Canadian Health Ministers reached an agreement in September to plan and develop a purchasing alliance that will be responsible for negotiating prices for prescription drugs and medical supplies across provinces and territories. Ontario's government will lead the way on the drug purchasing aspect of the agreement, as the province is one of the largest prescription drug buyers in the world. Furthermore, Ontario Health Minister Deb Matthews has experience in securing lower prices; in early 2010 she banned professional allowances—rebates given by generic drug companies to pharmacies to stock their product—that totaled about $750 million annually and that the Ontario government says were driving up drug prices.

Although it is too early to estimate how much money could be saved with a purchasing alliance, the provinces and the federal government are interested in cutting costs. The provincial and territorial governments spend more than $10 billion annually on prescription drugs, and last year the federal government spent approximately $600 million on drugs and supplies.

Sources:
http://www.thestar.com/article/860324--ontario-leads-the-way-on-drug-cost-reform   

http://www.thespec.com/news/canada/article/255751--provinces-try-to-combat-rising-drug-costs  

The Canadian Institute for Health Information reported in October that $192 billion was spent on national health care in 2010—up from $182 billion in 2009 and $172 billion in 2008. Controlling for inflation and population growth, the report also estimated a spending increase of 1.4 percent per person in 2010, which is the lowest annual growth rate in the last 13 years.

The report, which shows data by province, demonstrated that spending was highest for senior care, but that this percentage had not changed dramatically in the past 10 years, going from 43.6 percent in 1998 to 43.8 percent in 2008. Another important issue raised was that hospitals, pharmaceutical drugs, and physician services accounted for the top areas of spending, with physician spending outpacing the others for the fourth year in a row (an estimated growth of 6.9% this year).

In a response to the physician expenditure estimates, provincial Health Minister Deb Matthews stated that she plans to strengthen Ontario’s salary-based payment methods rather than the more widely used fee-for-service model. This redirection could help place value on quality not quantity of service, as well as slow the spending growth.

Sources:
http://www.cihi.ca/CIHI-ext-portal/internet/en/Document/spending+and+health+workforce/spending/RELEASE_28OCT10  

http://www.theglobeandmail.com/news/politics/calls-grow-to-limit-doctors-slice-of-health-care-spending/article1776182/  

About 5,500 doctors in Ontario are now using electronic records, treating up to 5 million patients, or 39 percent of the province’s population. Although this represents important progress, most doctors can only exchange information with their local hospital or with other medical staff in their offices.

Physicians that make the switch to electronic medical records receive $28,000 over three years from the government to set up the system, with the ability to choose from 12 different compatible vendors. The implementation process has been overseen by the government-funded provincial organization eHealth Ontario. Each province is responsible for implementing health informatics independently, with the nationally run Canadian Health Infoway providing implementation support.

Greg Reed, eHealth Ontario’s CEO, said the next step is to develop a network through which a patient’s health information can be accessed from anywhere within the province.

Sources:
http://www.nationalpost.com/news/canada/Five+million+patients+have+digital+charts+minister+says/3767563/story.html#ixzz14KLMNSfO  

http://ottawa.ctv.ca/servlet/an/local/CTVNews/20101102/OTT_EHealth_Records_101102/20101103/?hub=OttawaHome  

Chancellor of the Exchequer George Osborne, Britain’s highest ranking finance official, presented his Spending Review to the House of Commons in October, unveiling £83 billion (US$130 billion) in cuts by 2015. Government departmental budgets will be reduced by an average of 19 percent over the next four years. The National Health Service (NHS), however, has been spared. The NHS is not only exempt from the cuts, but will receive annual increases until 2015.

NHS spending in England will rise by 0.1 percent per year over the next four years, from a total of £104 billion (US$160 billion) in 2010 to £114 billion in 2014. However, this rise is relatively small when compared with the 6 percent annual increase the NHS has had for the last decade, and unlikely to keep up with the rising demands of the health sector, such as the costs of medical advances and an aging population. In fact, the extra money is expected to go toward the planned Value Added Tax (VAT), or sales tax, hike and by increases in salary costs.

