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Commonwealth Fund International Health News Brief: 2018, No. 5

International Health News Brief Australia

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“My Health Record” Improving Patient Outcomes in Australia

Country Correspondent: Sonĵ Hall

An electronic medical record used by providers and patients is now being rolled out across Australia. “My Health Record” is designed to increase connectivity across the system, reduce waste, and improve care quality and outcomes. Patients may select which providers are allowed access to their record. After a national initiative to “opt in” to the record proved unsuccessful, Australians may now choose to opt out before November 15, 2018.

The Australian government has developed a framework for the use and protection of the My Health Record for public health and research purposes. Patients across Australia will benefit from 15 new research projects that use information from consenting patients’ records. This AUD 8.5 million (USD 6 million) “Digital Health Test Beds” program will test new approaches in chronic health, palliative care, and post hospital support.

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Canada

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Team-Based Care Key to Primary Health Care Strategy in British Columbia

Country Correspondent: Aisha Gomez

Last spring, British Columbia launched several initiatives to strengthen primary care. The province aims to recruit 200 graduating family physicians and 200 nurse practitioners into team-based practices within newly established primary care networks. Practices will be paid through alternative payment arrangements instead of traditional fee-for-service payments. The strategy seeks to provide recent medical graduates a steady level of compensation, a better work–life balance, support from a team of health professionals, and more time to provide patient-centered care. The province also will expand primary care networks across 70 percent of British Columbia communities over the next three years, add 10 new urgent primary care centers, and create community health centers that offer integrated preventive health care and social services.

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Simple, Safe, Secure, and Free Access to Digital Health Records for Québec Patients

Country Correspondent: Aisha Gomez

Last spring, Québec launched Carnet Santé Québec, a digital portal that allows patients in the province to access their own health records from their computers, tablets, or smart phones — all for free. Currently, patients can access a list of medications, imaging and lab results for the past five years, and medical bills. In the future, the portal will show all medical interventions received and a patient’s progress on wait lists. It also will allow patients to book family physician appointments. The portal will be rolled out provincewide over the next two years, with an initial cost of CAD 11 million (USD 8.43 million) and annual maintenance costs of CAD 2 million (USD 1.53 million).

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McGill First in North America to Use Augmented Reality Technology for Target-Guided Surgery

Country Correspondent: Aisha Gomez

Target-guided surgery — which uses augmented reality to allow surgeons to conduct complicated surgeries with greater precision and accuracy — is being used in North America for the first time at the McGill University Health Center. The German technology creates a roadmap derived from the patient scans that are displayed on monitors during surgery to help surgeons navigate across delicate areas of the body, such as the sinuses. Equipped with alerts and guiding mechanisms, the system provides surgeons, especially inexperienced ones, with an additional safety net during difficult surgeries. The tool also allows doctors to study a patient’s anatomy before surgery.

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Europe

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Health Spending in Industrialized Countries Is Slowly Picking Up After the Global Recession

Correspondent: Roosa Tikkanen

A new report finds that health spending grew 3.4 percent in 2016 across 36 countries in the Organisation for Economic Co-operation and Development (OECD), the fastest rate since 2009. This rate remains lower than before the financial crisis, when health spending grew around 4 percent to 6 percent per year across countries. While long-term care was the fastest-growing spending area before the financial crisis, spending on outpatient care (up 4.4%) has now outpaced growth in long-term care spending (up 3%) and inpatient care spending (up 2.2%). Retail pharmaceutical spending has remained flat or negative in previous years but is now back on a growth path, at around 3 percent per year on average across OECD countries. This trend is partly the result of the introduction of expensive hepatitis C and oncology drugs.

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European Union Launches Three-Year Initiative on “Health Equity in Europe”

Country Correspondent: Roosa Tikkanen

In June, the European Commission held its first meeting in Luxembourg on the Joint Action on Health Inequalities. The initiative aims to achieve greater equality in health outcomes for all social groups across 28 participating countries, with a focus on migrants and other vulnerable groups, socioeconomic determinants of health, and lifestyle-related health factors. The objectives of the meeting included implementing and transferring best practices across countries, with eight work packages focusing on promotion, design, and implementation of concrete actions. The initiative has a combined budget of EUR 3.125 million (USD 3.56 million).

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France

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Public Health Insurance Launches Local Units Targeting French Patients Giving Up on Health Care

Country Correspondent: Paul Dourgnon

Although France has one of the lowest out-of-pocket health expenditure rates among wealthy nations, it ranks poorly on rates of patients skipping needed care because of costs. Following a successful experiment in the Gard region of southern France, a network of units aimed at tackling patients who skip needed care has been rolled out in 101 local public health insurance offices. The units aim to identify people who are likely to skip care based on patient data from doctors, social workers, and nongovernmental organizations. Working with these patients, their medical providers and caregivers, and a social worker, the units will then design an individualized plan for the patients to re-engage with their health care. So far, 35,000 insured people have benefited from the program.

