Plan: Reform Strategy - Bermuda Experience. Caribbean Conference on Health lhfinancing Initiatives
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1 National Health Plan: Evidence & Reform Strategy - Bermuda Experience Caribbean Conference on Health lhfinancing i Initiatives J Attride-Stirling, PhD Chief Executive Officer 23 rd November 2011
2 Overview Background k d to National Health Plan Development process Evidence base The NHP Consultation Current t roll-out Lessons & reminders
3 Health system profile Health status Life expectancy 79 years Low infant and maternal mortality Heart disease and cancer 72% of deaths Public health problems: Obesity Diabetes Road traffic injuries Violence System characteristics Provision Mix of private & public 2 physicians per 1,000 Public health services free Hospital care QUANGO Financing Health expenditure $628 M 70% private & 30% public Health coverage Mandatory hospital insurance for employed persons 94% insurance coverage Government subsidies
4 Background to National Health Plan Origin 2009 Throne Speech Since healthcare reviews Purpose 1. To reset the founding principles of our health system to ensure it meets the needs of 21 st century Bermuda 2. To provide direction, context and coherence to future reforms Process MOH Strategy Group developed NHP through 2010 Assessed current strengths & weaknesses
5 Foundations of NHP development WHO Health System Model WB/HSPH Flagship Framework Stewardship Responsiveness Generating Resources Delivering Services Health Outcomes Financing Fair financial contribution
6 The Flagship Course Conducted jointly by Harvard School of Public Health and the World Bank Purpose: To train executive leaders in a strategic approach to improve health systems Course has been held for 13 consecutive years More than trainees More than 1,900 trainees from 52 countries
7 Flagship approach: some key lessons Be clear about ethical basis of reforms Role of politics Focus on problems in health system outcomes Use evidence to analyze performance Reform strategy based on policies to impact performance Design g implementation
8 Development process Development Phase II: Phase I: Phase Development of Consultation Implementation Plans Phase III: Implementation
9 Problem definition Health Status Responsiveness Financial Risk Protection
10 Evidence base to analyze performance and define problem Strategic planning Past healthcare reviews Data on performance
11 Healthcare reviews Common themes in recommendations of 15 reviews: Review the Standard Hospital Benefit Contain the rate of increase in healthcare costs Address the inequitable access to insurance coverage Place greater emphasis on prevention and health promotion Reform the way we pay providers Establish a central electronic data repository for all Establish a central electronic data repository for all healthcare data
12 Data on performance
13 Health in Review: An international comparative analysis of Bermuda health system indicators Produced jointly by DOH and BHeC Based on OECD model 76 indicators Bermuda trends Benchmark to OECD Available at
14 Data = objective assessment of performance Capacity Utilization Outcomest Access Responsiveness Satisfaction Cost
15 Capacity
16 000 Nurses per 1,0 Source: Statistics Annual Employment Survey
17 Medical technologies
18 Utilisation
19 MRI exams
20 Caesarian 100 live births deliveries per
21 Outcomes
22 Life expectancy at birth
23 Infant mortality
24 Obesity rate, adult ts
25 Diabetes prevalence
26 Diabetes lower extremity amputation ti rates
27 Cancer mortality rates
28 Females Males Netherlands Ro oad accid dents mo ortalit ty ra ates Sweden Norway Switzerland Japan Denmark United Kingdom Germany Ireland Finland Iceland Australia France Austria Canada OECD Czech Republic Italy ay New Zealand Luxembourg Spain Slovak Republic Poland Hungary United States Greece Korea Portugal Mexico Bermuda Age-standardised rates per 100,000 population
29 Smoking daily, adults
30 Access, Responsiveness and Satisfaction
31 Pap test in past 12 months by income NOTE: includes all women aged includes women aged 25-64
32 Unmet healthcare need by income
33 Health insurance coverage Healthcare coverage: Promotes access Provides financial security Results in better health outcomes Most OECD cover 98% to 100% of population Source: OECD (2009)
34 Satisfaction with health system
35 Cost
36 Total health expenditure per capita 2007 Bermuda: 20087/08 Per capita health exp. = BDA$7,885 = PPP US$4,959 Health share of GDP = 8.5%
37 Health expenditure by function
38 Overall assessment of performance
39 Current health system strengths Sound health outcomes Adequate resources However
40 Our health system is expensive Costs significantly more than most countries Fails to achieve e universal coverage Not value for money: Not value for money: lower health outcomes
41 Life expectancy at birth and health spending per capita Life expectancy at birth and health spendingper capita, 2007 (or latest year available) 84 Life expectanc cyinyears JPN ISL CHE ITA AUS FRA ESP SWE CAN NOR NZL DEU NLD LUX KOR IRL PRT BDA GRC DNK GRB BEL AUT USA FIN CZE POL MEX SV VK R² = TUR HUN Health spending per capita (USD PPP) Bermuda: 20087/08 Per capita health exp. = BDA$7,885 = PPP US$4,959 Health share of GDP = 8.5%
42 Health system is unaffordable to lower income brackets Low High
43 Current health system limitations It is expensive It is inequitable Healthcare is a privilege of employment or welfare for the poor
44 National Health Plan: Bermuda Health System Reform Strategy
45 NHP principles Mission: Healthy people in healthy communities Bermuda s health system shall assure the conditions to enable the human capacity to adapt and cope in achieving optimal health and quality of life Core values Equity Equal access to basic healthcare with proportional financial burden Sustainability Health spending growth in line with general inflation Affordable to the economy, payors, providers employers, individuals, and families
46 Health Sector Goals
47 Building on strengths Organization of healthcare delivery Public health services Subsidies for vulnerable population
48 NHP phase Development Phase II: Phase I: Phase Development of Consultation Implementation Plans Phase III: Implementation
49 Consultation: Politics and policy Politics permeates reform Need skill as much as will Stakeholder analysis helps navigate political landscape
50 Consultation Feedback Core Values Overall Health Professionals Public Advocacy Members of the public Business Advocacy Sustainability Equity + Business advocacy includes local and international businesses, employers groups and health insurers * Public advocacy includes charities, unions, public protection agencies, and political parties Key: Supportive Opposed Mixed response
51 Roll out of NHP Implementation Phased, seven year timeline Task Groups set up to develop implementation plans MOH Steering Committee overseeing Monitoring by MOH Evaluation by BHeC
52 Lessons & reminders to date Nothing will make everyone happy The Equity Question: if as a country we do not first resolve the equity question, all future attempts at reform will stall in the same place Keeping momentum in rapidly changing g circumstances is vital No amount of consultation will ever be enough, but doing stakeholder analysis first helps Ready, set...
53 Thank you Any questions? Visit bm for more information Coming soon:
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