[EQ] The Finnish Health Care System: A Value-Based Perspective

de: "Ruggiero, Mrs. Ana Lucia (WDC)" - ruglucia@paho.org
para: EQUIDAD@listserv.paho.org
fecha: 06-abr-2009 12:12
asunto: [EQ] The Finnish Health Care System: A Value-Based Perspective


The Finnish Health Care System: A Value-Based Perspective





Michael E. Porter, Bishop William Lawrence University Professor, Harvard Business School

Juha Teperi, Medical doctor and health services researcher at the University of Helsinki

Lauri Vuorenkoski, senior researcher at Finland National Institute for Health and Welfare (THL)

Jennifer F. Baron, Senior Researcher, Institute for Strategy and Competitiveness, Harvard Business School

The Sitra Reports - Helsinki 2009



Available online as PDF file [117p.] at:

http://www.isc.hbs.edu/pdf/Finnish_Health_Care_System_SITRA2009.pdf



“….This report applies a value-based framework of health care delivery in order to provide a holistic view of the current state of Finnish health care. This report consists of three parts. Section 2 presents a brief overview of the general principles of value-based care delivery. Sections 3 to 7 then utilize these principles to analyze the Finnish health care system as it looks today. While the text aims to cover the essential features of the Finnish system, special attention is paid to aspects that are crucial from a value-based perspective. Finally, Section 8 proposes a set of general conclusions and recommendations for Finland….”





“……..In only a few decades, Finnish health care has developed from a somewhat rudimentary health care system into one that is internationally acclaimed. Every permanent resident in the sparsely populated country has access to an extensive set of services, yet total per capita health care costs remain lower than in most comparable countries. Despite recent concerns about equity issues, Finns are generally very satisfied with their health care services.



However, as in any country, Finland cannot rest on its laurels. Advancing medical science raises a new bar for quality in terms of the outcomes achieved in the treatment of illness. An aging population and rising public expectations threaten to increase costs and impede timely access to care, thus jeopardizing sustainability.



One challenge in particular, the aging Finnish workforce, affects not only patient demographics but also the availability of clinicians. The upcoming wave of retiring health care professionals will occur at just the time when Finland will need more of them. To overcome these challenges, every health care system will have to use its resources more effectively; the achievements of past decades are to be maintained and built upon. Access and equity will remain necessary characteristics

of optimal health care systems, but they are insufficient goals in terms of improving quality and achieving financial sustainability.



Instead, the value created by the system as a whole must be continuously improved; for each euro spent, more health needs to be achieved. The large variations in health care quality and costs have been described and documented in many advanced economies, signaling a lack of consensus concerning best practices, not only in individual care processes but also in the organization of care delivery itself. Finnish researchers, for example, have shown that outcomes like disease-specific mortality rates vary across and even within providers in a way that cannot be explained by the severity of the condition or other initial patient conditions…..”



Content:



I Introduction


II Principles of value-based delivery

The fundamental goal is value for patients

The only way to truly contain cost and increase value is to improve health outcomes

Care should be organized around medical conditions over the full cycle of care

Value is increased by provider experience, scale, and learning at the medical condition level

Value must be universally measured and reported 3

Reimbursement should be aligned with value and reward innovation

Competition should occur for patients based on value, while encouraging the restructuring of care

Electronic medical records must enable the restructuring of care delivery, support integrated care and produce outcome measures

Health plans or funding agencies should contribute to value, rather than act as passive payers


III Overview of the Finnish health care system


IV Access and standards for coverage

Municipal health care system

National health insurance system

Private insurance

Occupational health care system

Assessment


V Structure of health care delivery

Providers

Employers

Patients

Suppliers

Clinical guidelines


VI Health information technology

Assessment


VII Results measurement

Use of measurement data in health care management Assessment


VIII Overall assessment and recommendations

Intensify outcome measurement and link it to incentives and management

Create integrated practice units

Strengthen primary health care

Create true health plans

Reimburse full cycles of care

Increase value by service consolidation combined with competition

Encourage innovation in care delivery and its structures

Invest in health information technology

Increase the role of patients in health care

Moving to action


References





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