OECD 2017

Systemic changes on where and how health care is delivered will optimise both quality and efficiency

Health care systems need to engage patients as active players in improving health care, while modernising the role of health professionals

Health care systems need to better employ transparency and incentives as key quality improvement tools

Conclusions

Delivering high-quality care is an essential feature of a high-performing and resilient health care system. High-quality care is care that is safe, effective and patient-centred, and should never be taken for granted. Health care systems face tremendous challenges – complex care needs and care processes, increased health care demands (especially for chronic conditions), and, crucially, an economic landscape in which health care systems will have to achieve more for less. Assuring, monitoring and improving the quality of health care is more than ever a central concern across all OECD health care systems.

To meet these demand- and supply-side challenges while ensuring health care systems’ financial sustainability, governments should insist upon transparency to support their health care systems to continuously secure better quality and outcome of care. Remodelling health care systems and changing cultures is not an easy task, but experiences from OECD countries reveal three priority areas for action:

• Places: Health care systems need to invest in key primary care functions to offer comprehensiveness, continuity and co-ordination to patients with complex needs. Building a strong primary care foundation requires investment to create co-ordinated and high-quality community care services and to develop a rich information infrastructure to underpin transparent quality monitoring and improvement.
• People: Transparency means placing patients at the centre, to deliver high-value care that maximises both quality and efficiency. This should encompass affording respect to patients, involving them in decisions affecting health care, as well as promoting their voice and choice through greater health literacy. Collecting patient experience measures is also pivotal to delivering health services that are truly responsive to patients’ needs. Listening and engaging with patients while modernising the role of health professionals will be central to the foregoing priority of strengthening primary care.
• Data and incentives: Health care systems need to invest in the right data and incentives to promote accountability and transparency. Collecting and publishing information around outcomes and quality (rather that inputs and activities), moving to performance feedback and linking payment to the provision of high-quality care are key instruments that should not be underestimated, especially in times of acute financial stress.

Accountability frameworks and incentives are, in particular, important levers to support quality improvement. In primary care, health care systems should collect more quality indicators around prevention, management of chronic diseases, elder care and mental health care (as seen in the United Kingdom, Portugal, Israel and Denmark). Performance feedback and rigorous open comparison are also key tools to create a platform to share experiences and facilitate learning to improve. Combined with public reporting, non-financial incentives are successful drivers for quality improvement (as seen in Israel, Korea and Sweden). Financial incentives, such as those linking payment to quality and outcomes of care, are effective when they are directed towards high-priority areas such as greater management of chronic conditions (as seen in Australia and the United Kingdom), quality of hospital care (as seen in Korea) or mental health and long-term care (as seen in Sweden). Last but not least, more research is needed to achieve a better understanding of health care system achievement and performance. Proper and repeated application of the plan-do-study-act cycle should underpin this, focussed on patient outcomes to steer local and national policy making. While OECD health care systems are getting better at embedding evaluation of local initiatives, system-wide assessment of health care system performance is still lacking. Such evaluation should be more systematically conducted to assess the impact of policies and to fill existing gaps in knowledge. To plan national health strategies and prepare health reforms, concerted action is needed to undertake national health care system performance assessments and to benchmark results internationally.

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