ortra ltd. - conference official travel agent email: info ... · society of pharmacoepidemiology...

PROGRAM & ABSTRACTS

www.ortra.com

Ortra Ltd. - Conference Official Travel AgentEmail: [email protected] Tel: +972-3-6384444 Fax: +972-3-6384455

JOINT CONFERENCE OF THE OECD AND THE MINISTRY OF HEALTH ISRAEL

F INANCING MODELS OF HEALTHCARE SYSTEMSTEL-AVIV, OCTOBER 22-23, 2012

Chairs:Prof. Mordechai Shani (Israel)Prof. Richard Saltman (US)

Sunday, October 21, 201219:30 Welcome Get Together at the David Intercontinental Hotel (for overseas participants) (Royal H)

Monday, October 22, 201208:00-09:00 Convening and Registration (Ballroom Foyer)09:00-09:30 Opening and Greetings (Ballroom BC) Greetings by: Rabbi Yakov Litzman MK, Israels Vice Minister of Health Background and Goals of the Meeting: Mark Pearson, Head of Health Division, OECD Ronni Gamzu, Director General, Israel Ministry of Health Overview of the 1st day: Mordechai Shani, Israel Chair 09:30-11:30 Plenary - Part 1: Establishing a National Policy in Health Chair: Dr. Boaz Lev (Ballroom BC) 09:30-10:10 Game Theory in the World of Health Yisrael (Robert) Aumann (Israel), 2005 Nobel Memorial Prize in Economics 10:10-10:50 Health Policy Challenges in an Era of Permanent Austerity Richard Saltman (US) 10:50-11:30 National Health Reforms Intentions, Obstacles and Implementation Hans Maarse (Netherlands)

11:30-11:45 Coffee Break (Ballroom F)

11:45-13:45 Plenary - Part 2: Debates and Challenges in Keeping Healthcare Systems Sustainable Chair: Prof. Gabriel Barbash (Ballroom BC) 11:45-12:25 Privatization of Funding as a Response to the Financial Crisis Josep Figueras (European Observatory on Health Systems and Policies) 12:25-13:05 Does One Size Fit All? In the Pursuit of the Best Healthcare Formula Ronni Gamzu (Director General, Israel Ministry of Health) 13:05-13:45 Financial Sustainability of Healthcare Systems Joshua Atwood, (World Economic Forum and McKinsey & Company)

13:45-14:40 Lunch (Jaffa Court, Level 3)

14:40-16:20 Plenary - Part 3: Public Health Insurance and Private Insurance: Partners or Competitors? (Ballroom BC) Chair: Prof. Avigdor Kaplan

14:40-15:20 The Interface Between Voluntary Private Health Insurance and a Mandatory Public Health Insurance; Challenges, Opportunities and Options for National Policy Design Francesco Paolucci (Australia) 15:20-16:00 The Role of the Private Sector in Healthcare Services Birger Forsberg (Sweden) 16:00-16:20 From the Bismarck Model to a unique National Insurance Act: The Evolution of a Public Healthcare System in Israel - Haim Bitterman (Clalit Health Fund, Israel) 16:20-16:40 Concluding Remarks: Ronni Gamzu, Director General, Israel Ministry of Health (Ballroom BC)

19:30 Gala Dinner at the David Intercontinental Hotel (Ballroom DE)

1

Scientific Program

13:00-14:00 Lunch (Jaffa Court, Level 3)

14:00-15:30 Parallel Sessions Session A: Public/Private Mix (Ballroom B) Chair: Aviva RonPresenter: Orit Jacobson (Israel) Public/Private Mix in the Provision of Health Services: The Tension between Greater Care Co-ordination Across Providers, Increased Competition, and Freedom of ChoiceDiscussant: Richard Saltman (US)

Session B: Healthcare Systems Confronting Current and Future Challenge (Ballroom C) Chair: Arnon AfekPresenter: Mark Clarfield (Israel) Coping with the Financial and Organizational Challenges of the Delivery of Health Services to an Aging PopulationDiscussant: Hans Maarse (Netherlands)


16:00-16:15 Concluding Remarks: Richard Saltman, Co-chairperson (US) (Ballroom B)16:15-16:30 Concluding Remarks: Mark Pearson, Head of Health Division, OECD (Ballroom B)16:30-16:45 Conclusions and Lessons for the Israeli Healthcare System (Ballroom B) Ronni Gamzu, Director General, Israel Ministry of Health

Tuesday, October 23, 2012

08:30-09:00 Convening and Registration (Ballroom Foyer)

09:00-11:00 Plenary Session (Ballroom BC) Chair: Prof. Avi Israeli 09:00-09:10 Overview of the 2nd day: Prof. Richard Saltman (US. Chairperson) 09:10-09:40 Innovation in the Israeli Healthcare System Mordechai Shani (Israel) 09:40-10:05 Cost Containment Measures of Financing Health Expenditures Giuseppe Ruocco (Italy) 10:05-10:30 Financial and Organizational Challenges in Treating Multiple Chronic Conditions: The National Perspective Ran Balicer (Israel) 10:30-11:00 Prevention or Cure: the Problem of Evidence Alan Maynard (UK)


