OECD HEALTH SYSTEM CHARACTERISTICS SURVEY 2012
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1 OECD HEALTH SYSTEM CHARACTERISTICS SURVEY 2012 Emily Hewlett OECD Health Data National Correspondents and Health Accounts Experts Meeting, 17 th October 2013
2 Health System Characteristics Survey 2012 HSC survey complements existing OECD data questionnaires with detailed information on health systems: (i) Governance (ii) Organisation and delivery (iii) Financing First wave of HSC survey carried in survey results released in OECD Health Working Paper No 50.
3 Health System Characteristics Survey 2012 Second HSC survey carried out in , following the same structure but with some updates: Updating 2008 information where necessary Enhanced information on key areas: health financing and health coverage, health care delivery (providers payment and regulation of prices and supply) Included questions for specific OECD projects (including on workforce and primary care) Surveys sent out second half of 2012 almost 100% response rate!
4 USING THE HSC SURVEY DATA
5 Governance Questions on Governance: Responsibility for setting and implementing health policy, targets and standards Health Technology Assessments Main systems of health financing and budgeting Centralisation/decentralisation in policy and budgeting Patient rights
6 Governance: SBO-Health Joint Network Source: OECD Health System Characteristics Survey 2012
7 Using the HSC Survey Data: governance Source: OECD Health System Characteristics Survey 2012
8 Organisation and delivery Questions on Organisation and delivery: Key purchasers by category of services Service delivery: staff and settings Hospital and physician organisation and payment Workforce supply, teaching, training and research Patient choice Information on the quality of services The use of guidelines
9 Organisation and delivery 7 6 Large variations in number of practising doctors per capita across OECD countries (2010) Per inhabitants Data include not only doctors providing direct care to patients, but also those working in the health sector as managers, educators, researchers, etc. (adding another 5-10% of doctors). 2. Data refer to all doctors who are licensed to practice. Source: OECD Health Data
10 Organisation and delivery Issues related to physician supply No particular issue Maintaining the current level of physician suppply Meeting increasing demand Maintaining the current share of GPs Identified shortage in some specialties Mal-distribution of physician supply Source: OECD Health System Characteristics Survey 2012 No particular issue : Netherlands 10
11 Financing Questions on Financing: Basic coverage Cost sharing by service (acute inpatient care, outpatient primary care, outpatient specialist care, pharmaceuticals, lab tests etc ) Exemptions (children, elderly, beneficiaries of social benefits, pregnant women, etc ) Private health insurance
12 Financing Provision of basic primary coverage (for the "typical" employed adult) Main source of basic health care coverage Countries Tax-funded health system National health system Local health system Australia, Canada, Denmark, Iceland, Ireland, Italy, New Zealand, Norway, Portugal, Spain, United Kingdom Finland, Sweden Health insurance system Single payer Multiple insurers, with automatic affiliation Korea, Luxembourg, Poland, Slovenia, Turkey, Hungary Austria, Belgium, France, Greece, Japan, Multiple insurers, with choice of insurer Chile, Czech Republic, Germany, Israel, Mexico, the Netherlands, Slovak Republic, Switzerland, United States Note: coverage for an adult not subject to any exceptions Source: OECD Health System Characteristics Survey 2012 and Secretariat s estimates
13 Financing: links between the HSC Survey Data and SHA Data Expenditure by financing agent as % of current expenditure, 2011 Country General government Social security funds Private insurance Private households out-ofpocket exp. Other Total expenditure Australia (2010) 68.0% 0.0% 8.3% 20.4% 3.3% 100.0% Austria 32.3% 44.9% 4.5% 17.0% 1.2% 100.0% Belgium 10.5% 65.4% 4.2% 19.7% 0.2% 100.0% Canada 68.5% 1.4% 12.9% 15.5% 1.6% 100.0% Chile 38.3% 6.6% 16.9% 38.3% 0.0% 100.0% Czech Republic 4.7% 79.2% 0.1% 15.0% 1.0% 100.0% Source: OECD SHA Data, 2013
14 Financing: links between the HSC Survey Data and SHA Data The types and level of cost-sharing requirements outpatient primary care, outpatient specialist contacts, for an adult not subject to any specific exemption. Countries Outpatient primary care physician* contacts Outpatient specialist contacts Australia Free at the point of care when doctors accept direct payments from Medicare (about 79% of GP services ). Otherwise, patients may be exposed to costs. Outpatient specialist contacts can be provided by the public hospital system (fully covered) or by Medicare (typically covered if the patient has been referred by a doctor, with a co-payment). Austria Mostly free at the point of use for contracted physicians, with a EUR 10 (USD 11.80) annual payment. Certain professional groups have coinsurance rates (14-20%) instead of the service fee. Belgium Copayment of EUR 6.50 (USD 7.48) or EUR 4.00 (USD 4.60) with GMD, reduced to EUR 1.50 (USD 1.73) or EUR 1.00 (USD 1.15) for patients with preferential reimbursement. Patients pay the full price and are reimbursed afterwards. Mostly free at the point of use for contracted physicians, with a EUR 10 (USD 11.80) annual payment. Certain professional groups have coinsurance rates (14-20%) instead of the service fee. Copayments between EUR 2.50 (USD 2.88) and EUR (27.94) depending on service type and patient status (GMD/preferential reimbursement). Patients pay the full price and are reimbursed afterwards. Canada Free at the point of care Free at the point of care Chile Depending on health insurer, visits are either free of charge, or cost sharing is around 39% (average in 2010). Depending on health insurer and chosen coverage plan, cost sharing ranges from 10% to 50%. Czech Republic Copayment of EUR 1.20 (USD 2.24) per visit. User fee of EUR 1.20 (USD 2.24) per visit. Note: coverage for an adult not subject to any exceptions Source: OECD Health System Characteristics Survey 2012 and Secretariat s estimates
15 Financing Level of coverage for different functions of care in OECD countries in % % % % % 40-0 % Note: coverage for an adult not subject to any exceptions Source: OECD Health System Characteristics Survey 2012 and Secretariat s estimates
16 Expected outputs from the HSC Survey HSC Survey to be used in upcoming working paper: Health workforce in 2013 (impact of the crisis and geographical distribution) Measuring Coverage in 2014 HSC data is will continue to be used across a OECD projects: Ongoing work of the SBO-Health Joint Network New work on payment of providers Country-specific studies
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