Cambridge 10 th International Health Leadership Programme

1. Cambridge 10th International Health Leadership Programme Healthcare system aspirations breakout Cambridge, March 15, 2006

2. Welcome and icebreaker • 10 min Agenda • Typical aspirations of modern healthcare systems • 30 min • Survey results • 10 min • Example mechanisms to achieve aspirations • 30 min • Preparation of plenum presentation by group • 15 min plus working lunch

3. Agenda • Welcome and icebreaker • 10 min • Typical aspirations of modern healthcare systems • 30 min • Survey results • 10 min • Example mechanisms to achieve aspirations • 30 min • Preparation of plenum presentation by group • 15 min plus working lunch

4. 6 • 5 • 4 • 3 • 1 • 2 • System aspirations typically stand in trade- off to each other e.g., • Increased access might raise system cost • Increased cost- efficiency might sacrifice quality efforts by hospitals • Policy makers must make conscious decisions about aspiration prioritization • Patientchoice • Patients are enabled to chose their healthcare provider • Patients are provided with sufficient information to make educated choices in a situation where they can choose • Financial efficiency and sustainability • The healthcare system is efficient and cost effective (e.g., it achieves high quality outcomes such as high life expectancy with relatively small per capita spending) • A savings system in place to cope with challenges of an aging population • Accountability/ transparency • Data is collected and made available to provide for transparency (e.g., quality data for hospitals, financial audits on public institutions) • Clear standards are set, monitored and enforced for all players of the system • Quality • The healthcare system produces top macro and micro level clinical and non- clinical quality outcomes in comparison to international best practice Typical aspirations of modern healthcare systems • Aspiration • Explanation • Accessibility • Patients can, regardless of their social status and wealth, access care within a clearly defined distance and time span • Fairness • People can, regardless of their social status and wealth, access a minimum level of care • A safety net will take care of the poorest members of the society

5. Welcome and icebreaker • 10 min Agenda • Typical aspirations of modern healthcare systems • 30 min • Survey results • 30 min • Example mechanisms to achieve aspirations • 20 min • Preparation of plenum presentation by group • 15 min plus working lunch

6. Survey result- how important is the aspiration for you and where does your country stand today? • Very important • Financial stability/ efficiency • Quality • Accessibility • Fairness • Accountability/ transparency • Focus future policy efforts • Keep policy efforts going • How impor-tant is this aspiration in your opinion? • Important but not our no. 1 priority • Patient choice • Rethink importance of aspiration • Take policy efforts out if resources limited • Not impor-tant at all • Do not agree • Strongly agree • In my country the above statement is fulfilled Source: Participant survey results

7. Welcome and icebreaker • 10 min Agenda • Typical aspirations of modern healthcare systems • 30 min • Survey results • 30 min • Example mechanisms to achieve aspirations • 20 min • Preparation of plenum presentation by group • 15 min plus working lunch

8. NON EXHAUSTIVE • 4 • 3 • 6 • 2 • 5 • 1 Example mechanisms to achieve system aspirations • Aspiration • Example mechanisms to achieve aspiration • Country examples • Accessibility • Have clearly defined standards for waiting times and geographic distance to care e.g., “next hospital must be with 20 kilometres” • Develop demographics-based “demand forecast models” to guide capacity planning • Norway • Fairness • Allow everyone to access all care facilities • Create a solidarity based financing with the wealthy subsidising the poor through e.g., a progressive income tax and a safety net • Singapore • Create a payment system where “money follows the patient” (as opposed to a funded hospital system where patients follow the money) • Publish waiting times and quality indicators for patients to have sufficient information to make informed provider choices • Patientchoice • Norway • Financial efficiency and sustainability • Install an activity based reimbursement system (e.g., DRGs) to incentivise efficient treatment of diseases • Structure capitation payment systems to incentivise treatment of diseases at lower cost care segments; e.g., incentivise and equip GPs to conduct chronic disease monitoring • Install co-payments and sin taxes to make patient cost- and health conscious • Germany, US • UK • Germany • Separate responsibilities between policy maker, regulator, payor, provider to introduce checks and balance into the system • Set, monitor and enforce clear input and output standards for all players of the system (e.g., hygiene standards for hospitals) • Put “rules of the game” in place to govern the interaction of key players (e.g., guidelines for payor- provider contracting) • Accountability/ transparency • UK • Quality • Clearly define and monitor macro and micro level quality targets • Establish a process to investigate non- compliance of quality standards • Establish clinical pathways to ensure standardized high quality care • US

9. Agenda • Welcome and icebreaker • 10 min • Typical aspirations of modern healthcare systems • 30 min • Survey results • 10 min • Example mechanisms to achieve aspirations • 30 min • Preparation of plenum presentation by group • 15 min plus working lunch

10. Key factors for successful structural change in Healthcare systems • 100% commitment by leadership with all relevant parties involved (e.g., Ministry of Health, Ministry of Finance, Ministry of Education) • A clearly formulated vision by the leadership based on sufficient stakeholder consultation and time investment • A prioritized transition plan (e.g., before opening market to private providers define quality minimum standards and reimbursement system) • “Champions” for each topic that believe in what they are about to do and that are sufficiently rewarded for their efforts • Early successes to create positive momentum and credibility in the eye of the public and stakeholders (e.g., quick win initiatives around quality of primary care, reduction of waiting lists in secondary care) Source: Team synthesis on reform experiences

11. Sustainable patient flows • Key thrusts • Triage early • Avoid inappropriate hospitalisation • Provide scheduled care where possible Blue light ambulance • Acute Care • “A&E” • ITU • CCU • Inpatient care Paramedic Elective care Specialist advice Patient Telephone service Social care Emergency care Diagnostics Intermediate care Community care Source: Team analysis

12. Commissioners can identify a number of initiatives to reduce spend and improve quality of care • Improvement area • Savings • Strengthen triage at first point-of contact • Create Emergency Care centres by integrating A&E, Minor injury units and GP Out of Hours services • Transform chronic disease management and case management • Facilitate Community Care access to diagnostics • Increase use of GPs/nurses/GP with Special Interests • Adopt robust criteria for emergency admissions to Acute Care • Increase range and reach of alternatives to Acute Care admission • Adopt robust criteria for elective activity and specialist advice • £10m • £24m • £26m • £19m • £25m • £10m • £6m • £53m • Total commissioner cost saving (%) • £173m(6.1%) Source: McKinsey analysis

13. 163 • Gross savings The priority areas deliver significant financial benefits • Service Investment Projected annual savings after 5 years, £m • Net savings • 314 • (11.1%) • 16 • 10 • Manage system entry • -6 • 163 • Optimise patient flows • -73 • 237 • 140 • Improve provider efficiency • 140 • 0 * Service Investment does not include CapEx investment or project management costs detailed in the final section Source: Team analysis