Correspondents: Aisha Gomez and Roosa Tikkanen, the Commonwealth Fund

The Australian government has announced reforms that aim to make private health insurance simpler and more affordable. The reforms will introduce standardized plans — gold, silver, bronze, and basic — that will make it easier to compare and choose coverage. Seniors are also expected to see cheaper premiums as a result of lower government-negotiated prices for implanted medical devices. To encourage younger adults ages 18 to 29 to sign up for coverage, the government will allow insurers to offer a 10 percent discount on hospital insurance premiums, as well as the option to expand existing coverage to include mental health treatment. In addition, health insurers will be able to pay for travel and lodging for Australians living in rural communities. More than half of all Australians currently have private health insurance.

• Health insurance reforms to help seniors
• Major reforms to make private health insurance simpler and more affordable
• Reforms to make health insurance cheaper and easier to work out

Correspondents: Aisha Gomez and Roosa Tikkanen, the Commonwealth Fund

The Australian government has launched a new mental health website — Head to Health — as part of an AUD 4 billion national investment in preventive mental health care. The website aims to reach people before they have a mental health crisis, through digital tools that complement face-to-face therapy. The site serves as a one-stop shop for services and resources, and is set to expand to include telephone support for patients and health professionals. Each year, an estimated one of five working-age Australians experiences mental illness.

• Australia’s new digital mental health gateway now live

Correspondents: Aisha Gomez and Roosa Tikkanen, the Commonwealth Fund

The Australian National Health and Medical Research Council has awarded AUD 2.5 million to set up the new Centre for Research Excellence in Digital Health. Over the next five years, the Centre will bring together health informatics scholars across all Australian universities, frontline service providers, and industry leaders to collaborate on research, policy development, and training. The research will focus on ensuring the safety and quality of digital health systems; translating the next generation of clinical decision support technologies; and ensuring successful implementation of consumer digital health tools. The Centre also will develop an automated IT critical incident database that will disseminate critical alerts in response to risks identified in reports collated from national and international databases.

• National digital health research centre to set up IT critical incident database
• Macquarie University to lead new national Centre for Research Excellence in Digital Health

Correspondents: Aisha Gomez and Roosa Tikkanen, the Commonwealth Fund

In October, the Minister of Health and Long-Term Care of Ontario, Eric Hoskins, M.D., announced funding for an additional 2.6 million hours of home care. The majority of hours will be devoted to assisting individuals with personal support services such as help with bathing, dressing, and exercising. Additional hours are earmarked for respite services for caregivers, nursing care, and services such as physiotherapy and occupational therapy. The province also will create new models for clients and caregivers that aim to give them more control over their care and launch a caregiver organization to give them a single point of access for information, services, and other resources.

• Ontario Boosting Nursing, Personal Support in Major Expansion of Home Care

Correspondents: Aisha Gomez and Roosa Tikkanen, the Commonwealth Fund

Since medically assisted death was legalized in June 2016, more than 2,000 Canadians have chosen to end their lives with the help of a doctor, according to a new report released by Health Canada. In a one-year period, the number of assisted deaths has accelerated, with 1,179 deaths recorded during the first six months of 2017 compared with 803 deaths during the first six months after legalization. The report finds that trends in medically assisted deaths were comparable to other parts of the world where the practice is legal, including Oregon, the Netherlands, and Belgium. Only 1 percent of all deaths in Canada were medically assisted, and the majority of cases, 63 percent, represented cancer patients. Patients had an average age of 73 at the time of death, and increasingly chose to end their lives at home instead of in hospital settings.

• Health Canada says more than 2,000 medically assisted deaths since legalization

Correspondents: Aisha Gomez and Roosa Tikkanen, the Commonwealth Fund

In October 2017, Canada’s provincial and territorial health ministers attended a two-day meeting last fall in Edmonton to discuss the nation’s most pressing health concerns. Among the top priorities were collaborative efforts to address the opioid epidemic, which ministers acknowledged has become a national public health crisis. Among the strategies discussed were an electronic prescription database that would be available across provincial borders, harm reduction measures, and addressing regulatory barriers. The two-day meeting also covered other priorities such as cannabis legalization, prescription drug coverage and access, home and indigenous health, and mental health.

