JANUARY

Recommendations

Info

ENGLAND How are costs contained? Rather than using patient cost-sharing or imposing direct constraints on supply, costs in the NHS are constrained by a global budget that cannot be exceeded. NHS budgets are set at the national level, usually on a three-year cycle. CCGs are allocated funds by NHS England, which closely monitors their financial performance to prevent overspending. They are expected to achieve a balanced budget each year. The current economic situation has resulted in a largely flat NHS budget against a backdrop of rising demand. Between March 2010 and March 2015, the NHS budget rose by between 0.6 percent and 0.9 percent (in real terms), versus the 5.6 percent growth between 1996–97 and 2009–10 (King’s Fund, 2015b). NHS England (2014a) estimated that the gap between rising demand and a continuation of this minimal increase in funding would be equivalent to GBP30 billion (USD42.4 billion) per year by 2020–21, assuming no additional efficiencies, but also that efficiencies equivalent to 2 percent to 3 percent of the annual budget are possible, versus a historic rate of 0.8 percent. Although some of the savings targets have been met in the past five years, the financial pressure on the NHS is being associated with some deterioration in quality of care—notably waiting time targets (Nuffield Trust and Health Foundation, 2015). Cost-containment strategies to date include freezing staff pay increases, supporting increased use of generic drugs, reducing DRG payments for hospital activity, managing demand, and reducing administration costs (King’s Fund, 2015a). There are a number of tools for local purchasers to maximize value by addressing unwarranted variations in utilization and clinical practice, provided by the government-funded “Rightcare” program. Local purchasers can also run competitive tenders for certain services. What major innovations and reforms have been introduced? In October 2014, NHS bodies, led by NHS England, published the Five Year Forward View, which sets out the challenges facing the NHS and a series of strategies to address them (NHS England, 2014a). These included setting up a number of pilot programs across England to test new models of care known as “vanguards.” To date there are 37 vanguard sites, which focus on scaled-up primary care, enhanced health care in long-term care homes, vertically integrated hospital and community care, and networks to improve emergency care. NHS England hopes that, among other benefits, evaluations of the program will lead to better tools for identifying those at risk of becoming high-need, high-cost patients, and to the development of capitated contracts to incentivize providers to collaborate in the care of complex patients. The Five Year Forward View also sets out strategies to improve health and well-being, including a diabetes prevention initiative (NHS England, 2015a). The primary challenge facing the NHS is finding a way to redesign services and invest in prevention while at the same time generating efficiencies without compromising service quality or access. In November 2014, the National Audit Office reviewed the financial health of hospital providers in the NHS and warned that the trend of increasing financial distress was unsustainable (National Audit Office, 2014). The new Conservative government elected in May 2015 endorsed the Five Year Forward View and committed an additional GBP8 billion (USD11 billion) per year. But measured against the GBP30 billion (USD42 billion) gap identified by NHS England, this additional funding equates to an annual savings target of GBP22 billion (USD31 billion). Moreover, this funding will need to cover the implementation of new pledges, made in the election manifesto, to implement full seven-day working weeks in hospitals and general practice by 2020. The authors would like to acknowledge Anthony Harrison, the author of earlier versions of this profile. 56 The Commonwealth Fund