11:30-13:00 Parallel Sessions

Session A: Public/Private Mix (Ballroom B) Chair: Mark PearsonPresenter: Jacob (Kobi) Glazer (Israel) Why Healthcare Systems are so Sick and why it is so Difficult to Cure Them?Discussant: Josep Figueras (European Observatory on Health Systems and Policies)

Session B: Healthcare Systems Confronting Current and Future Challenges (Ballroom C) Chair: Joshua ShemerPresenter: Bruce Rosen (Israel) Private Financing and Private Delivery in Israel and in Other Countries: Time for a More Integrated Approach?Discussant: Alan Maynard (UK)

2

Joshua Atwood

Joshua Atwood, based in Geneva, was trained as an economist at Wesleyan University. He has been with McKinsey & Company for over 4 years and has served clients in the healthcare sector in 3 continents around the world. He is currently leading the McKinseys collaboration with the World Economic Forum focused on the Financial Sustainability on Health Systems, which entails holding high-level workshops defining the 2040 vision for the countrys health system and strategies to achieve that vision with ministry officials, industry leaders, and academics in the United Kingdom, the Netherlands, Germany, Spain, the Peoples Republic of China, and Turkey.

Financial Sustainability of Healthcare Systems Abstract:Healthcare is one of the great success stories of our time. The healthcare sector has spurred economic growth, created high skilled jobs, improved quality of life, extended life expectancy, and contributed to country competitiveness in the global labor market. That said, this extraordinary success has come at a cost: OECD countries have seen healthcare costs consistently outgrow the economy for decades. While this has long been seen as a significant challenge, the confluence of cost drivers across supply

and demand have brought the issue into national debates across the globe.

A financially sustainable health system is a goal of both developed and developing countries. Developed countries struggle to find the balance of a sustainable system with excessive rationing on one end and financial insolvency on the other. Developing countries strive to achieve improved outcomes and access, and should leapfrog the pitfalls that developed systems have encountered. There is no silver bullet to fix the ailments of developed health systems, and developing economies need to be broad and bold in their investments for growth to the future.

The lecture will outline the healthcare financing gap that many countries are at risk of facing in coming years and describe the factors that are driving healthcare expenditure growth. In response to this, the lecture will propose seven levers that health systems can use to improve their financial sustainability and provide concrete examples of each lever, describing what kind of impact it achieves and how it is transforming health systems today.

3

Speakers Biographies & Abstracts

Yisrael (Robert) Aumann

Robert Aumann was born in Frankfurt am Main, Germany, in 1930, to a well-to-do orthodox Jewish family. Fleeing Nazi persecution, he emigrated to the United States with his family in 1938, settling in New York. In the process, his parents lost everything, but nevertheless gave their two children an excellent Jewish and general education. Aumann attended Yeshiva elementary and high schools, got a bachelors degree from the City College of New York in 1950, and a Ph.D. in mathematics from MIT in 1955.

He joined the mathematics department at the Hebrew University of Jerusalem in 1956, and has been there ever since. In 1990, he was among the founders of the Center for Rationality at the Hebrew University, an interdisciplinary research center, centered on Game Theory, with members from over a dozen different departments, including Business, Economics, Psychology, Computer Science, Law, Mathematics, Ecology, Philosophy, and others.

Aumann is the author of over ninety scientific papers and six books, and has held visiting positions at Princeton, Yale, Berkeley, Louvain, Stanford, Stony Brook, and NYU. He is a member of the American Academy of Arts and

Sciences, the National Academy of Sciences (USA), the British Academy, and the Israel Academy of Sciences; holds honorary doctorates from the Universities of Chicago, Bonn, Louvain, City University of New York, and Bar Ilan University; and has received numerous prizes, including the Nobel Memorial Prize in Economic Sciences for 2005.

Aumann is married and had five children (the oldest was killed in Lebanon in 1982). Also, he has twenty-one grandchildren, and ten great-grandchildren. When not working, he likes to hike, ski, cook, and study the Talmud.

Game Theory in the World of Health

Abstract:

4

The lecture will describe highly practical applications of Game Theory in the area of health, such as assignment of medical students to hospitals for their residencies, streamlining organ donations, appropriate management of risk in public health, and proper handling of labor disputes with health professionals.


Ran Balicer

Director, Clalit Research InstituteDirector, Health Policy Planning Department, Clalit Health Services, Chief Physician office

Dan D. Balicer, a public health physician and researcher, serves as Director of the Clalit Research Institute and Director of Health Policy Planning, Chief physician office, at Clalit - