Evidence of comparative efficacy should have a formal role in European drug approvals

Despite methodological concerns, comparative efficacy evidence should be required at the time of drug approval, says Corinna Sorenson and colleagues, to allow patients, clinicians, and other healthcare decision makers to determine whether a new drug is superior, equivalent, or inferior to its existing alternatives

United Kingdom (Scotland): health system review

Over the last decade, Scotland’s health system has increasingly diverged from the health system in England. Scotland has pursued an approach stressing integration and partnership among all parts of its NHS as opposed to an English approach in part driven by market forces. Comparatively fewer organizational and structural changes, in addition to consistent policy objectives, have provided a strong launching pad for achieving improvement. Substantial increases in funding have led to significant growth in the clinical workforce and numerous performance targets have been set to improve population health, the quality and outcomes of health care, and the efficiency of the health system. As a result, Scotland has made well-documented progress in terms of population health and the quality and effectiveness of care. However, a number of challenges remain. More progress is needed to close the gap in health status between Scotland and other developed countries, and to address persistent inequalities in health within Scotland. As in many other countries, increased fiscal pressures may make it difficult to maintain current levels of health care quantity and quality in future

The challenges of using cross-national comparisons of efficiency to inform health policy

Many comparative efficiency metrics focus on scrutinising the operation of specific parts of a single health system. This article reviews the key issues involved in international comparisons of various aspects of efficiency. It examines data sources and analytic techniques used to create comparative indicators, and discusses approaches to interpreting variations. It also highlights key challenges and promising new initiatives, such as the consistent use of international definitions and technical developments, such as data linkages, which hold the potential to enhance work in this area

What drives people’s perceptions of their health system? In the UK, overall satisfaction with the NHS is closely associated with GP performance

Surveys of satisfaction with the NHS tend to prompt discussion about reform. Research by Irene Papanicolas, Jonathan Cylus and Peter Smith investigates what determines people’s satisfaction with their health system and why it is oftentimes erratic. International comparisons show that overall satisfaction appears to represent something different in each health system, indicating that there is no panacea for improving satisfaction ratings in all countries. In the UK, they find that GP performance is closely linked to overall opinions of the NHS, and so policies that addresses GP responsibilities might have an important influence on satisfaction levels

Catastrophic health spending in Europe: equity and policy implications of different calculation methods

Objective To investigate the equity and policy implications of different methods of calculating catastrophic health spending. Methods We used routinely collected data from recent household budget surveys in 14 European countries. We calculated the incidence of catastrophic health spending and its distribution across consumption quintiles using four methods. We compared the budget share method, which is used to monitor universal health coverage (UHC) in the sustainable development goals (SDGs), with three other well established methods: actual food spending; partial normative food spending; and normative spending on food, housing and utilities. Findings Country estimates of the incidence of catastrophic health spending were generally similar using the normative spending on food, housing and utilities method and the budget share method at the 10% threshold of a household’s ability to pay. The former method found that catastrophic spending was concentrated in the poorest quintile in all countries, whereas with the budget share method catastrophic spending was largely experienced by richer households. This is because the threshold for catastrophic health spending in the budget share method is the same for all households, while the other methods generated effective thresholds that varied across households. The normative spending on food, housing and utilities method was the only one that produced an effective threshold that rose smoothly with total household expenditure. Conclusion The budget share method used in the SDGs overestimates financial hardship among rich households and underestimates hardship among poor households. This raises concerns about the ability of the SDG process to generate appropriate guidance for policy on UHC

Perceptions of health care access in Europe: How universal is universal coverage?

The past decade has witnessed a growing interest in the ability of health systems to protect citizens from the financial consequences associated with ill health and the use of medical care. In order to improve financial protection and access to care the WHO World Health Report 2010 firmly emphasizes that health systems move towards universal coverage of their populations. Of all regions, Europe has shown the most commitment to the goal of universal coverage. However, not all Europeans may feel as though they are able to access care if in fact they should need it. It is therefore important to investigate how the citizens of different European countries perceive their access to health care in order to better understand who these individuals are and what role different systems can play in providing better access to care

Using data envelopment analysis to address the challenges of comparing health system efficiency

Efficiency is one of the most potent measures of health system performance and is of particular interest to policy makers because it seeks to assess the valued outcomes of a health system in relation to the resources that are sacrificed to achieve those outcomes. However, the production process of the health care system is a complex sequence, and most indicators are only able to capture part of that process; these indicators offer limited scope for analysis. While researchers have previously constructed composite indicators which combine partial measures into a single number, the weights used for aggregating data can be contentious and may not be universally applicable across systems. Data envelopment analysis (DEA) is most often used to compare the productivity of different producing entities, including health systems. In this article, we instead propose a method that relies on DEA to construct composite health system efficiency indicators from several partial efficiency measures. Among other noted benefits, this enables the construction of composite indicators where different weights are attached to partial indicators for each country, allowing countries to be viewed according to the weights that cast each in the best light. Our application of this method suggests that there is reasonable consistency among the countries that are found to be efficient

Kaitse suurte ravikulude eest Tšehhis, Eestis ja Lätis: kolm kõrge sissetulekutasemega riiki – kolm erinevat kogemust

Eesti Arst 2018; 97(6):301–304 &nbsp

Assessing the economic costs of unhealthy diets and low physical activity: an evidence review and proposed framework

Unhealthy diets and low physical activity contribute to many chronic diseases and disability; they are responsible for some 2 in 5 deaths worldwide and for about 30% of the global disease burden. Yet surprisingly little is known about the economic costs that these risk factors cause, both for health care and society more widely. This study pulls together the evidence about the economic burden that can be linked to unhealthy diets and low physical activity and explores How definitions vary and why this matters The complexity of estimating the economic burden and How we can arrive at a better way to estimate the costs of an unhealthy diet and low physical activity, using diabetes as an example The review finds that unhealthy diets and low physical activity predict higher health care expenditure, but estimates vary greatly. Existing studies underestimate the true economic burden because most only look at the costs to the health system. Indirect costs caused by lost productivity may be about twice as high as direct health care costs, together accounting for about 0.5% of national income. The study also tests the feasibility of using a disease-based approach to estimate the costs of unhealthy diets and low physical activity in Europe, projecting the total economic burden associated with these two risk factors as manifested in new type 2 diabetes cases at €883 million in 2020 for France, Germany, Italy, Spain and the United Kingdom alone. The ‘true’ costs will be higher, as unhealthy diets and low physical activity are linked to many more diseases. The study’s findings are a step towards a better understanding of the economic burden that can be associated with two key risk factors for ill health and they will help policymakers in setting priorities and to more effectively promoting healthy diets and physical activity

Identifying the causes of inefficiencies in health systems

Persistent growth in health expenditures coupled with fiscal pressures have led to widespread calls for efficiency improvements. However, identifying the sources of inefficiencies in health systems remains challenging. In this article, we provide an analytic framework to facilitate better understanding and interpretation of common health system efficiency metrics. To demonstrate its potential, we apply the framework to a simple efficiency metric comparing per capita health care expenditure to amenable mortality rates in the EU-28 Member States. This exercise highlights the information each metric can and cannot tell analysts and decision-makers. Going forward, more refined metrics should be developed based on more standardised and detailed cost accounting data and linked datasets and registries