• Health ministers looking at electronic database to fight opioid crisis
• Conference of Provincial-Territorial Ministers of Health
• FPT Communique - Health Ministers' Meeting (HMM)

Correspondent: Paul Dourgnon

In France, the government sets a theoretical upper limit for how much public health insurance expenditures can grow each year. For 2018, the cap has been set at 2.3 percent of the previous year's total spending — much lower than the estimated natural growth trend of 4.5 percent. According to these forecasts, the Public Health Insurance Scheme would need to save approximately €4.2 billion in 2018 to meet the 2.3 percent growth cap. To help compensate for impending budget cuts to meet this target, patients’ deductibles for inpatient stays are set to increase by 2 percent. France has set upper spending limits for public health insurance since 1997.

• Assurance-maladie: 4,2 milliards d'économies en 2018
• Projet de loi de financement de la sécurité sociale 2018

Correspondent: Isabelle Scholl

The German Federal Joint Committee has announced a call for research proposals focusing on two areas: new and innovative health care models and health services research. The Committee’s Innovation Fund is tasked with financing research that will inform ways to improve the existing statutory health insurance system in Germany between 2016 and 2019. The Fund allocates €300 million each year, of which €225 million are earmarked for evaluations of new and innovative care models and €75 million for health services research. The announcement outlined six priority funding areas for innovative care models including models for vulnerable patients, and four priority areas for health services research including patient safety and quality improvement.

• Innovationsausschuss veröffentlicht weitere Förderbekanntmachungen
• Der Innovationsfonds und der Innovationsausschuss beim Gemeinsamen Bundesausschuss

Correspondent: Isabelle Scholl

The number of care workers in nursing homes has more than doubled since 2013, from 28,000 to approximately 60,000 in 2017, according to the latest figures released by the German Ministry of Health. This increase translates to more than four additional care staff per nursing home. These personal caregivers provide a supportive function to nurses, helping residents with activities of daily living, doing their exercises, reading together, or going for walks. A statement released by the Ministry attributed the workforce increase to the government’s nursing care reforms enacted in recent years.

• Zahl der zusätzlichen Betreuungskräfte in Pflegeeinrichtungen steigt auf 60.000

Correspondent: Isabelle Scholl

The German Ministry of Health has launched a nationwide helpline that will provide information on long-term care to individuals who need care services, as well as to caregivers and relatives. German residents can talk to qualified care advisors about any topic relating to long-term care, such as a person’s right to personal care services or the level of nursing services available in their region. Approximately 500 municipalities, 12 of the country’s 16 states, and the federal government already joined this help line collaboration, making it available to 43 million residents, or approximately half the population. The caregiving help line can be accessed Monday to Friday from 8 a.m. to 6 p.m., and is funded as part of the Ministry’s annual $5 billion investment to support long-term care.

• Die 115 als Wegweiser für Pflegebedürftige und pflegende Angehörige

Correspondent: Isabelle Scholl

The absolute increase in health insurance spending in Germany dropped to 3.6 percent in the first half of 2017 — the lowest figure recorded in the past three years, according to the Germany Ministry of Health’s financial results for the Statutory Health Insurance (SHI). The absolute increase in health insurance spending has dropped from 5.7 percent in 2014 to 4.3 percent in 2015 and 4.2 percent in 2016. Spending slowed despite the SHI covering an additional 1.2 million people compared to 2016. Individuals who newly registered for SHI are younger and claim less health benefits, which has likely contributed to the flattening of health care expenditures.

• Finanzreserven der Krankenkassen steigen auf 17,5 Milliarden Euro

Correspondent: Marthe Haverkamp

Seven months after the Dutch general election in March 2017, a new cabinet was sworn in under Prime Minister Mark Rutte. The Ministry of Health, Welfare and Sport is now led by two ministers, Hugo de Jonge of the Christian Democratic Appeal party and Bruno Bruins of the People’s Party for Freedom and Democracy. De Jonge will be responsible for youth health care, district nursing, quality of care, and medical-ethical decisions; Bruins for curative care, the health care insurance market, pharma, and infectious disease prevention. Paul Blokhuis of the Christian Union party will function as State Secretary of Health, Welfare and Sport, and will be responsible for behavioral health.

