67 research outputs found
Disparities in Regular Health Care Utilisation in Europe
Despite common recommendations and quasi universal health care coverage in all European countries, there are large differences in the utilisation patterns of different health services. Little comparative information is available on different types of health service utilisation and variations in utilisation patterns over a longer time span. The objective of this study is to compare and investigate individual and cross-country determinants of health care utilisation habits over the life span across European countries. We found that while there is a general shift toward more regular and preventive care utilisation in all countries; there are still significant social inequalities between countries and cohorts. There is also evidence that once the individual effects have been isolated, cross-cohort and country differences in the prevalence of regular care use are partly associated with differences in welfare states interventions.Healthcare, Social inequalities, Welfare state, Multi-level models, Lifespan analysis, International comparisons.
Impact of health care system on socioeconomic inequalities in doctor use
This study examines the impact of health system characteristics on social inequities in health care use in Europe, using data from national surveys in 13 European countries. Multilevel logistic regression models are estimated to separate the individual level determinants of generalist and specialist use from the health system level and country specific factors. The results suggest that beyond the division between public and private funding and cost-sharing arrangements in health system, the role given to the general practitioners and/or the organization of the primary care might be essential for reducing social inequities in health care utilisation.Equity, Health system, Doctor utilisation, Multilevel, International
Estimation du surcoût des événements indésirables associés aux soins à l'hÎpital en France
Les Ă©vĂ©nements indĂ©sirables associĂ©s aux soins (EIS) reprĂ©sentent non seulement un problĂšme de sĂ©curitĂ© et de qualitĂ© des soins pour les patients, mais Ă©galement un problĂšme Ă©conomique puisque leurs consĂ©quences financiĂšres peuvent ĂȘtre importantes. Cependant, jusquâici en France, il nây avait aucune Ă©tude de coĂ»t Ă lâĂ©chelle nationale regardant lâimpact Ă©conomique des Ă©vĂ©nements indĂ©sirables associĂ©s aux soins. Notre Ă©tude exploite les donnĂ©es hospitaliĂšres collectĂ©es en routine afin dâĂ©tablir lâimportance et les consĂ©quences Ă©conomiques de neuf EIS Ă lâhĂŽpital. Nous avons suivi la mĂ©thodologie dĂ©veloppĂ©e aux Etats-Unis pour construire des indicateurs de sĂ©curitĂ© des patients (PSI) et dĂ©nombrer les EIS Ă lâhĂŽpital. Les surcoĂ»ts et allongements de durĂ©es de sĂ©jour liĂ©s aux EIS sont mesurĂ©s selon deux mĂ©thodes : la mĂ©thode de stratification et lâanalyse de rĂ©gression. Les rĂ©sultats montrent quâenviron 0,5 % des sĂ©jours hospitaliers sont associĂ©s Ă lâun ou lâautre des neuf Ă©vĂ©nements indĂ©sirables Ă©valuĂ©s dans notre Ă©tude. Il existe toutefois de fortes disparitĂ©s de surcoĂ»ts, ceux-ci pouvant varier de prĂšs de 500 ⏠pour les traumatismes obstĂ©tricaux Ă plus de 15 000 ⏠pour les septicĂ©mies. Ces surcoĂ»ts sont Ă©troitement corrĂ©lĂ©s avec la durĂ©e des sĂ©jours et lâintensitĂ© des soins. Quatre Ă©vĂ©nements indĂ©sirables (dĂ©sordres physiologiques et mĂ©taboliques postopĂ©ratoires, septicĂ©mies, escarres et embolies pulmonaires) concentrent 90 % du coĂ»t total de prise en charge des Ă©vĂ©nements indĂ©sirables en 2007. Notre Ă©tude contribue Ă repĂ©rer les domaines oĂč intervenir en prioritĂ© et cibler les ressources visant Ă lâamĂ©lioration de la sĂ©curitĂ© des patients.Ă©vĂ©nements indĂ©sirables, indicateurs de sĂ©curitĂ©, qualitĂ© des soins, coĂ»t, PMSI.
Activity based payment in hospitals: Principles and issues drawn from the economic literature and country experiences
In 2005, France joined the ranks of most other developed countries when it introduced an activity based payment system to finance all acute care hospitals. Despite some basic principles in common, the design of these systems can vary significantly across countries. In order to understand better the issues raised by the new system in France, this paper examines the economic rationale for such a system, the key implementation decisions to be made and the challenges involved. The principle of paying hospitals according to their activity in relation to homogeneous groups of patients has some obvious advantages to improve efficiency and the transparency in health care financing. However, the literature and the experience of the other countries presented in this paper show that this mechanism of payment presents a certain number of risks and requires regular and careful adjustments to obtain the benefits expected of such a system. To ensure both the clinical and economic coherence of the classification used to define hospital activity, and to establish the corresponding level of tariffs, constitute two major challenges. The principle of paying a fixed price which is directly indexed on the average costs observed and which remains common to all types of hospitals has been increasingly subject to criticism. Furthermore, activity based payment, by its nature, can induce some perverse effects which requires complementary regulatory mechanisms to guarantee the quality of the care and equitable access. From the point of view of controlling health expenditure, it is equally important to follow closely the evolution of health care activity in different hospital settings, as well as in ambulatory care, since activity based payment may encourage hospitals to increase their activity by inducing greater demand for profitable services while shifting part of their costs towards medium/long-term care settings or to home-based or informal care.Activity based payment, hospital, regulation, international comparison.
La qualité des soins en France : comment la mesurer pour l'améliorer ?