The NHS is still expected to realize £20 billion in efficiency savings over the next four years, with the Department of Health, which oversees the NHS, facing a 30 percent cut to management costs and the NHS itself facing a 45 percent management cut. Savings are expected to be reinvested in patient care, though Sir David Nicholson, chief executive of the NHS, acknowledged that part of the savings will go toward organizing GP consortia and introducing other reforms set out in the white paper, "Equity and Excellence: Liberating the NHS."

Sources:
http://www.direct.gov.uk/en/Nl1/Newsroom/SpendingReview/DG_191682

http://www.bbc.co.uk/news/uk-politics-11569160

http://www.nytimes.com/2010/10/21/world/europe/21britain.html

http://www.bmj.com/content/341/bmj.c6024.full (subscription required)

http://www.bmj.com/content/341/bmj.c5952.full (subscription required)

http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_120676  

A Department of Health review of the NHS’s National Programme for IT (NPfIT) concluded that a local, plural approach should replace the current centralized, national strategy. The program was originally designed to replace local NHS computer systems and to procure information technology (IT) centrally. But it has been criticized for implementation delays, concerns about patient privacy and security risks, a low degree of clinical functionality, and its expense.

Under the new policy, NHS trusts and general practitioners will choose their own IT systems and providers, rather than adopt an appointed "local service provider." These localized IT systems will be connected, rather than replaced, to create a national IT infrastructure. IT systems that are already integrated into health services will remain in place. The Department of Health expects the transfer of responsibility for IT from national to local bodies to save £700 million (US$1 billion), though the department has not detailed where the savings will come from.

NHS Connecting for Health was established in 2003 as the agency responsible for implementing the NPfIT. The agency’s primary objective was to implement a single, national Spine, containing Summary Care Records for each NHS patient; the Summary Care Record was to be a secure electronic record containing demographic and clinical information, accessible from any point of service within the NHS. In addition, Connecting for Health has been responsible for development and implementation of a national electronic prescription service (including electronic transfers from physician to pharmacy) and Choose and Book, an electronic appointment booking system accessible across NHS sites.

Two separate reviews of the Summary Care Record commissioned by Health Minister Simon Burns, health minister responsible for IT (and led by Professor Sir Bruce Keogh, medical director of the NHS in England, and Joan Saddler, director of patient and public affairs), concluded that a core record containing electronic summaries of core patient information "will prove valuable for patients needing emergency care." However, the reviews recommended that the record be scaled back to contain only patients' demographic details, medications/treatments received, allergies, and adverse reactions. To address privacy concerns, it recommended that this information be copied from a patient’s GP’s records, with any additional information added only with explicit consent of patients. The reviews also recommended increasing awareness about patients’ right to opt out of the record.

Sources:
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_119293

http://www.bmj.com/content/341/bmj.c4988.full (subscription required)

http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_120379

http://www.bmj.com/content/341/bmj.c5714.full (subscription required)

Prime Minister David Cameron and the Coalition Government have committed £164 million to the NHS for cancer care. The commitment aims to bring U.K. cancer survival rates up to those of the best-performing European countries. The Prime Minister expects these plans to save 5,000 lives if the NHS achieved the European average survival rates, and 10,000 lives if it achieved the best European rates. Last year, the Organization for Economic Cooperation and Development (OECD) ranked Britain second to last in colon cancer survival rates, followed only by patients in the Czech Republic, and the funding specially targets colon cancer survival. The plans include introducing flexible sigmoidoscopy, a colon cancer screening technology available in U.S.; providing additional funding for new cancer drugs; increasing the number of NHS cancer specialists from about 1,000 to 1,200 by 2012; expanding radiotherapy capacity; and raising awareness through the NHS’s "Signs and Symptoms" campaign.

