The five ministers are: conference host, Allan Rock, health minister of Canada; Minister Osmo Soininvaara of Finland; Minister Julio Frenk from Mexico; Minister Annette King of New Zealand; and Secretary Tommy Thompson from the United States.
Building durable quality
Allan Rock, Minister of Health, Government of Canada
Having successfully turned around the fiscal deficits of the early to mid 1990s, Canada’s federal, provincial and territorial governments have been able to turn their attention to longer-term investments in the health system.
In Canada, the healthcare system is run largely by the provincial and territorial governments. The federal government plays a key financing role, supporting health research and information, promoting new approaches to healthcare and adopting modern information technologies. Health Canada is also responsible for ensuring the availability of, and access to, health services by Aboriginal peoples, who are increasingly assuming the management and delivery of their own healthcare systems.
Recognising that more money alone will not achieve the results we need, Canadian governments signed an historic Agreement on Health in 2000. The agreement outlined a common vision and specific priorities for renewing our publicly funded healthcare services, as well as for reporting on performance. We agreed that improving access to timely, high-quality health services for Canadians is a key priority. We are co-ordinating efforts to ensure appropriate supply and distribution of health professionals. We are building on successes already seen in many innovative pilot projects in primary healthcare. We continue to emphasise disease prevention and health promotion. We are also working together to develop a Canada-wide health “infostructure” that will feature electronic health records and such technological services as telehealth.
For accountability, the agreement commits federal, provincial and territorial governments to public reporting. This includes the development of a performance measurement framework that will encompass health status indicators such as life expectancy; health outcomes, for example reduced burden of disease and illness; and quality, such as patient satisfaction and hospital re-admission rates.
Canadian governments have agreed to report in all of these areas, and to develop mechanisms to support appropriate, third-party verification of those reports. The first such reports will be made public by September 2002 and will be followed by “comprehensive and regular public reporting by each government on the health programmes and services they deliver”.
Canada is aware of the international dimension of health issues and the value of sharing experiences and knowledge across borders. Our hosting of the OECD Conference on Health System Performance Measurement and Reporting in Ottawa this November demonstrates our commitment. After all, in today’s global economy, health policy is everyone’s business.
Exceeding the norm
Osmo Soininvaara, Minister of Health and Social Services, Finland
In Finland, it is the 448 municipalities that are responsible for providing social and health services. Our decentralised system seems to deliver value for money. Indeed, according to international opinion polls, the Finns are more satisfied with their healthcare than citizens in many other countries. Simultaneously, the share of GNP used for health services is among the lowest in the European Union. The ongoing trend is to emphasise outpatient care in the overall balance of health services. After a major reform in 1993 the government no longer regulates the system by setting norms and guidelines, but by means of legislation, financial incentives and information management.
Recession in the 1990s forced us to make deep cuts in the public sector, which also led to a rapid increase in the productivity of the healthcare system. It can even be said that the system’s technical efficiency has achieved a very remarkable level and it is hard to see where it can be improved further. From now on our focus will be on achieving a more efficient allocation of resources. Are we doing it right? Where are the priorities and how should the division of tasks be arranged within and between different organisations?
The financial limitations of the public sector, ageing of our population and an impending lack of labour will put great demands on health service performance. The government has launched a national health project, with the objective of outlining the reforms needed to secure the future of Finland’s health services. Main tasks include improvement of health service performance and efficiency, allocation of resources and financing of healthcare. A first progress report is expected as soon as March 2002.
It has become evident that there is a need for more detailed and more up-to-date information for accurate system assessment. In addition to traditional measures, like cost-benefit analysis and other budget-related factors, assessing availability of both services and manpower, as well as waiting times, will be important.
A national crusade
Julio Frenk, Secretary of Health, Mexico
The Mexican healthcare system faces complex challenges. The country has accumulated a health “backlog”. At the same time, it must confront emerging problems, like certain non-communicable diseases common in developed nations, such as heart disease and diabetes. Quality of care is another challenge. Long waiting times in ambulatory services and an insufficient supply of drugs are frequent sources of complaint. Lastly, financial problems associated with healthcare already represent a serious public burden that has to be managed.
