International Health News Brief: 2019 no. 6
Correspondent: Roosa Tikkanen
OECD Releases New Health Spending Projections for High-Income Countries, Including U.S.
The Organisation for Economic Co-operation and Development estimates that by 2030, health spending across OECD countries will average between 9.6 percent and 10.8 percent of gross domestic product, up from 8.8 percent in 2015. The new estimates, which cover 36 high-income member countries, were modeled for a “base scenario” that assumes no major policy changes as well as alternative scenarios in which policies considered to be effective in reining in health care costs — health technology assessment, health workforce regulations such as task-shifting, and strengthened health promotion and prevention activities — have been implemented. The analysis also modeled the effect of policies considered to be ineffective in containing costs.
Under most scenarios, growth in health spending per capita is projected to be slower than historical growth but higher than inflation. By 2030, U.S. health care spending is expected to account for 19.3 to 21.3 percent of GDP — up from the current 16.8 percent — depending on which policy levers will be implemented.
How Do Countries Track and Project Future Pharmaceutical Spending?
All high-income countries are facing escalating drug costs because of the launch of expensive new hepatitis C, cancer, and biologic medications. Now a new OECD report funded in part by the European Commission looks at how 17 high-income countries track national pharmaceutical utilization and expenditures and forecast the future budget impact of expensive new drugs.
The report finds that countries use a variety of methods to calculate projected pharmaceutical spending, such as examining past spending trends; “horizon scanning” for the cost impact of new therapeutics entering the market; anticipating changes in the uptake of generic and biosimilar drugs; and monitoring changes in prescribing and treatment patterns and behaviors. The report also found that 13 countries set pharmaceutical budgets and 10 set expenditures caps at the national level.
Resolutions on Price Transparency, Migrant Health Among Highlights of World Health Assembly and G7 Health Meeting
The 72nd session of the World Health Assembly (WHA), the decision-making body of the World Health Organization (WHO), saw the adoption of resolutions to improve price transparency for drugs and medical devices; a five-year global action plan to promote the health of refugees and migrants; and the declaration of 2020 as Year of the Nurse and the Midwife.
Held in Geneva in May, the eight-day event also featured three resolutions on universal health coverage. One of these urges countries to implement the 2018 Declaration of Astana, which emphasizes the importance of primary health care as a cornerstone of universal health care, while another calls for following WHO's guidelines on optimized use of community health workers. Member states also agreed to adopt the 11th revision of the International Classification of Diseases and Related Health Problems, known as ICD-11, on January 1, 2022. The WHA session was preceded by a meeting in Paris of health ministers from the G7 countries, who issued a joint declaration on achieving access to health for all and strengthening primary care.
- Seventy-second World Health Assembly
- G7 Ministers commit to improving access to health care for all
- The G7 Primary Health Care Universal Knowledge Initiative
WHO Adopts First-Ever Guidelines for Digital Health Services
Correspondents: Marianne Storm and Roosa Tikkanen
The World Health Organization has released its first-ever guidelines for the use of digital technologies in health care, including mobile-based video consultations with providers, online prescription refill services, and “big data” for the development of artificial intelligence solutions. The guidelines, based on 11 Cochrane reviews — systematic studies that synthesize existing research — aim to provide decision-makers with evidence-based recommendations on important digital initiatives. Development of the guidelines was coordinated by the Norwegian Cochrane Center at the Norwegian Institute of Public Health.
- WHO Guideline: recommendations on digital interventions for health system strengthening
- Første WHO-retningslinje for digitale helsetenester (in Norwegian)
Correspondent: Sonĵ Hall
Supporting the Journey to Value-Based Care in Australia
The opening of the Centre for Value-Based Health Care in June by the Australian Healthcare and Hospitals Association signals a desire to create a health system focused on achieving the best possible outcomes at an affordable cost to both patients and the system. The Centre, which also hosts a think tank, the Deeble Institute for Health Policy Research, is developing and curating a collection of Australia-focused best practices and research to support health care organizations along their journey to value-based care.
Correspondent: Aisha Gomez
Opioid Crisis Stalls Canadian Gains in Life Expectancy
After four decades of increasing life expectancy, life expectancy at birth failed to increase between 2016 and 2017, according to a recent report from Statistics Canada. While older adults ages 55 to 89 are living longer, younger adults — particularly men 20 to 44 — are dying at faster rates, in large part because of accidental drug overdoses.
While new treatments for cancer and cardiovascular disease have contributed to increased longevity, these gains have been offset by overdose-related declines in life expectancy. The vast majority of drug poisonings were opioid-related, with the majority involving fentanyl or related substances. Health Canada has announced several measures to combat the opioid epidemic, including supervised consumption sites in major cities and the introduction of two new treatments, injectable hydromorphone and diacetylmorphine.