Following the Prime Minister’s commitment, Health Secretary Andrew Lansley announced the creation a Cancer Drugs Fund providing £200 million per year from 2011 through 2013 to help increase access to innovative new cancer drugs that either extend life or improve quality of life. All drugs recommended by the National Institute for Health and Clinical Excellence (NICE) will continue to be funded by the NHS. The new £200 million available through the Cancer Drugs Fund (as well as the £50 million commitment which has been available since October 1, 2010) is intended to cover drugs not normally available to NHS patients, but which clinicians think their patients need.

Sources:
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_120941

http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_120076

http://www.guardian.co.uk/society/2010/oct/03/cancer-treatment-nhs-screening-cameron

http://www.guardian.co.uk/politics/2010/oct/03/david-cameron-cancer-health

As part of its pension reforms to reduce the Social Security deficit to just over €23 billion in 2011, the French government announced a plan to achieve €2.4 billion in health care savings. These savings would help reduce the health sector deficit and attain French President Nicolas Sarkozy's 2.9 percent target rate for medical inflation in 2011, a growth rate slower than both health care spending (4.4% last year) and growth in the GDP in previous years.

Proposed cost-control measures cut across the health sector. Measures affecting patients include increased cost-sharing for some prescription drugs and medical devices, increased copayments for doctor visits (from 30% to 30.5%), and a higher ceiling on out-of-pocket expenditures for some hospital costs. The measures will not affect out-of-pocket spending for the 87 percent to 90 percent of the French population with complementary private insurance, who will remain fully covered through this supplemental coverage. (In France, supplemental private health insurance reimburses statutory cost-sharing for services also covered by the public health insurance scheme.)

Three measures will affect chronically ill patients, who have previously been exempt from all cost-sharing: transportation will no longer be routinely reimbursed in full, but will be subject to disease-specific guidelines; new patients with mild hypertension will no longer be supported in full (existing hypertensive patients will remain unaffected); and diabetics will only be reimbursed for one blood glucose self-testing strip per day. Again, patients with complementary private health insurance will be covered for the remaining cost through their supplementary coverage. The complementary private health insurance companies (mutuelles) to whom the financial burden will be shifted resisted the reforms.

Other measures include a reduction of hospital management expenses to be achieved through efficiency savings and changes in pricing. General practitioners, however, will receive a one euro increase (from €22 to €23) in their consultation fee. In addition, the income ceiling for low-income people to receive state subsidies to purchase complementary health insurance will be raised, meaning that a greater number of low-income persons will be able to benefit from the subsidies. The unpopular pension reforms, which were met with nationwide strikes, were approved by the French National Assembly in September and the French Senate in October.

Sources:
http://www.securite-sociale.fr/chiffres/lfss/lfss2011/2011_plfss.pdf

http://www.lemonde.fr/societe/article/2010/09/16/reduction-du-deficit-de-la-secu-les-malades-appeles-a-contribuer_1411739_3224.html

http://www.lesechos.fr/economie-politique/france/actu/020791471572-assurance-maladie-les-assures-vont-etre-mis-a-contribution-pour-limiter-le-deficit.htm

http://www.lesechos.fr/entreprises-secteurs/grande-consommation/actu/020790691387.htm  

On November 1, the Australian government implemented a landmark change to the current health system through an extension of Medicare Benefits Schedule (MBS) payments to cover patients seen by nurse practitioners and midwives working at private clinics and hospitals. NPs and midwives will also be able to prescribe medications through the Pharmaceutical Benefits Scheme (PBS), a fee schedule administered by Medicare Australia that provides subsidies to patients taking prescription drugs. Over the next four years, the government will provide $59.7 million to expand access to and insurance support for nurse practitioners, and $91.6 million for eligible midwives.

In order to gain access to the MBS and PBS, nurse practitioners and midwives will be required to work in a "collaborative arrangement" with a medical practitioner. Australian Health Minister Nicola Roxon said that these reforms will not only help to ease the burden on doctors, especially in rural areas, but will also increase services in a wider range of settings and will allow more choice for patients.