References ENGLAND Centre for Economic Performance and London School of Economics (2012). How Mental Health Loses Out in the NHS: A Report by the Centre of Economic Performance’s Mental Health Policy Group. Competition and Markets Authority (2014). “Private Healthcare Market Investigation.” Department of Health (2013a). Guidance on Implementing the Overseas Visitors Hospital Charging Regulations. Department of Health (2013b). The NHS Constitution for England. Department of Health (2013c). A Simple Guide to Payment by Results. Department of Health (2014a). Hard Truths—The Journey to Putting Patients First: Volume One of the Government Response to the Mid Staffordshire NHS Foundation Trust Public Inquiry. Department of Health (2014c). Personalised Health and Care 2020—Using Data and Technology to Transform Outcomes for Patients and Citizens: A Framework for Action. Nov. 2014. https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/384650/NIB_Report.pdf. GHK Consulting Ltd and Office of Fair Trading (2011). Programme of Research Exploring Issues of Private Healthcare Among General Practitioners and Medical Consultants: Population Overview Report for the Office of Fair Trading. Health and Social Care Information Centre, (2015a). “General and Personal Medical Services, England: 2004–2014.’ Health and Social Care Information Centre, (2015b). “NHS Hospital & Community Health Service and General Practice Workforce.” Heath and Social Care Information Centre (2015c). “GP Earnings and Expenses.” Health and Social Care Information Centre (2015d). “Investment in General Practice, 2010/11 to 2014/15, England, Wales, Northern Ireland and Scotland.” http://www.hscic.gov.uk/catalogue/PUB18469. Health and Social Care Information Centre (2014a). “Prescriptions Dispensed in the Community, Statistics for England, 2003–13.” The King’s Fund (2015a). The NHS Under the Coalition Government. Part Two: NHS Performance. March 2015. http://www. kingsfund.org.uk/publications/nhs-performance-under-coalition-government. The King’s Fund (2015b). How Is the NHS Performing? July 2015: Quarterly Monitoring Report. http://www.kingsfund.org.uk/ publications/articles/how-nhs-performing-july-2015. The King’s Fund (2014). The UK Private Healthcare Market. Appendix to the Commission on the Future of Health and Social Care in England: Final Report. The King’s Fund and Nuffield Trust (2013). Securing the Future of General Practice: New Models of Primary Care. http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130718_securing_the_future_summary_0.pdf. Laing and Buisson (2013). “Laing’s Healthcare Market Review.” Local Government Association (2013). “Better Care Fund: Support and Resources Pack for Integrated Care.” NHS Choices (2013). Annual Report 2012/13. National Audit Office (2014). The Financial Sustainability of NHS Bodies. Nov. 2014. https://www.nao.org.uk/report/ financial-sustainability-nhs-bodies-2/. NHS England (2015a). Five Year Forward View. Time to Deliver. June 2015. https://www.england.nhs.uk/2015/06/04/ time-to-deliver/. NHS England (2015b). NHS England Annual Report. July 2015. NHS England (2014a). Five Year Forward View. Oct. 2014. https://www.england.nhs.uk/ourwork/futurenhs/. NHS England (2014b). “The care.data Programme—Collecting Information for the Health of the Nation.” http://www. england.nhs.uk/ourwork/tsd/care-data/. Nuffield Trust (2011). Setting Priorities in Health: A Study of English Primary Care Trusts. http://www.nuffieldtrust.org.uk/ sites/files/nuffield/setting-priorities-in-health-research-report-sep11.pdf. Nuffield Trust (2013). Public Payment and Private Provision: The Changing Landscape of Health Care in the 2000s. Nuffield Trust (2014a). Into the Red? The State of the NHS’ Finances. Nuffield Trust (2014b). Focus On: Social Care for Older People. http://www.nuffieldtrust.org.uk/publications/ focus-social-care-older-people. Nuffield Trust and Health Foundation (2015). “Closer to Critical? QualityWatch Annual Statement 2015.” http://www. qualitywatch.org.uk/annual-statement/2015-closer-critical. International Profiles of Health Care Systems, 2015 57
Page 1 and 2:
JANUARY 2016 2015 International Pro
Page 3:
2015 International Profiles of Heal
Page 6 and 7: Table 1. Health Care System Financi
Page 8 and 9: Table 3. Selected Health System Per
Page 11 and 12: The Australian Health Care System,
Page 13 and 14: AUSTRALIA low-income adults, childr