- Government of Canada approves new treatment options for opioid use disorder and supports research, treatment, and harm reduction projects in Ontario
- Changes in life expectancy by selected causes of death, 2017
- Opioid-related death count up to more than 11,500 in Canada, according to government data
Correspondent: Angèle Malâtre-Lansac
1.6 Million French Quit Smoking in Two Years, Report Shows
The French Agency of Public Health has found that 1.6 million people in France quit smoking between 2016 and 2018. According to its report, a quarter of adults smoked on a daily basis at the end of 2018, down from nearly a third in 2016. The 17 percent relative drop in tobacco consumption is said to be the result of recent antismoking measures, including an increase in price per cigarette pack that is now one of the highest in Europe; enhanced access to smoking cessation services; and public education campaigns to reduce tobacco use, including “tobacco free” Novembers. Meanwhile, use of e-cigarettes is on the rise, with nearly 4 percent of adults in 2018 reporting they were daily users of the devices — up from 2.7 percent in 2017. The report also found that unemployed and low-income individuals were more likely to be smokers than others.
- Baisse de la prévalence du tabagisme quotidien parmi les adultes : résultats du Baromètre de Santé publique France 2018 (abstract in English)
Correspondent: Michael Laxy
Germany Saves Billions with Pharmaceutical Reference Pricing
Using a pharmaceutical reference pricing system in which a maximum reimbursement price is set for each therapeutic class of drugs, Germany’s statutory health insurance system saves about EUR 8.2 billion (USD 9.14 billion) each year, according to GKV-Spitzenverband, a national association representing more than 100 statutory health insurance funds — also known as sickness funds — and long-term care insurance funds. If a drug manufacturer decides to set its price above the maximum reference price for a given drug class, patients pay the difference between the maximum and actual price.
Officials say the pricing system incentivizes physicians and their patients to choose the most effective and affordable products. For their part, pharmaceutical companies are incentivized to anchor their prices to the maximum reference price to stay competitive in the market. GKV representatives maintain that reference pricing controls costs while also ensuring quality. Meanwhile, the pharmaceutical industry has called for the use of more therapeutically relevant criteria to determine prices.
Germany was one of the first countries to introduce reference pricing 30 years ago, and the system is now used in several other countries, including France and Switzerland.
- Arzneimittelpreise: Festbeträge bringen Milliardeneinsparung (in German)
- Erfolgsmodell: Seit 30 Jahren sichern Arzneimittel-Festbeträge bezahlbare und hochwertige Versorgung (in German)
Correspondent: Margje Haverkamp
Specialists Caring for Elderly and People with Mental Disabilities to Be Reimbursed Under Statutory Insurance
Dutch Minister Bruno Bruins has announced that, starting in 2020, care provided outside of hospitals to elderly adults and to patients with mental disabilities will be reimbursed through the national health insurance scheme, known as the “basis packet.” Currently, doctors treating these patients in ambulatory care settings were paid through a special arrangement set forth in the Long Term Care Act of 2015.
The change in policy, while an acknowledgment of the value of specialized care delivered in nonhospital settings, also keeps primary care physicians the gatekeepers for secondary care. Patients will have to pay a small out-of-pocket fee to see a specialist, while visits to regular primary care physicians will remain free.
- Specialist ouderengeneeskunde en arts verstandelijk gehandicapten in basispakket (in Dutch)
- Toelichting Ontwerpbesluit, houdende wijziging van het Besluit zorgverzekering in verband met het zorgpakket Zvw 2020 (in Dutch)
Correspondent: Aisha Gomez
New Zealand Reveals Budget for “Well-Being”
In a first for a Western country, New Zealand Prime Minister Jacinda Arden introduced a “well-being” budget in May 2019. The plan highlights five priorities: supporting a transition to a sustainable and low-emissions economy; bringing the nation into the digital age; lessening inequalities faced by Maori and Pacific Islanders; reducing child poverty; and increasing support for mental health care. New metrics, including those for overall well-being and mental health, may replace more traditional metrics, such as gross domestic product, to measure budget outcomes.
The first package of funding includes NZD 320 million (USD 205 million) for domestic violence and sexual abuse victims. While governments around the world are starting to focus on developing measures of well-being, New Zealand appears to be taking the concept further than any other nation.
- New Zealand has unveiled its first ‘well-being’ budget
- New Zealand’s Next Liberal Milestone: A Budget Guided by ‘Well-Being’
- New Zealand 'wellbeing' budget promises billions to care for most vulnerable
Correspondent: Marianne Storm
More Norwegians Than Ever Participate in International “What Matters to You?” Day
Norwegians participated in “What Matters to You?” Day in record numbers this year. Held on June 6, the annual international event aims to boost patient-centered care by encouraging a shift away from clinicians asking patients, “What's wrong with you?” It was the sixth year Norway participated, with health care professionals from more than 160 municipalities and 30 hospitals taking part. The day, also marked in some 40 other countries, is coordinated by the U.S.-based Institute for Healthcare Improvement in Boston.
