Is national public health care the answer to priority setting - - PowerPoint PPT Presentation

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Is national public health care the answer to priority setting - - PowerPoint PPT Presentation

Mar 26, 2024 22 likes •305 views

Is national public health care the answer to priority setting challenges? Input from Norway Olav Valen Slttebrekk, Deputy Director General The Norwegian Directorate of Health Photo: Johnr og Rebecca Ravneberg The Norwegian Directorate of

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Is national public health care the answer to priority setting challenges? Input from Norway

Photo: Johnér og Rebecca Ravneberg

Olav Valen Slåttebrekk, Deputy Director General The Norwegian Directorate of Health

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The Norwegian Directorate of Health:

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  • Provider of technical and legal advise to the Ministry
  • Implementing agency for health sector policies
  • Administrative agency for health sector laws and

regulations

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Norway

  • Much like Sweden
  • Somewhat different on the edge of Europe
  • Small & rich
  • Generous welfare state
  • High health care spending

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Facing some new challenges

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  • Reduced income from oil
  • Reduced income from

investments

  • Ageing population
  • Reduced work force
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The Norwegian Health Service

  • Nationally
  • Ministry of Health and Care Services
  • Directorate of Health
  • Regionally
  • 4 Regional Health Authorities 19

Health Trusts

  • Local level
  • 426 municipalities

More information at: European Observatory on Health Systems and Policies, Norwegian report 2013

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Health sector budget

‘The richest country in the world should not need to prioritize in health care’

Saying no in health care: “This is so painful to talk about that it has been sup- pressed for a long time. But now we must be frank“

Health Director Bjørn-Inge Larsen 2010

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Health sector budget

Reality: What are the benefits forgone?

‘important in assessing whether the health expected to be gained from its use exceeds the health expected to be forgone elsewhere as other NHS activities are displaced’ Claxton et al 2012

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Available measures for priority setting

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  • Legal measures
  • Established criteria
  • Fora for decisions and

discussions

  • National guidelines
  • Data and documentation
  • Financing
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Patient Rights Act (1999) Regulation on Priority Setting (2000-03)

  • Legal right to emergency care
  • Elective services

– Referrals: Individually assessed within 10 days – Criteria for priority setting – If criteria are met

  • Legal right to receive health care within an individually

assessed deadline

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Principles for priority setting

  • On the agenda since mid 80s
  • Principles outlined in official report 1997
  • Revised criteria 2016
  • Limited to hospital sector
  • White paper in progress on primary care

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The 3 criteria

  • Health gains

– Effectiveness of an intervention – More health gains is always better

  • Resources spent on the intervention

– Less resource use is always better

  • Severity of the condition

– The larger your total lifetime health loss, the higher your priority

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Fora for decisions and discussions

  • The National System for

introduction of New Health Technologies in Specialized Healthcare

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The main components of the National System

  • The National Priority

Council (2007-2017)

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The national system that assess new drugs and other interventions is valuable. We ensure the patients all over the country equal access, and we ensure that they get effective treatment. Larv Vorland, CEO Northern Health Authorities April 5th 2017

Experiences

Yes Nei Total 2014 8 6 18 2015 17 18 2016 10 13 31

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National clinical guidelines

  • Published by the

Directorate of Health

  • Evidence based
  • Prevention
  • Diagnostic
  • Treatment
  • Rehab
  • Organization
  • Cost/effectiveness

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Priority guidelines

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The priority guidelines should be used

  • Priority guidelines are installed on the digital platform in all

hospitals

  • Supporting digital learning program
  • Some of the hospitals/ regional health authority have made the

program obligatory for specialists evaluating referrals to the hospital

  • There has yet not been a comprehensive evaluation of the use
  • f the priority guidelines.

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Financing as a measure for priority setting

  • As resource allocation mechanism between regional health

autorities

  • Cap on out of pocket payments
  • Activity based financing

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Available measures – Does it work?

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  • Legal measures!
  • Established criteria ?
  • Fora for decisions! and

discussions?

  • National guidelines!
  • Data and documentation?
  • Financing!?
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Percentage of patient with legal right to specialized health care, each regional health authority

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10 20 30 40 50 60 70 80 90 100

Helseregion Sør-Øst Helseregion Vest Helseregion Midt-Norge Helseregion Nord

Kilde: NPR rapportgenerator

1.tertial 2008 – 1. tertial 2014

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Dagbladet 18.10.2017 Dagens medisin

Differences gain attention in public

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Differences among Norwegian Health Trusts in waiting time before the first visit 2012-17

54 61 63 55 53 47 41 46 43 39 27 28 33 37 34 33 31 33 35 30 29 22 24 21 88 93 92 92 83 64 74 66 66 72 57 55 90 71 58 57 66 66 79 86 80 90 49 59 75 75 74 72 63 56 54 55 53 54 47 46 55 55 51 50 51 49 64 66 59 48 37 37 10 20 30 40 50 60 70 80 90 100 2012 2013 2014 2015 2016 2017 2012 2013 2014 2015 2016 2017 2012 2013 2014 2015 2016 2017 2012 2013 2014 2015 2016 2017 Somatic care Mental health - adults Mental health - children and adolescents Substance abuse

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Number of recipients of primary health care services at home or institutions

69 60 52 46 42 45 50 57 51 56 57 57 61 56 137 125 121 88 95 83 66 102 103 97 85 85 82 71 102 93 83 68 67 64 57 75 73 73 69 68 70 64 20 40 60 80 100 120 140 160 1-1999 innb 2000-4999 innb 5000-9999 innb 10000-19999 innb 20000-49999 innb 50000-99999 innb 100 000 innb + 1-1999 innb 2000-4999 innb 5000-9999 innb 10000-19999 innb 20000-49999 innb 50000-99999 innb 100 000 innb + Unadjusted Adjusted by needs

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Challenges

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  • Priority by decibel
  • Cancer
  • Mental health
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Total spending on specialist health care

Percent of change in fixed prices from 2006.

17 10 62 37 18

  • 10

10 20 30 40 50 60 70 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Percent of change from 2006

Somatic care Mental health Substance abuse Ambulances and patient transportation Total expenditures

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Challenges

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  • Priority by decibel
  • Cancer
  • Mental health
  • Geography
  • Urban vs rural areas
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Some reflections

  • Priority setting is a complex and controversial exercise
  • Transparency is important and access to high quality data
  • National instruments are in place
  • Extension to primary health care needed
  • Open discussions among the clinicians and management about

variation is in itself very important

  • Money talks – also in health care

– Beware of possible unintended effects of payment systems

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What are the determinants of good health?

  • Most important outside health sector
  • Education
  • Employment
  • Participation in society
  • Increase attention to children and youth health
  • Increasing mental health issues among youths
  • Immigration health
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25.10.17

Thank you!