Ian Forde (Policy analyst, OECD Health Division)

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OECD REVIEWS OF QUALITY

OF HEALTH CARE

RAISING STANDARDS

:

THE NORDIC COUNTRIES

Ian Forde

Health Policy Analyst

OECD Health Division

May 2014

Where are the Nordic countries today?

Commitment to health coverage for the whole population

Excellent performance on most quality indicators

Very good health and LTC systems

Preparing the health system to face new challenges

A strategic vision of how health services should develop over time

Good outcomes, especially for hospital care

Health systems are generously funded

Health expenditure per capita, 2011 (or nearest year)

High levels of public expenditure on

LTC

EMERGING CHALLENGES

Primary care is strong

Primary and community care is being asked to do more and demonstrate better value for money…

… but often ‘flying blind’

Increasing pressure on community services

Co-ordinated and integrated care is much discussed …

… but yet to deliver much benefit for patients and their families

A distinctive policy choice to take LTC outside of institutions

Private providers are increasingly important players in the market place of care…

… but getting the right balance between freedom and regulation remains unclear

Strong local governance is characteristic

Central authorities playing an increasingly prominent role in quality monitoring and improvement…

… but this can create tensions and inefficiencies

Thank you

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WHAT THE NORDIC

COUNTRIES COULD DO…

Improving the quality of primary care

Nordic countries need to ensure that

• there is a clear strategic vision for primary care shared by national government, county councils, municipalities and leaders in primary care

• the reforms on choice and competition promote co-ordinated care and avoid fragmentation

• payment and incentive systems foster cooperation, co-ordination and joint working.

Encourage GPs to adopt a leading role in assuring quality and outcomes

Coordination

Better coordination between primary and secondary care

Governance

A clearer role for central government

Developing/ better use of information infrastructure

Information

Some examples…

• define a set of core quality standards for primary care that can be used to consistently and transparently monitor, assure and improve the quality of care

• study the effects of recent choice and competition reforms to ensure that they do not fragment services for patients with complex needs

• equip the primary care workforce to play a more proactive role in primary and secondary prevention of chronic disease

• standardise the information infrastructure in primary care to support improvements in the measurability of quality in primary care on a consistent basis.

Continuous quality improvement in longterm care

Strengthen measurement

• e.g. develop quality indicators for the sector and encourage comparison across providers

Balance tailored care against standards

• e.g. make wider use of standards, protocols and guidelines

Encourage coordination

• e.g. joint care-coordinators or health and social care planning and purchasing

TO CONCLUDE…

Key policy recommendations

1. Develop richer information systems,

2. Clarify the role of central government,

3. Strengthen co-ordination and integration across services

4. Evaluate closely the effects of recent reforms

Want to read more?

www.oecd.org/health

/qualityreviews

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