Designing value based health care systems

The current economic climate is leading to calls for expanding the role of user charges. Although there is mounting evidence that this would lead to reduced access for those most in need in most cases, current evaluations of a valued based orientation in health system design suggests that, in some circumstances, both cost savings and health gains could be achieved.

A value based system could include abolishing any user charges for high value health care interventions, keeping them unchanged for those of moderate value and increasing them for those of low value. In a simulation study with US data, researchers have observed that such a system might increase population health gains (as measured in life years) by between 0.6% and 9.4%, depending on how broadly the system was implemented, and, significantly, without increasing costs and without increasing overall out-of-pocket payments.

It is not clear, however, what would be the role of such an approach in the NHS. Certain characteristics of the NHS, such as the strong primary care focus and the gatekeeping system, do already deliver the expected benefits of a value based design. Based on this argument, resaerchers at LSE Health and the European Observatory of Health Systems and Polocies have recently advocated in this respect the complete abolition of user charges.

Further information:
On value based health systems design: Chernew M et al. Health Affairs 2007 link
On the simulation study: Braithwaite R et al. PLoS Medicine 2010 link
On the implications for the UK and the NHS: Thomspson S et al. BMJ 2010 link

Do audit and feedback to health professionals improve the quality and safety of health care?

The short answer is yes, but with effects that are generally small to moderate. This is the conclusion of a recent report by the Health Evidence Network.

The full report is available here.

Additional reports on health workforce have been also released.

The ethics of personalised healthcare

The report "Medical profiling and online medicine: the ethics of 'personalised healthcare' in a consumer age" by the Nuffield Council on Bioethics has been lauched today in an event at the Law Society, London.

The report explores the application of five relevant ethical values (confidentiality, autonomy, harm reduction, equity and efficiency, and social solidarity) to selected case studies on personal genetic profiling, direct-to-consumer body imaging, telemedicine and three additional uses/services available through the internet: health information, health records, and purchase of medicines.

Prof. Christopher Hood, Gladstone Professor of Government at the Univeristy of Oxford, has summarized the key messages during the presentation. These technologies have the potential for radically transforming medical care, but most of them are still in development, making it difficult to predict how much use will be made of them in the future. They offer a mix of potential benefits and harms and they affect key ethical values. Regular scrutiny is advocated in the report, along with an appeal for caution about exagerated claims about them.

Full details are available here.

Using financial incentives to achieve healthy behaviour

Is there any evidence for the impact of positive individual financial incentives for modifying health behaviours? There is indeed, and although they seem to have a positive impact on discrete, infrequent behaviours, the evidence is far from impressive in terms of sustained behaviour. Marteau, Ashcroft and Oliver reviewed last year the available evidence in a paper in the British Medical Journal, which also examined the basis for moral and other concerns about their use. Full details are available here.

The White Paper

It has been almost three months since the NHS White Paper, Equity and excellence: Liberating the NHS, which sets out the Government's vision for the future of the NHS was released. Here is the most succint summary: patients at the centre of this vision, with a focus on quality, outcomes, information and choice.

Full details available here.

How tele-health can help in the provision of integrated care

The European Observatory for Health Systems and Policies produces jointly with the Health Evidence Network a series of policy briefs, which synthesizes available research evidence to inform policy options for good practice. The most recent policy brief focusses on the potential of tele-health for enhancing the provision of integrated care. It shows that increasingly solid evidence base is emerging indicating that tele-health can be
used effectively to help support better integrated care, in particular for those
with long-term chronic conditions. The full report is available here.

European Health Policy events in October

The 13th annual meeting of the European Health Forum Gastein will take place in October (6-9). This forum brings together politicians, senior decision-makers, representatives of interest groups, and experts coming from government and administration, business, industry, and academia. Details about the programme can be found here. A few days later, an EU Ministerial Conference will focus on innovative approaches for chronic illnesses (19 and 20 October 2010, further details available here). The conclusions will be presented to the Employment, Social Policy, Health and Consumer Affairs Council in December 2010.

Welcome

This is the Health Policy blog of the new Health Services and Policy Research Group (HSPRG) within the Department of Primary Health Care, University of Oxford. We will post each week information and commentary on new health policy developments in the UK and abroad, and relevant updated information on HSPRG projects of general interest. Please, do check the side bar for other health policy blogs that you may find of interest.