The High Performance Health System

1. The High Performance Health System Dov Chernichovsky, Ph.D. Ben-Gurion University of the Negev, Israel

2. Objectives of Presentation • Articulate goals and objectives of the health care system • Examine (some) performance indicators • Identify structural features of health systems associated with actual and potentially good performance Dov Chernichovsky - Draft

3. Background “The Emerging Paradigm in Health Systems” • Study -- Funded by the Commonwealth Fund -- of the health systems of eight developed nations: Australia, Canada, Germany, France, Israel, The Netherlands, the U.K. and the U.S. • Audience: U.S. policy makers • Approach: technocratic, to the extent possible Dov Chernichovsky - Draft

4. Goals & Objectives of Society Regarding the Healthcare System • Invest in health, balancing between spending on medical care and on other means to enhance health • Objectives: • (Health) • Equity • Cost containment • Efficient production of quality medical care • Client satisfaction Dov Chernichovsky - Draft

5. Health – Life Expectancy(data sources in full paper) Dov Chernichovsky - Draft

6. Equity – Instrumental Rationale • Equitable distribution of medical resources can improve average health • Protection of household non-medical consumption from ‘catastrophic’ medical spending Dov Chernichovsky - Draft

7. Equity - Equitability of Funding Resources Dov Chernichovsky - Draft

8. Cost Containment – (Instr.) Rationale • Helps protect household income and spending • Contributes to lower production costs, competitiveness, and employment Dov Chernichovsky - Draft

9. Cost Containment (a) -Relative Price Increases in Medical Care Dov Chernichovsky - Draft

10. Cost Containment (b) – Real (General Price Index) Per Capita Growth in Health Spending Dov Chernichovsky - Draft

11. Production Efficiency - Rationale • More resources for quality care and other uses Dov Chernichovsky - Draft

12. Production Efficiency – Spending Dov Chernichovsky - Draft

13. Client Satisfaction – Client Desire for Reform Dov Chernichovsky - Draft

14. Preliminary Conclusions • Systems in-between the U.K. and U.S.A do better in balancing health system goals • They are more relevant to the U.S.A., anyhow Dov Chernichovsky - Draft

15. Principles for Success • Universal entitlement • Centralized funding of care -- not necessarily by the state budget -- for • Equity • Cost containment • Competition and choice– not necessarily in private markets -- for • Efficient production of quality care • Client satisfaction Dov Chernichovsky - Draft

16. State Regulation Funding Pool, Real or Virtual Contracting First Market Non-state Fund holding, OMCC Institutions: Sickness Funds, HMOs, etc. Purchasing Second Market Providers Apparently Successful Dual Internal Market Structure Dov Chernichovsky - Draft

17. Fully Centralized K Z ↑ OMCC & Provision ↓ Transitional Economies Transitional poor nations The U.S & poor nations A P Competitive Out of Pocket, Private ← Funding → General Revenues, Fully Public Reform Directions Europe Dov Chernichovsky - Draft

18. Basic Features of Dual Internal Market • Enables multiple Lines of accountability • Enables pluralism and choice in • Form of entitlement • Content of entitlement • Enables client empowerment vis a vis state, on the one hand, and providers, on the other Dov Chernichovsky - Draft

19. Fundraising & Allocation OMCC Institution OMCC Institutions2 Providers Finance Accountability Multiple Lines of Accountability Dov Chernichovsky - Draft

20. Model A Model B OMCC OMCC Primary Care Primary Care Primary care Professional care and hospitalization Professional care and hospitalization Model C Model D OMCC Primary care OMCC Primary care Professional care and hospitalization Professional care and hospitalization Multiple Forms of Care Dov Chernichovsky - Draft

21. Expansion of Entitlement Private entitlement and finance Discretionary public entitlement, financed by a pre-set portion of public-based finance Core public entitlement – common to all groups Multiple Content of Entitlement Dov Chernichovsky - Draft

22. Key Function & Institution Organization and Management of Care Consumption (OMCC) / Competing Budget Holder

23. Basic References • Chernichovsky, D. 1995. “Health System Reforms in Industrialized Economies; An Emerging Paradigm”. The Milbank Quarterly Vol. 73, no. 3: 339-372. • Chernichovsky, D. 2002. “Pluralism, Choice, and the Sate in the Emerging Paradigm in Health Systems.”The Milbank Quarterly. Vol. 80, No.1:5-40. Dov Chernichovsky - Draft

24. Thanks Dov Chernichovsky - Draft