Page 15 and 16: AUSTRALIA In 2013, the federal gove
Page 17 and 18: What is being done to reduce dispar
Page 19: References AUSTRALIA Australian Bur
Page 22 and 23: CANADA What is covered? Services: T
Page 24 and 25: CANADA funding to 145 not-for-profi
Page 26 and 27: CANADA Organization of the Health S
Page 28 and 29: CANADA provides recommendations to
Page 30 and 31: CANADA Health Council of Canada (20
Page 32 and 33: CHINA Private health insurance: Com
Page 34 and 35: CHINA is not substantially more exp
Page 36 and 37: CHINA Organization of the Health Sy
Page 38 and 39: CHINA References Chen, X. (2014).
Page 40 and 41: DENMARK In addition, nearly 1.5 mil
Page 42 and 43: DENMARK Social psychiatry and care
Page 44 and 45: DENMARK Quality data for a number o
Page 46 and 47: DENMARK portion is small, it makes
Page 48 and 49: 48
Page 50 and 51: ENGLAND immunization, and vaccinati
Page 52 and 53: ENGLAND Hospitals: Publicly owned h
Page 54 and 55: ENGLAND Organization of the Health
Page 58 and 59: ENGLAND Organisation for Economic C
Page 60 and 61: FRANCE VHI finances 13.8 percent of
Page 62 and 63: FRANCE The average income of primar
Page 64 and 65: FRANCE What are the key entities fo
Page 66 and 67: FRANCE inequities in prevention rel
Page 68 and 69: FRANCE Nolte, E., C. Knai, and M. M
Page 70 and 71: GERMANY There were 42 substitutive
Page 72 and 73: GERMANY The 16 state governments de
Page 74 and 75: GERMANY management system, by the s
Page 76 and 77: GERMANY What major innovations and
Page 78 and 79: INDIA Private health insurance: The
Page 80 and 81: INDIA provide after-hour care, reim
Page 82 and 83: INDIA are provided by other ministr
Page 84 and 85: INDIA How are costs contained? Ther
Page 86 and 87: 86
Page 88 and 89: ISRAEL Together, these two types of
Page 90 and 91: ISRAEL Primary care physicians are
Page 92 and 93: ISRAEL Organization of the Health S
Page 94 and 95: ISRAEL • Using electronic health
Page 96 and 97: 96
Page 98 and 99: ITALY during hospitalization (Thoms
Page 100 and 101: ITALY Some regions are promoting ca
Page 102 and 103: ITALY Organization of the Health Sy
Page 104 and 105: ITALY although the degree of evolut
Page 106 and 107:
ITALY The author would like to ackn
Page 108 and 109:
JAPAN What is covered? Services: Al
Page 110 and 111:
JAPAN incentives for providers to c
Page 112 and 113:
JAPAN Organization of the Health Sy
Page 114 and 115:
JAPAN The author would like to ackn
Page 116 and 117:
THE NETHERLANDS receive faster acce
Page 118 and 119:
THE NETHERLANDS Hospital payment ra
Page 120 and 121:
THE NETHERLANDS Organization of the
Page 122 and 123:
THE NETHERLANDS References Organisa
Page 124 and 125:
NEW ZEALAND provided in GP clinics.
Page 126 and 127:
NEW ZEALAND management (e.g., clean
Page 128 and 129:
NEW ZEALAND including such informat
Page 130 and 131:
NEW ZEALAND largely through efficie
Page 132 and 133:
132
Page 134 and 135:
NORWAY Primary, preventive, and nur
Page 136 and 137:
NORWAY Patients are free to choose
Page 138 and 139:
NORWAY What are the major strategie
Page 140 and 141:
NORWAY The National System for the
Page 142 and 143:
142
Page 144 and 145:
SINGAPORE Medifund is the governmen
Page 146 and 147:
SINGAPORE Public hospital funding i
Page 148 and 149:
SINGAPORE Public consultation: The
Page 150 and 151:
SINGAPORE To keep demand for servic
Page 152 and 153:
152
Page 154 and 155:
SWEDEN What is covered? Services: T
Page 156 and 157:
SWEDEN Hospitals: There are seven u
Page 158 and 159:
SWEDEN Care, which promotes use of
Page 160 and 161:
SWEDEN What major innovations and r
Page 162 and 163:
SWITZERLAND Insurers offer premiums
Page 164 and 165:
SWITZERLAND Hospitals: About 70 per
Page 166 and 167:
SWITZERLAND Organization of the Hea
Page 168 and 169:
SWITZERLAND To control pharmaceutic
Page 170 and 171:
170
Page 172 and 173:
UNITED STATES What is covered? Serv
Page 174 and 175:
UNITED STATES Administrative mechan
Page 176 and 177:
UNITED STATES The Institute of Medi
Page 178 and 179:
UNITED STATES adopted at least a ba
Page 180:
The COMMONWEALTH FUND Affordable, q
show all

JANUARY

Create successful ePaper yourself

Delete template?

Save as template?