Sales of Sedatives and Sleep Aids Continue to Decline in Norway
Sales of sedatives and sleep medications in Norway have fallen by almost one-third in the past decade, according to a recent report from the Norwegian Institute of Public Health. At the same time, sales of melatonin — a natural hormone treatment for sleep problems that is available in Norway only by prescription — nearly tripled over that time.
The report, which provides an overview of drugs purchased wholesale by Norway’s pharmacies, hospitals, and grocery stores, shows a continuation of last year’s decline in sales of sedatives and sleep aids.
“Addictive drugs can have many negative effects, and over time there has been increased awareness of the proper prescribing and use of these drugs,” said Solveig Sakshaug, a senior adviser at the institute.
- Fortsatt nedgang i salet av beroligande middel og sovemiddel (in Norwegian)
- Legemiddelforbruket i Norge 2014–2018 (in Norwegian)
Correspondent: Ulrika Winblad
Sweden to Introduce Standardized Care Pathways for New Diagnoses
In an attempt to equalize quality of care across patients and regions, Sweden has introduced 31 standardized care pathways for different cancer diagnoses since 2015. The pathways specify the care processes for a given diagnosis, including maximum wait times for medical tests and procedures.
With evaluations of the cancer care pathways demonstrating their effectiveness, pathways will now be developed for other conditions, including diabetes, cardiovascular disease, mental illness, rheumatic diseases, asthma, and chronic obstructive pulmonary disease, starting in 2020.
- Standardiserade vårdförlopp införs för fler sjukdomsområden (in Swedish)
- Minst fem nya vårdförlopp 2020 (in Swedish)
Swedish Government Report Calls for “Closer Health Care”
The Swedish government is proposing an ambitious reorganization of the health care system to bring health care “closer” to people, according to the latest of three reports issued since an investigation into ways to improve health care delivery began in 2017. According to the report, care would be steered away from hospitals to the primary care sector, as well as to patients’ homes. Municipalities are also supposed to play important roles in the transformation, including increasing the integration of health care and social care. The plan also involves engaging patients more in their own care. The final report is expected in March 2020.
- God och nära vård (in Swedish)
- Fokus på tillgänglighet i framtidens vård (in Swedish)
- Nergårdh: Vi måste lyfta kommunerna i den nära vården (in Swedish)
Updated “queue-billion” presented by Swedish government
Many regions of Sweden are struggling with long wait times for medical procedures, with one-quarter of all Swedish residents waiting more than 90 days for a first visit to a specialist and 36 percent waiting more than 90 days for elective surgeries. As part of a larger allocation of funds to the health care sector, the Swedish government will provide SEK 1.6 billion (USD 166 million) in funding for efforts to shorten wait times for patients.
Each region will receive a payment if they shorten waits for specialist care and surgery compared to the previous year. Regions can also qualify for payments by meeting national targets — for example, by ensuring that at least 71 percent of patients receive a first visit to specialist care or surgery within 90 days. The new approach differs from a 2009 initiative that rewarded regions only if they shortened their waits compared to other regions.
- Regeringen satsar på bättre förutsättningar för vårdpersonal (in Swedish)
- 1,6 miljarder för kortare vårdköer (in Swedish)
Correspondent: Adam Briggs
NHS England Hands 50,000 People Control Over Their Own Care
More than 50,000 people with long-term health conditions or disabilities in England now have a personal health budget, giving them control over how they use money from the National Health Service (NHS) to meet their health and care needs. The personal health budgets can be used to purchase everything from electronic devices for controlling doors and heating in the home to assistance dogs and respite care. The NHS plans to provide personal health budgets to up to 200,000 people over the next five years.
One in Three in England Are Now Enrolled in an Integrated Care System
NHS England’s integrated care systems (ICS) now cover more than 20 million people – one in three people. In an ICS, NHS organizations work with local government and community organizations to manage resources and improve population health. As of June, three new ICSs were announced, bringing the total number in England to 14.
ICSs, built on a foundation of primary and community care, use population health management techniques to identify patient groups or populations most at risk of poor health so that appropriate resources can be targeted. ICSs are expected to cover the entire country by April 2021.
- One in three people will benefit from faster and more convenient health and care
- Local sustainability and transformation partnerships
Editor: Roosa Tikkanen
Project manager: Aisha Gomez
World News — Roosa Tikkanen and Marianne Storm
Australia — Sonĵ Hall
Canada — Aisha Gomez
France — Angèle Malâtre-Lansac
Germany — Michael Laxy
Netherlands — Marthe Haverkamp
New Zealand — Aisha Gomez
Norway — Marianne Storm
Sweden - Ulrika Winblad
United Kingdom — Adam BriggsInternational Health Policy Center
Roosa Tikkanen (ed.), Commonwealth Fund International Health News Brief, no. 6, Nov. 1, 2019. https://doi.org/10.26099/tjmg-w192Roosa Tikkanen Roosa Tikkanen
International Health News Brief: Issue 6 for 2019.International Health Policy https://doi.org/10.26099/tjmg-w192 Show Link Improving Health Care Quality International