Irene Papanicolas

Health effects of financial crisis: omens of a Greek tragedy

www.thelancet.com Vol 378 October 22, 2011 1457 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ with 2009, and of 8% in the fi rst half of 2011 compared with the same period of 2010. Major private health providers, although comprising a smaller proportion of care delivery than public providers, were also hit by pressure on personal budgets and registered losses after the onset of the crisis. A 2010 study reported a 25–30% decline in admissions to private hospitals. There are signs that health outcomes have worsened, especially in vulnerable groups. We noted a signifi cant rise in the prevalence of people reporting that their health was “bad” or “very bad” (1·14, 1·02–1·28; fi gure). Suicides rose by 17% in 2009 from 2007 and unoffi cial 2010 data quoted in parliament mention a 25% rise compared with 2009. The Minister of Health reported a 40% rise in the fi rst half of 2011 compared with the same period in 2010. The national suicide helpline reported that 25% of callers faced fi nancial diffi culties in 2010 and reports in the media indicate that the inability to repay high levels of personal debt might be a key factor in the increase in suicides. Violence has also risen, and homicide and theft rates nearly Health eff ects of fi nancial crisis: omens of a Greek tragedy

Performance measurement for health system improvement : experiences, challenges and prospects

of health providers to be measured, there is a need for a more strategic vision of the role that performance measurement can play in securing health system improvement. This volume meets this need by presenting the opportunities and challenges associated with performance measurement in a framework that is clear and easy to understand. It examines the various levels at which health system performance is undertaken, the technical instruments and tools available, and the implications using these may have for those charged with the governance of the health system.This summary makes the case for performance measurement as key tool for policy-makers endeavouring to improve health systems in the European Region. It highlights the various elements required of a comprehensive health system performance measurement framework; pinpoints how performance measurement can be used in practice; and stresses the role of government stewardship in securing improved performance. It reviews existing evidence and provides examples of the empirical application of performance measures, demonstrating that if governments invest in health they can expect those resources to be used well.

Impact of symptoms on quality of life before and after diagnosis of coeliac disease: results from a UK population survey

BackgroundCoeliac disease is a common chronic autoimmune disorder. Underdiagnosis is common and the quality of life impact of symptoms may be severe. We report a study of symptom duration and quality of life before and after diagnosis in a representative sample of people with diagnosed coeliac disease in the UK.MethodsPostal questionnaire of 2000 people with diagnosed coeliac disease, requesting information on date of diagnosis, type and duration of symptoms, and quality of life before and after diagnosis using the EQ-5D instrument.ResultsThe survey response rate was 40% (788/2000). Mean duration of symptoms prior to diagnosis was 13.2 years, with some evidence of shorter duration in recent years. Respondents reported a mean of 13 consultations with their GP about their symptoms prior to diagnosis. The mean utility value of pre-diagnosis quality of life was 0.56, compared to 0.84 at time of survey, a highly statistically significant improvement of 0.27 (95% c.i. 0.25, 0.30).ConclusionsThe symptoms of undiagnosed coeliac disease are associated with a prolonged and substantial decrement to quality of life. These results strengthen the case for detailed examination of the cost-effectiveness of improved methods of detection and diagnosis, including population screening.

Economic crisis, austerity and the Greek public health system

For 2 years the Greek financial crisis has captured global attention. In return for loans from the International Monetary Fund (IMF) and European institutions, Greece agreed on harsh across-the-board austerity measures, yet most commentators offer little hope for recovery, at least in the short run. The economy is expected to contract by a further 6.1% in 2011 and 3% in 2012, while unemployment is projected to reach 18.5% in 2012 up from 7.7% in 2008. The Greek health-care system has been accumulating structural problems for a decade1 that have been exacerbated by the economic crisis. In terms of expenditure, a failure to contain costs, in part due to an absence of explicit funding criteria, created budget deficits for sickness funds. Although the system is highly centralized, resource allocation suffers from a lack of planning and coordination, weak managerial and administrative capacity, and underdeveloped mechanisms for assessing needs and setting priorities. In addition, an oversupply of specialist physicians coexists with an undersupply of general practitioners and nurses. The combination of an absence of a functioning referral system and irrational pricing and reimbursement mechanisms leads to poor coordination of care, large out-of-pocket payments and a sizable black economy, impeding the systems ability to deliver equitable financing and access to services. Since the onset of the crisis, …

Health Care Spending in the United States and Other High-Income Countries

Importance Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs. Objective To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations. Evidence Analysis of data primarily from 2013-2016 from key international organizations including the Organisation for Economic Co-operation and Development (OECD), comparing underlying differences in structural features, types of health care and social spending, and performance between the United States and 10 high-income countries. When data were not available for a given country or more accurate country-level estimates were available from sources other than the OECD, country-specific data sources were used. Findings In 2016, the US spent 17.8% of its gross domestic product on health care, and spending in the other countries ranged from 9.6% (Australia) to 12.4% (Switzerland). The proportion of the population with health insurance was 90% in the US, lower than the other countries (range, 99%-100%), and the US had the highest proportion of private health insurance (55.3%). For some determinants of health such as smoking, the US ranked second lowest of the countries (11.4% of the US population ≥15 years smokes daily; mean of all 11 countries, 16.6%), but the US had the highest percentage of adults who were overweight or obese at 70.1% (range for other countries, 23.8%-63.4%; mean of all 11 countries, 55.6%). Life expectancy in the US was the lowest of the 11 countries at 78.8 years (range for other countries, 80.7-83.9 years; mean of all 11 countries, 81.7 years), and infant mortality was the highest (5.8 deaths per 1000 live births in the US; 3.6 per 1000 for all 11 countries). The US did not differ substantially from the other countries in physician workforce (2.6 physicians per 1000; 43% primary care physicians), or nursing workforce (11.1 nurses per 1000). The US had comparable numbers of hospital beds (2.8 per 1000) but higher utilization of magnetic resonance imaging (118 per 1000) and computed tomography (245 per 1000) vs other countries. The US had similar rates of utilization (US discharges per 100 000 were 192 for acute myocardial infarction, 365 for pneumonia, 230 for chronic obstructive pulmonary disease; procedures per 100 000 were 204 for hip replacement, 226 for knee replacement, and 79 for coronary artery bypass graft surgery). Administrative costs of care (activities relating to planning, regulating, and managing health systems and services) accounted for 8% in the US vs a range of 1% to 3% in the other countries. For pharmaceutical costs, spending per capita was

Health system performance comparison: New directions in research and policy

1443 in the US vs a range of

Effects of Greek economic crisis on health are real

466 to

Molecular testing for somatic cancer mutations: a survey of current and future testing in UK laboratories

939 in other countries. Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were

Molecular testing for somatic mutations in common cancers: the views of UK oncologists

218 173 in the US compared with a range of

Challenges in International Comparison of Health Care Systems

86 607 to