Sources:
http://www.smh.com.au/national/nurse-practitioners-and-midwives-to-work-under-medicare-umbrella-20101031-178y3.html  

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/1EE2D6AE9180323DCA2577CE0007BD7E/$File/nr165.pdf

http://ama.com.au/node/6071  

Legislation submitted to parliament in October proposes that the federal government assume 60 percent of funding responsibility for public hospitals and full responsibility for primary and aged care. The legislation followed a health reform agreement between the Australian Commonwealth, led by Prime Minister Julia Gillard, and seven states and territories that would transition primary responsibility for the nation’s hospitals from the states to the federal government. Federal funding of public services had dropped to as low as 38 percent under the previous administration.

The existing arrangement is based on five-year contracts between the Australian government and each state and territory, through which the states and territories receive federal funding to provide free hospital services and perform daily administration and management of public hospitals. The reforms would relieve states and territories of $15.6 billion in health costs between 2014 and 2020, allowing them to invest in other services. In exchange, the states and territories have agreed to contribute up to one-third of their Goods and Service (GST) revenue to the federal government.

In addition, hospitals will now be paid for each service they provide rather than through block grants. Prime Minster Julia Gillard said that this new funding arrangement will help hospitals meet increasing demands and shorten hospital waiting lists, as well as increase accountability.

Sources:
http://www.heraldsun.com.au/news/julia-gillards-legislation-for-health-reforms-to-cure-system/story-e6frf7jo-1225943294921  

http://www.smh.com.au/national/government-to-introduce-health-reforms-20101025-16zvf.html  

http://www.health.gov.au/internet/main/publishing.nsf/Content/sooph10/$file/SoOPH_2010_FINAL%20REPORT.pdf

The German parliament officially passed Health Minister Phillip Roesler's health reform bill on November 12, 2010. Health care system changes include increases to public insurance premium contributions starting in January 2011—from 14.9 percent of employees’ gross income to 15.5 percent of income. Contributions are to be split between employers and workers, at 7.3 percent and 8.2 percent respectively. Previously, premiums had been split equally between employers and workers. This premium contribution increase is expected to bring in an extra €6 billion per year.

Health insurance has been mandatory for all citizens since 2009, either through the public or private market. All employed citizens earning less than €4,163 (US$5,262) per month or €49,950 (US$63,142) per year (in 2010) are covered by a mandatory public health insurance scheme. The new law allows public insurers that have a deficit to charge an additional fee from each member, ranging approximately from €8 to €15 per month. Sixteen insurance companies levied additional payments in 2010. Minister Roesler believes that the law will help ease the burden of an aging population and the rising cost of treatments, helping to close up an €11 billion deficit in the public health care system.

The law will also end pharmaceutical companies’ ability to price their drugs freely. Pharmaceutical companies will be able to charge their own prices on brand-name drugs during the drug’s first year of marketing. But within this first year, drug companies must negotiate pricing with health insurers for subsequent years. If an agreement is not met within this time frame, Germany’s independent drug and medical treatment review body, the Institute for Quality and Efficiency in Healthcare, will have the authority to assess the drug’s cost-effectiveness and make recommendations for pricing. Minister Roesler said that this will help to create a balance between giving people having access to the latest medications and controlling drug costs.

Sources:
http://www.thelocal.de/politics/20101112-31135.html  

http://online.wsj.com/article/SB10001424052748703848204575608361174337040.html (subscription needed)

http://online.wsj.com/article/BT-CO-20100922-706752.html (subscription needed)

http://www.google.com/hostednews/afp/article/ALeqM5i3yYO0OFzn2deSmRJRxlQ5HSF50w

http://www.dw-world.de/dw/article/0,,6031043,00.html

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/International-Profiles-of-Health-Care-Systems.aspx

Revenues from Norway’s oil reserves have allowed the country to manage a robust economic policy throughout the current financial crisis. The recently released 2011 state budget, however, is the first step toward restricting public spending to 4 percent of oil revenues. The health care sector is still prioritized in the overall budget: 13 percent of total expenditure has been allocated to health care services (a growth of 1.4%), representing a total of US$133.6 billion. Priorities include funds for new hospitals and preparations for upcoming care coordination reforms.

