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01.11.2013.

Patient Power: Lesson from the best healthcare systems in Europe

Since 2005 Health Consumer Powerhouse (HCP) has published a comprehensive annual index measuring the performance of the many different health services across Europe. This report draws conclusions from that index about what makes a good health service.

There is little clear correlation between money spent and quality of healthcare. Nor is a multi-agency system, with independent healthcare providers and financers, necessarily expensive.

For the first time EHCI has split out Scotland from the rest of the UK. Scotland and England are now pursuing radically different health policies, with England introducing promising reforms aimed at encouraging competition in the provision of healthcare. At the moment, overall performance is very similar.

But spending on health is 11% higher in Scotland to little effect.

Generally, ‘Bismarckian’ systems with a separate financing system and producer competition perform better than ‘Beveridge’ systems where the industry is centrally managed.

Health care performance is enormously variable across Europe, implying huge costs in both financial and human terms.

Cross border competition in healthcare should improve patient choice, care quality and costs by allowing patients to access the best and most cost effective treatment abroad and spreading best practice across the continent.

 

In Brief

1. Since 2005 Health Consumer Powerhouse (HCP) has published a comprehensive annual index measuring the performance of the many different health services across Europe. This report draws conclusions from that index about what makes a good health service.

2. Since the inception of the European Healthcare Index (EHCI) in 2005, the most striking feature is the superiority of the Netherlands in the study.

3. Switzerland, the Scandinavian countries, Belgium, Luxembourg, Germany and France have all done well over the years.

4. There is little clear correlation between money spent and quality of healthcare. Nor is a multi-agency system, with independent healthcare providers and financers, necessarily expensive.

5. The Dutch healthcare system is well funded, but the main additional spending – on inpatient treatment, care of the elderly and psychiatric care - does not explain its good performance.

6. For the first time EHCI has split out Scotland from the rest of the UK. Scotland and England are now pursuing radically different health policies, with England introducing promising reforms aimed at encouraging competition in the provision of healthcare. At the moment, overall performance is very similar. But spending on health is 11% higher in Scotland to little effect.

7. Adjusting EHCI scores to show ‘Bang-for-the-Buck’ reveal productivity problems in countries with centralized systems like Spain, Italy and Scotland.

8. There is little correlation between spending and waiting times, which are instead connected to the presence of ‘gatekeepers’ such as GP’s referring patients to specialists.

9. The Dutch health system is characterized by numerous independent healthcare insurers and providers competing for custom, high patient involvement and low political interference.

10. Generally, ‘Bismarckian’ systems with a separate financing system and producer competition perform better than ‘Beveridge’ systems where the industry is centrally managed.

11. Patient empowerment in Europe is improving, but patients and their representatives often lack knowledge as to what their entitlements are and what services they can access at home and abroad.

12. Health care performance is enormously variable across Europe, implying huge costs in both financial and human terms.

13. Cross border competition in healthcare should improve patient choice, care quality and costs by allowing patients to access the best and most cost effective treatment abroad and spreading best practice across the continent.

14. Policy makers should emulate systems such as the Dutch one, encourage competition among providers, improve patient knowledge and implement the EU directive on the application of patients’ rights in cross-border healthcare in full.

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