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Germany

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German Innovation Fund Supports More Than 200 Projects During Its First Two Years

Country Correspondent: Michael Laxy

The German Joint Federal Committee launched the Innovation Fund in 2015 to improve quality of care and promote innovation in the statutory health care system. With a budget of EUR 1.2 billion (USD 1.37 billion), it was created to support new care models and health systems research over four years. During its first two years, more than 200 projects involving collaborations between insurers and providers were funded. The majority of projects include university hospitals as partners. Projects include the Health Kiosk in Billsted/Horn, which aims to improve access to care for an urban population with a high chronic disease burden, and StimMT, which integrates care through a regional provider network and a coordination center. The fund was recently extended for an additional four years because it has exceeded initial expectations. The first evaluation results are expected in the next two years.

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Netherlands

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Dutch Minister of Health Care Proposes Measures to Limit Drug Prices

Country Correspondent: Margje Haverkamp

Under Dutch law, drug prices may not exceed the mean price of that drug in four neighboring countries: Belgium, France, Great Britain, and Germany. The Dutch health care minister, Bruno Bruins, has suggested dropping Germany as a comparison country, in favor of Norway or Sweden, starting in 2020, because German prices are higher compared to the Nordic countries. In addition, Bruins wants to increase patient cost sharing for some expensive drugs for which therapeutically equivalent, cheaper versions are available. Bruins also proposed limiting patient cost sharing for these drugs to EUR 250 (USD 285) per patient per year, on top of the existing EUR 385 (USD 439) deductible that currently applies to health care costs. These changes are expected to save EUR 467 million (USD 533 million) on drug spending between 2019 and 2021.

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New Zealand

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New App Trains Educators in New Zealand as Digital Health Workers

Country Correspondent: Aisha Gomez

To address shortages of health care professionals in New Zealand, a new micro-credentialing program offered through an app allows teachers to complete 200 hours of training as digital health care workers, for free. The digital credentials, called EduBits and developed with Otago Polytechnic, enable teachers at schools and day care centers to securely send student health information, about head lice or strep throat, for example, to a digital health team in Auckland. There, digital health assessors respond with a diagnosis and treatment plan and send prescriptions to the parents or caregivers via the app, which is called iMOKO. The iMOKO program has provided credentials to up to 300 educators across New Zealand.

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Royal New Zealand College of General Practitioners Promotes Choosing Wisely Recommendations

Country Correspondent: Aisha Gomez

The recommendations from the Choosing Wisely campaign that educates health professionals and patients on treatments, tests, and procedures that are potentially unnecessary or harmful have been endorsed by the Royal New Zealand College of General Practitioners. The college has been promoting these recommendations to general practitioners through their electronic weekly newsletter as a "tip of the week." The college has endorsed several measures that recommend avoiding: overprescribing antibiotics for upper respiratory infections; ordering unnecessary CT scans on otherwise healthy emergency room patients; and prescribing benzodiazepines to older adults. The college has decided not to create its own list of recommendations since many of the Choosing Wisely recommendations are applicable to general practitioners who are often faced with limited resources, overwhelming workloads, and little time with patients.

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Norway

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Telecare Services for Norwegians with Chronic Conditions

Country Correspondent: Marianne Storm

The Norwegian Ministry of Health and Care Services has provided NOK 18.5 million (USD 2.2 million) for 2018 to 2021 for continued testing of telehealth services for individuals with chronic health conditions at risk of deterioration. Six Norwegian municipalities will participate in the project, which will include municipal health and care services and general practitioner offices. The project will focus on exploring the effectiveness of telehealth services on follow-up of chronic medical and mental health conditions, user satisfaction, and health care costs.

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Norwegian Government’s Quality Reform for the Elderly

Country Correspondent: Marianne Storm

A new Norwegian program, Live Your Whole Life (Å leve hele livet), has been launched to offer solutions for municipalities to help ensure safe and healthy aging for their residents. The main aim is to spread and implement innovative approaches to support aging at home, social inclusion and community integration of seniors, provision of meals and/or nutrition services, and continuous and coordinated health care services. The federal government will provide financial support to help ensure spread and local adaption of the models. State funding plans will be implemented prioritizing solutions that are implemented in municipalities.

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Sweden

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New Data on the Use of Digital Health Care Services in Sweden

Country Correspondent: Roosa Tikkanen

The Swedish National Board of Health and Welfare (Socialstyrelsen) has released a report highlighting the use of digital health care services. In Sweden, digital health consultations are offered by public and private providers including doctors, midwives, and physiotherapists for services ranging from diagnostic tests and examinations to nurse triage. Services are provided via video chat or text messaging, and providers are reimbursed SEK 650 (USD 71) per consultation. The report includes data for 361,910 digital visits provided over two years by three of the largest digital providers in the country. Patients living in urban areas and those age 50 or younger were the most frequent users, and skin diseases and infections were among the most common reasons for visits. In Sweden, most counties offer some form of digital health services, and the number of digital visits has increased threefold in just one year.