Approximately US$25 million have been earmarked for municipal level organizations called Local Medical Centers (LMC), which aim to provide comprehensive, coordinated medical care to patients on a local level. LMCs are considered an intermediary between primary and highly specialized care, and coordinate their care with community social services. While LMCs do not provide emergency care, the LMC can be an efficient alternative to hospital care in many cases. The government has also stated that there will be additional funding for nursing homes to meet the demand for nursing homes beds by 2015.

Source:
http://www.tnp.no/2000-2011-budget-better-health-and-welfare  

Health Minister Tony Ryall announced the 25 providers and provider groups selected to develop and deliver Whanau Ora services to New Zealand Maori. Whanau Ora is an inclusive, integrated approach to providing health and social services to families across New Zealand that empowers families as a whole, rather than working on separate issues with individual family members. The successful applicants were chosen from 130 proposals and were selected for their readiness to provide services, scale of operation, scope of service provision, history of service delivery and outcomes achieved, and the quality of relationships within provider groups.

The selected providers include a wide range of organizations—some are existing Maori Primary Health Organizations (PHOs) that will expand their scope to integrate a range of services and providers, such as mental health care, smoking cessation programs, and fighting truancy; others are separate organizations that would work closely with a PHO at the point of the individual or family in need of assistance. Minister Ryall also launched the $6.6 million Whanau Integration, Innovation and Engagement Fund, open to these Whanau Ora providers as well as nongovernmental organizations.

Sources:
http://beehive.govt.nz/release/five+cars+driveway+down+one

http://nzdoctor.co.nz/un-doctored/2010/october-2010/29/whanau-fund-launched-.aspx

http://nzdoctor.co.nz/un-doctored/2010/october-2010/29/whaenau-ora-providers-shows-widening-enthusiasm-for-whaenau-centered-services-.aspx  

The New Zealand House of Representatives passed the New Zealand Public Health and Disability Amendment bill with unanimous support from all parties. Following the recommendations of the Ministerial Review Group last year, the bill will amend the New Zealand Public Health and Disability Act of 2000 and establish a new Health Quality and Safety Commission. The Commission will be tasked with advising the Health Minister on any epidemiological and quality assurance matters; determining quality and safety measures for health services provided in the health and disability system; and leading and coordinating work to monitor and improve quality and safety in the health and disability system. Upon consulting the Commission, the Minister is also able to authorize it to perform any other quality improvement and safety-related functions within the health and disability system.

The Amendment also requires district health boards (DHBs) to collaborate with relevant organizations to plan and coordinate care, and to deliver the most effective and efficient health services to meet local, regional, and national needs. To support DHBs on how to comply with these new responsibilities, the Ministry of Health will provide direction on how administrative, support, and procurement services should be obtained and who should provide these services.

Sources:
http://www.parliament.nz/en-NZ/PB/Legislation/Bills/BillsDigests/9/f/9/49PLLawBD17731-New-Zealand-Public-Health-and-Disability-Amendment.htm  

http://beehive.govt.nz/release/health+law+passed+unanimous+support

A major Dutch health insurer recently published its hospital rankings on breast cancer surgery. The list includes four hospitals (down from six, previously) with whom the insurer, Central Zorgverzekeraar (Central Health Insurer, CZ), will no longer contract because of their low rank. The rankings are primarily based on the volume of operations performed each year. CZ determined that at least 70 operations must be performed annually to ensure quality of care.

In response to CZ’s announcement that it would not contract with poorly ranking hospitals (which CZ made prior to the publication of the list), the Dutch Health Inspectorate reaffirmed that all breast cancer treatment in the Netherlands must meet standards of care, and the Dutch Association of Surgeons accused CZ of using standards that the insurer had set independently and arbitrarily. The Dutch Hospital Association, claiming the rankings to be misleading and damaging, filed suit in court to block publication of the list; the judges barred CZ from publishing its list until hospitals had been given the right of reply.

Source:
http://www.bmj.com/content/341/bmj.c6853.full