• Rutte Finalizing New Dutch Cabinet After Record-Long Coalition Talks
• Portefeuilleverdeling op VWS
• ‘Kabinet wil niet stilstaan op medisch-ethisch vlak’

Correspondent: Marthe Haverkamp

The Dutch Council for Health and Society (known as RVS in the Netherlands) is an authoritative national advisory board that makes recommendations on issues concerning public health and society. In October, RVS published a report that recommends changing the way health care is currently purchased by health insurers in selective and detailed contracts with providers. It states that the current system with competing private health insurers that was introduced in 2006 has failed to create sufficient value. RVS proposes to stop the annual selective contracting and its requirements as a means to improve health care delivery and to focus instead on professional responsibility and the power of patients to choose the best provider.

• A focus on the healthcare relationship

In an effort to curb spending on expensive hospital drugs, Dutch hospitals and insurance companies will launch a pilot project in 2018 to jointly buy cancer drugs. The alliance aims to give payers and providers a stronger position when negotiating prices with pharmaceutical companies, thereby cutting costs. The pilot project will focus on leukemia medications, which cost the Dutch health care system €30 million each year.

• Hospitals and insurers experiment with cancer drugs purchase alliance
• Verzekeraars en ziekenhuizen gaan samen dure medicijnen inkopen

Correspondent: Birgitte Graverholt

Norway has one of the highest rates of intestinal cancer in the world, particularly among people age 55 and older. The Norwegian government has announced plans to offer every citizen free colorectal cancer screening the year they turn 55. The program would start in 2019, with an aim to cover the entire population within a five-year period. The government’s 2018 budget proposal included funds for health information technology infrastructure, health care professionals recruitment, training, and new screening facilities.

• Tarmkreftscreening til alle 55-åringer

New numbers show that 78 percent of Norwegians diagnosed with cancer in 2017 were enrolled in Cancer Pathways. The Pathways are national, standardized care pathways where the overall aims are efficient and rapid diagnosis and treatment. On a national level, 70 percent of cases were treated according to the pathway recommendations, which represents an improvement from the year before.

• Kreftpasienter får raskere behandling i pakkeforløp

Correspondent: Aisha Gomez, the Commonwealth Fund

In 2015, the New Zealand government invested over NZD 3 million to boost access to patient portals. In the past year alone, the number of individuals registering with their general practice’s patient portal doubled. More than 400,000 patients — up from 233,839 in 2016 — signed up to access their medical records, save time on booking appointments, request repeat prescriptions, and more. Patient portals also save practices time spent on administrative tasks, freeing up more time to spend with patients. However, less than half of all general practices currently offer patient portals; Health Minister Jonathan Coleman would like to see more practices adopt them.

• Patient portal registrations more than double

Correspondent: Aisha Gomez, the Commonwealth Fund

For the first time ever, New Zealand has successfully eliminated endemic measles and rubella, two deadly childhood diseases. This means that there have been no cases of these diseases that have originated in New Zealand in the past three years, although infected people can still bring in the disease from overseas. The World Health Organization, which is responsible for verifying countries for successfully eliminating diseases, made the official announcement at its Regional Committee for the Western Pacific’s annual meeting.

• Measles and rubella officially eliminated in New Zealand

Correspondent: Aisha Gomez, the Commonwealth Fund

Healthy Families NZ — an initiative by the federal government to help New Zealanders think differently about healthy life changes — received positive results in its first interim evaluation. The report found that approaching the community with integrity and targeted purpose, the program has strengthen preventive measures and the promotion of healthy environments for over a million residents across 10 locations. The initiative receives an annual stipend of NZD 10 million and is designed to receive ongoing evaluations, with the next slated for mid-2018.

• Healthy Families NZ a promising approach

Correspondent: Roosa Tikkanen, the Commonwealth Fund

Health care is among the top priorities in the Swedish government’s budget proposal for 2018. Overall, the proposal devotes SEK 4.7 billion ($592 million) to health care. One billion kronor is earmarked for strengthening primary care coordination, particularly for patients with complex care needs, over three years (2018–2021). Another one billion kronor per year will be invested in maternity care over the next four years. The proposal also prioritizes mental health, increasing the budget allocation from 650 million kronor in 2018 to more than one billion kronor in years 2019 and 2020. In addition, the government has proposed making free Pap screenings available to all women.