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First “Patient Billion” Paid to Swedish County Councils to Improve Primary Care Access

Country Correspondent: Roosa Tikkanen

The Swedish Government has allocated approximately SEK 3 billion (USD 328.4 million) to be paid from 2018 through 2021 to strengthen primary care for patients. Last spring, the first “patient billion” was paid to Sweden’s 21 county councils; the amount per county was based on population size. The funds will be used for two purposes: Starting in 2019, patients will be guaranteed to receive a medical evaluation within three days of seeking care, faster than the current guarantee of seven days. Second, funds will support the implementation of a patient contract, a personalized care plan to help coordinate care among multiple providers. County councils will be responsible for developing the necessary infrastructure to enable sharing treatment plans with patients and their caregivers and booking appointments online.

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Medical Community Criticizes Sweden’s Plan to Introduce Rehabilitation Coordinators Reduce Sick Leave

Country Correspondent: Roosa Tikkanen

Sweden has passed a law that will shift the responsibility of managing high rates of absenteeism from employers to the primary care sector. Starting in 2019, primary care practices will be mandated by law to have rehabilitation coordinators, who will be responsible for creating reentry plans for individuals returning to work after a lengthy sick leave. In a recent opinion article in a medical journal (Läkartidningen), the medical community criticized the new law, raising concerns over the lack of evidence to support the effectiveness of rehabilitation coordinators in reducing absenteeism. The medical community also felt that they were not adequately consulted in drafting the new law and were concerned over the lack of clarity dividing responsibilities between rehabilitation coordinators and primary care doctors.

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Switzerland

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Swiss Federal Council Proposes Relief for Workers Who Provide Care for Sick Family Members

Country Correspondent: Lars Hemkens

The Swiss government wants to make it easier for employed people to provide care for family members. The Federal Council proposes a legal obligation for employers to continue salary payments during short work absences to provide necessary care for relatives, including seriously ill or injured children. The goal is to ensure that family caregivers are able to remain in their jobs, given that the country faces a shortage of skilled care workers.

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United Kingdom

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NHS England to Introduce a System for Monitoring Medication Errors

Country Correspondent: Molly FitzGerald

In an effort to reduce medication errors, the English National Health Service (NHS) is implementing a system that will link primary care prescribing data to hospital admissions. Minister of State for Social Care Caroline Dinenage says the estimated 237 million medication errors per year necessitate finding a consistent way to measure these errors in the NHS and provide data to improve care and reduce costs. Other measures to reduce medication errors and increase transparency will be introduced in conjunction with these indicators, including the acceleration of implementing electronic prescribing systems across more NHS hospitals.

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England Offers Financial Support for Local Programs Serving People at Risk of a Mental Health Crisis

Country Correspondent: Molly FitzGerald

A new program in England will distribute GBP 15 million (USD 19.3 million) across 51 local projects supporting people at risk of a mental health crisis. The Beyond Places of Safety program seeks to reduce accident and emergency visits among people experiencing a mental health crisis by integrating health and care support with other services such as housing, improving partnerships with the voluntary and community sectors, and providing safe spaces for those in distress. According to Jackie Doyle-Price, the U.K. minister for mental health, inequalities, and suicide prevention, the projects “will provide a safety net for those at risk of mental health crisis and make sure they receive the care they need in a safe and secure setting.”

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Cross-Government Support in England for Unpaid Caregivers

Country Correspondent: Molly FitzGerald

The Department of Health and Social Care has released a two-year action plan to support people who provide unpaid care for a family member or friend in England. Ministers from the Government Equalities Office and various departments, including business, energy and industrial strategy, and work and pensions, contributed to and invested in the plan, which was informed by views from nearly 7,000 people. Specific measures include a new program to improve employment support for caregivers and a review of best practices in the identification of young caregivers.

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Lord Darzi Appointed Chair of Accelerated Access Collaborative in U.K.

Lord Ara Darzi, a former Minister in the Department of Health and Social Care, was appointed chair of the Accelerated Access Collaborative. Bringing together leaders from the NHS, industry, and government, the collaborative seeks to identify transformative medical innovations and accelerate their clinical development and NHS approval. As a result, products for the treatment of diseases such as cancer, diabetes, and dementia may be available on the NHS up to four years earlier. Lord Darzi stated that giving patients faster access to “cost-effective, transformative treatments on the NHS” will both improve health and benefit the British economy by creating jobs.

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Commonwealth Fund International Health News Brief: 2018, No. 5