scope for public health interventions, especially on obesity, but lack of evidence on effectiveness • Limiting the scope of the publicly funded ‘health basket’ – Careful exclusion of treatments with low cost-effectiveness – More targeted patient charges for treatments of intermediate value
- 26. Further reading • McKee, M. and Figueras, J. (2011), Health systems, health, wealth and societal well-being: assessing the case for investing in health systems, Maidenhead: Open University Press.
Notas do Editor
- This conceptual framework provides the conceptual backbone for this presentation. The case for health systems investment rests on the understanding that health systems are intricately linked to health, wealth and well being , with the causal, direct and indirect relationships between the key elements captured by the ‘conceptual triangle’ . Importantly, it positions health system investment in a direct relationship with the ultimate goal of all social systems: societal well-being. Health systems contribute to societal well-being in three main ways : First, and above all health systems produce health which is both a major and inherent component of well-being and through its impact on wealth creation, and indirect (yet key) contributor to well-being. Second, although to a much lesser extent, health systems have a direct impact on wealth as they are a significant component of the economy which again impacts on societal well-being. Third, health systems contribute directly to societal well-being because societies draw satisfaction from the existence of health services and the ability of people to access them. Note that there is much debate about the boundaries of the health system with Member States taking different definitional approaches. This presentation takes a pragmatic approach and adopts the definition of health systems as all the activities whose primary purpose is to promote, restore or maintain health including i) the delivery of (personal and population based) health services; ii) those activities (within the functions of finance, stewardship and resource generation) to enable the delivery of services and iii) stewardship activities aimed at influencing the health impact of activities in other sectors such as education or environment. Therefore, the presentation takes a broad approach including all public health interventions those provided by the health services (secondary and tertiary prevention) as well as those aimed at addressing health determinants outside the health sector i.e. Health in All Policies. Ultimately, the aim is not to assess investment on health service interventions in isolation but to set them against interventions in other sectors and compare them in light of their health and cost effectiveness impact.
- Gives public spending by ICD chapter per capita. Excludes ‘other’, mainly GP services, £495.50 per capita. Total spending is £2,043.23 pc
- Calculated using econometric analysis of link between disease programme spending and mortality data in 152 English primary care trusts