Several strategies have been implemented. To relieve the health backlog, programmes aimed at providing effective access to basic health services for the poor have been established. Emerging problems are being confronted through a clear definition of priorities, the promotion of healthy lifestyles and the early detection of non-communicable diseases. The National Crusade for the Quality of Health Services aims to improve the quality of services through the definition of codes of practice for health professionals, the use of clinical guidelines in public institutions, and the certification of professionals and health units. In order to provide financial protection against the costs of illness, the National Health Program proposed the creation of a popular insurance scheme, the promotion of social security, and of pre-paid plans for those population groups with the ability to pay.
Mexico is moving towards a new civic culture. Public institutions are increasingly obliged to inform society about their activities. In response to these demands, the Ministry of Health will report on the evaluation of the health system’s performance to the population, to the National Health Assembly, to the legislature (via presentations to the Commission of Health in Congress), and to the health sector and the Federation, with reports to the National Sanitary Council and the National Health Council. Finally, the present administration will also incorporate regular perception surveys into its management tools. The results of these surveys will be disseminated widely through print and electronic media.
Toolkits for improvement
Annette King, Health Minister, New Zealand
The New Zealand Health Strategy (NZHS), which I launched in December 2000, provides the framework for making our public health service meet the needs of New Zealanders. This strategy provides the overall context within which the health sector should operate, including the Ministry of Health and the newly formed District Health Boards (DHBs). It contains principles to guide the sector, as well as goals and objectives for priority health issues.
Thirteen population health areas have been selected as priorities in the short to medium term. To help DHBs the ministry has produced a series of toolkits, one for each priority area. The toolkits contain background information and evidence or guidance on treatments or interventions that will make the maximum impact upon population health. The ministry has produced these toolkits in conjunction with specific expert groups comprising individuals from academic, clinical and NGO backgrounds. The intention is to update the toolkits every six months.
All DHBs have signed accountability agreements with the Minister of Health, reflecting priority areas of the NZHS. The ministry will work with DHBs to develop appropriate indicators that reflect the focus of the toolkits. These indicators will then be reflected in the accountability agreements. The ministry is also required by legislation to submit an annual report to parliament on progress made on the NZHS.
The 13 priority population health objectives are to: reduce smoking; improve nutrition; reduce obesity; increase the level of physical activity; reduce the rate of suicides and suicide attempts; minimise harm caused by alcohol and drug use; reduce the incidence and impact of cancer; reduce the incidence and impact of cardiovascular disease; reduce the incidence and impact of diabetes; improve oral health; reduce violence in relationships, families, schools and communities; improve the health status of people with severe mental illness; and finally, ensure access to appropriate child healthcare services.
Tommy G. Thompson, Secretary of Health and Human Services, United States
Since arriving at the Department of Health and Human Services (HHS) in February, I have committed the entire department to becoming more responsive. We need to respond more effectively and more quickly to the needs of our customers – the American people. The health and well-being of our society is an important trust, one we are working to fulfill with energy and dedication.
To that end, HHS has cut bureaucratic red-tape and is working more closely with states to provide funding for innovative programmes helping them offer health insurance to some of their most vulnerable populations. This enables more than one million low-income Americans to gain access to quality medical care. Our Centers for Medicare and Medicaid Services, which administer Medicare (our nation’s health insurance programme for seniors), are actively working to provide millions of older and low-income Americans timely and cost-efficient payments of their medical bills. Under the leadership of President George Bush, we are also working to modernise and strengthen Medicare and add a prescription drug benefit to it.
HHS has also launched nationwide organ donation and preventive health initiatives and substantially increased funding for the National Institutes of Health, home to the country’s premier medical research facilities. The president’s budget includes significant funding for community health centres to help meet the needs of underserved communities. Minority and women’s healthcare are also high priorities. And we are continuing to strengthen the president’s anti-bioterrorism initiative.
Fundamentally, we are working to ensure that the American people enjoy ready access to quality, affordable healthcare and that the health research that has impelled breakthrough therapies and treatments over the past century will grow even stronger in coming decades. Medical innovation, research and responsiveness are our calling and challenge. We intend to answer the calling and meet the challenge for the sake of all our citizens.
©OECD Observer No 229, November 2001