1. Achieving Better
Value for Money
in Health Care
Nuffield Trust Health Policy Summit 2013
Mark PEARSON
7 March 2013

2. Groups of countries sharing broadly
similar institutions

3. Efficiency varies more within groups
of countries than across them
Potential gains in life expectancy (years, DEA)
5
HUN
4 SVK DNK
GRC FIN
LUX GBR
3 IRL
DEU BEL CZE
NLD AUT OECD average
NZL
2 CAN NOR
SWE ESP POL
FRA TUR PRT ITA
MEX
1 JPN
ISL
CHE KOR
AUS
0
0 1 2 3 4 5 6

4. Financing and revenues
Czech R 30% cut in Ministerial budget
Increase in alcohol, tobacco taxes
Estonia 24% cut in Ministerial budget
Increase in alcohol, tobacco taxes
Ireland Health levy doubled to 4% if
income<€75k; 5% otherwise
4

5. Coverage
Czech HTA to define benefit package
Exclusion of some foreigners
Inpatient charge up by 66%
Estonia Inpatient charges for nursing
Greece Uninsured only at certain hospitals, only generics
User charges up by 66% (some people protected)
Ireland Cuts in dental coverage
Income tests for free care for over 70s
User charges up all around
Portugal User charges more than doubled
Coverage reduced
Spain Exclusion of some foreigners, immigrants
Copays up a lot
5

6. Wages and prices
Czech 10% cut in salaries
Hospital prices frozen
Estonia Generics boosted for pharma
Greece Salaries slashed
Pharmacy margins cut
Pharma prices cut
Iceland Generics boosted
Salaries, overtime cut
Ireland Unilateral cuts in pharma prices
Pharmacies squeezed
Bit cuts in salaries, fees
Portugal Pharma prices cut
Salaries cut
Spain Salaries cut
Pharma prices cut 6

7. Quantities
Greece Reduced staff
Iceland Reduced staff
Ireland No replacement of staff on leave; voluntary
redundancies; reduced agency and locums
Portugal 50% reduction in infrastructure
Spain Reduced staff
7

8. Structural change
Czech Reformed hospital payments
Greece Positive list for pharma
Output-based funding
Merger of hospitals, regions
Centralised procurement
Iceland Merger of hospitals
Portugal Reform of primary care payments
Spain Centralised purchasing
8

9. Conclusions
• England’s health system efficiency is not great
• No ‘big picture’ model is obviously superior (but
provider choice looks worthwhile)
• Crisis countries have cut prices, wages without
negative effects
• Few structural reforms in crisis countries,
generally centralising
• Payment reform in a few countries (DRGs,
Bundling experiments)
• Why is no-one tackling the health labour market?
9