DĂ©finir et Ă©valuer la qualitĂ© des soins est une dĂ©marche fondamentale si l'on veut amĂ©liorer le systĂšme de santĂ©. MalgrĂ© sa rĂ©putation « de meilleur systĂšme de santĂ© dans le monde », selon lâOMS, la France est en retard sur l'Ă©tude de la qualitĂ© des soins. Il nâexiste pas Ă lâheure actuelle de systĂšme dâinformation permanent sur la qualitĂ© et la sĂ©curitĂ© des soins et les donnĂ©es demeurent partielles, contradictoires et difficilement accessibles. Afin d'obtenir une image globale des problĂšmes de qualitĂ© de soins et dĂ©velopper des stratĂ©gies pour lâamĂ©liorer, il est important de recueillir des donnĂ©es de maniĂšre systĂ©matique et sur une base nationale cohĂ©rente. Cet article fournit une vue d'ensemble des donnĂ©es disponibles sur la qualitĂ© de soins en France en suivant le cadre dâanalyse et les recommandations internationales pour mesurer la qualitĂ©. En comparant la situation de la France Ă celles dâautres pays dĂ©veloppĂ©s, elle vise Ă©galement Ă identifier les lacunes et les points forts du systĂšme actuel pour amĂ©liorer la gestion de la qualitĂ© des soins.QualitĂ©, comparaison internationale, systĂšme, France
Inegalites de recours aux soins en Europe. Quel role attribuable aux systemes de sante ?.
Cette Ă©tude Ă©value lâinfluence des caractĂ©ristiques des systĂšmes de santĂ© sur lâĂ©quitĂ© horizontale du recours aux soins en Europe. Lâutilisation dâun ensemble des donnĂ©es issues dâenquĂȘtes nationales rĂ©centes de treize pays europĂ©ens confirme lâexistence dâinĂ©galitĂ©s sociales de recours aux soins, Ă besoin de soins Ă©gal, dans tous les pays Ă©tudiĂ©s et montre que lâampleur des inĂ©galitĂ©s varie de maniĂšre significative entre les pays. Une analyse multiniveaux permet dâidentifier diffĂ©rentes caractĂ©ristiques des systĂšmes de santĂ© qui semblent contribuer Ă la rĂ©duction ou Ă la formation de ces inĂ©galitĂ©s. Les rĂ©sultats soulignent lâimportance du rĂŽle des mĂ©decins gĂ©nĂ©ralistes et de lâorganisation des soins primaires pour rĂ©duire ces inĂ©galitĂ©s au-delĂ du partage des coĂ»ts entre les sphĂšres publique et privĂ©e.This study examines the impact of health system characteristics on social inequities in health care use in Europe, using data from national surveys in 13 European countries. Multilevel logistic regression models are estimated to separate the individual level determinants of generalist and specialist use from the health system level and country specific factors. The results suggest that beyond the division between public and private funding and cost-sharing arrangements in health system, the role given to the general practitioners and/or the organization of the primary care might be essential for reducing social inequities in health care utilisation.Ăconomie de la santĂ©; Soins mĂ©dicaux; Pays de l'Union europĂ©enne;
Changing roles of health insurers in France, Germany, and the Netherlands:any lessons to learn from Bismarckian systems?
Bismarckian health systems are mainly governed by social health insurers, but their role, status, and power vary across countries and over time. We compare the role of health insurers in three distinct social health insurance systems in improving health systems' efficiency. In France, insurers work together as a single payer within a highly regulated context. Although this gives insurers substantial bargaining power, collective negotiations with providers are highly political and do not provide appropriate incentives for efficiency. Both Germany and the Netherlands have introduced competition among insurers to foster efficiency. However, the rationale of insurer competition in Germany is unclear because contracts are mostly concluded at a collective level and individual insurers have little power to influence health system efficiency. In the Netherlands, insurer competition is substantially more effective, but primarily focused on price and cost containment. In all three countries, the role of insurers has been transforming slowly to respond to common challenges of assuring care quality and continuity for an ageing population. To assure sustainability, they need to ensure that care providers cooperate with the same quality and efficiency objectives, but their capacity to do so has been limited by insufficient support to enforce public information on provider quality.</p
How well do DRGs for appendectomy explain variations in resource use? : An analysis of patient-level data from 10 European countries
Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106,929 appendectomy patients treated in 939 hospitals in ten European countries. In stage one, we tested the performance of three models in explaining variation in the (log of) cost of the inpatient stay (seven countries) or length-of-stay (three countries). The first model used only the Diagnosis Related Groups (DRGs) to which patients were coded; the second used a core set of general patient-level and appendectomy-specific variables; and the third model combined both sets of variables. In stage two, we investigated hospital-level variation. In classifying appendectomy patients, most DRG systems take account of complex diagnoses and comorbidities, but use different numbers of DRGs (range: 2 to 8). The capacity of DRGs and patient-level variables to explain patient-level cost variation ranges from 34% in Spain to over 60% in England and France. All DRG systems can make better use of administrative data such as the patientâs age, diagnoses and procedures, and all countries have outlying hospitals that could improve their management of resources for appendectomy
Are Health Problems Systemic? Politics of Access and Choice under Beveridge and Bismarck Systems
Industrialised countries face similar challenges for improving the performance of their health system. Nevertheless the nature and intensity of the reforms required are largely determined by each country's basic social security model. This paper looks at the main differences in performance of five countries and reviews their recent reform experience, focusing on three questions: Are there systematic differences in performance of Beveridge and Bismarck-type systems? What are the key parameters of health care system which underlie these differences? Have recent reforms been effective? Our results do not suggest that one system-type performs consistently better than the other. In part, this may be explained by the heterogeneity in organisational design and governance both within and across these systems. Insufficient attention to those structural differences may explain the limited success of a number of recent reforms.Health system, Beveridge, Bismarck, reforms, performance
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