• Healthcare, policing and climate among six key points in Sweden's 2018 budget
• Reforms for increased security and welfare in the Budget Bill for 2018

Correspondent: Roosa Tikkanen, the Commonwealth Fund

Falls are the most common form of injury leading to death in Sweden. Recent statistics from the National Board of Health and Welfare in Sweden show that in 2016, a thousand deaths resulted from fall injuries, and this number has been steadily increasing since 2000. What’s more, 69,000 individuals were hospitalized as a result of falling. The Director-General of the Swedish National Board of Health and Welfare has described falls as a “public health problem” and called for a more structured approach to finding solutions. The Swedish government held a nationwide public education campaign in October entitled “Balance More” that included tips to prevent fall injuries in daily life.

• Fallolyckor i hemmet ett folkhälsoproblem
• Balansera mera- kampanj för att förhindra fallolyckor

Correspondent: Roosa Tikkanen, the Commonwealth Fund

To reduce variation in and improve the quality of end-of-life care, the Swedish National Board of Health and Welfare has rolled out six quality measures. The measures were introduced following the release of data showing large variation in palliative care quality across the country. The six measures were drafted by an expert group comprising health administrators, medical experts, and patient group representatives. The quality indicators set expectations for the percentage of patients to be assessed for oral health, pain management, use of opioid painkillers and anxiety medications, pressure sores, and physician discussions about end-of-life decisions. Progress toward meeting the new goals will be carried out in the next two to four years.

• Målnivåer ska förbättra vården i livets slutskede

Correspondent: Lars Hemkens

The standard premiums for Swiss mandatory health insurance for adults age 18 and older will increase on average by 4.0 percent in 2018, the Swiss government announced — more than the 3.7 percent per year seen over the past 10 years. Premiums for children and for young adults ages 19–25 years will increase even more, by 5.0 percent and 4.4 percent, respectively. These average increases do not reflect regional variation, however. Eight cantons will see a smaller increase of only 3.0 percent for adult premiums, while four cantons will see a full 5.0 percent increase.

• Swiss health insurance premiums to rise four percent on average in 2018
• Wachstum der Gesundheitskosten: Standardprämie 2018 steigt um 4,0 Prozent

Correspondents: Aisha Gomez and Roosa Tikkanen, the Commonwealth Fund

The National Health Service (NHS) has announced new measures to strengthen the country's nursing workforce to meet future demands. The reforms will fund 5,170 additional clinical placements for nursing degrees as well as 5,000 nursing associate training places starting in 2018. Nursing associate degrees offer a new, work-based route into nursing for those unable to commit to a full-time university degree. The NHS also will introduce flexible working arrangements for staff in order to improve work–life balance and retain experienced staff. Health Secretary Jeremy Hunt described the move as representing “the biggest increase in nurse training places in the history of the NHS.”

• Health Secretary announces nursing workforce reforms

Correspondents: Aisha Gomez and Roosa Tikkanen, the Commonwealth Fund

NHS England’s National Cancer Programme released a report describing major changes planned for the next few years. The measures form part of the NHS’s five-year national cancer strategy, developed in 2015. The NHS has earmarked £130 million for modernizing radiotherapy equipment, as well as £200 million for new care models that aim to ensure earlier detection and improved survival. In addition, the NHS is testing two new quality metrics: a patient quality-of-life indicator that measures patients’ post-treatment outcomes, as well as a faster diagnosis standard that ensures patients receive a cancer diagnosis or an “all-clear” verdict within 28 days.

• New technology, earlier diagnosis and better coordination of care in cancer
• New quality of life measure for recovering cancer patients

Correspondents: Aisha Gomez and Roosa Tikkanen, the Commonwealth Fund

A new report released by the NHS showcases five leading health care providers that are using innovative approaches to integrate digital tools into frontline care delivery systems. The vanguards demonstrate how technology can be harnessed to deliver personalized care to better meet individual needs, as well as break down silos between primary, secondary, and social care services. The report was developed by the NHS Confederation, NHS Providers, NHS Clinical Commissioners, and the Local Government Association as part of NHS England’s new care models program, launched in 2015 to deliver on the NHS Five Year Forward View.

• New care models: Harnessing technology
• Vanguards offer key lessons for harnessing tech in new care models

Co-editors: Aisha Gomez (Australia, Canada, New Zealand), Molly Fitzgerald (UK), and Roosa Tikkanen (Sweden)

Country Correspondents: Paul Dourgnon (France), Isabelle Scholl (Germany), Marthe Haverkamp (Netherlands), Birgitte Graverholt (Norway), and Lars Hemkens (Switzerland)