Quasi Governmental Organisations
ƒTypology
Quasi Governmental Organisation
in Health Care Governance
ƒAdvantages & risks
Advantages, conditions, authority
ƒAuthority
ƒConditions
Plaats | datum
Bert Boer, MD, PhD
Academy Health, Washington, Feb 04 2009
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(selection) of “QGO’s” in Holland
Typology (1)
Advisory bodies
Function
ƒHealth Council (> 100 years)
ƒHealth Research Council
ƒCouncil for Public Health & Health Care
ƒAdvisory
ƒExecutive/administrative
ƒHybrid
Executive bodies
ƒCVZ: Health Care Insurance Board (= advisory and executive)
ƒDutch Health Authority
ƒNetherlands Organisation for Health R&D
Position
Agencies (= part of Ministry of Health)
ƒAgency
ƒIndependent authority
ƒPrivate body with public task
ƒHealth Care Inspectorate
ƒNational Institute for Public Health &Environment
ƒMedicines Evaluation Board
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Typology (2)
Typology (3)
Field of Operation
Position in policy cycle
ƒHealth & Environment
ƒEx ante advice/guidance
ƒMedical Science
ƒEx post supervision
ƒHealth Care (Safety, Efficacy, Effectiveness, Efficiency)
ƒCoverage
ƒBudgeting/Funding
Target field
ƒResearch
ƒInsurance companies
ƒQuality of Care
ƒHC suppliers/professionals
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QGO’s in the Netherlands
CVZ: executive & advisory
ƒVariety in position, function
QGO since 1999, evolution from Sickness Funds Council
ƒOld and new
Health Insurance Act (2006) defined task
ƒCombinations of functions
Legal tasks:
ƒOrigin/development: mostly incremental
ƒAdvice on package of benefits
ƒHealth Insurance Act (2006): increased rationality
ƒRisk equalisation/administration of funds
ƒAdministrative tasks
Staff: 350 fte
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QGO´s: advantages
QGO´s: risks
ƒIndependence, ‘shelter’ from policy and actors in HC
Distance from political responsibility
ƒ“Safe Haven” for MoH
ƒFocus of specialised expertise
The “double bind”:
ƒContinuity of expertise, ‘collective memory’
Minister of Health is “client” and “boss”
ƒConsistency
ƒContribution to rational policy: linking policy and
practice
ƒBuffer/filter for signals from Health Care
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QGO´s: tensions
QGO´s: conditions (1)
No problem with “double bind”
Rational design of function and position:
Gaps, overlaps, common language
Problem for both parties:
Conduct:
Financial restraints (small vs big money)
ƒVertical and horizontal collaboration
ƒ“predictability”: do what you say, say what you do
Using expertise from experience for policy advice
Quality: “pursuing perfection”
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QGO´s: conditions (2)
QGO´s: conditions (3)
Business P&C
Criteria:
ƒPolitical support for criteria
ƒExplicit application of criteria
Quality of staff & tools, knowledge mgt.
ƒConsistency
Resources
ƒTransparency, explicit on all considerations
ƒInteractivity combined with independence
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QGO´s: authority (1)
QGO´s: authority (2)
Te be trustworthy:
Input of expertise & interests:
ƒIn procedures
ƒIn scientific evidence
ƒAd hoc
ƒSystematic consultation
Listen to stakeholders and experts
Make up own your mind
ƒStanding committee (expertise): for content and
credibility
Explain what you did with comments
ƒRepresentation in board: “participative” model
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Conclusions:
1. QGO’s offer substantial advantages for politics & parties in
HC
2. Specific conditions for successful operation:
ƒdesign of role and position
Thank you
ƒindependence/interactivity
ƒtransparency
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3. Opportunity to design from scratch:
ƒRational role & position
ƒCommon language between subsystems
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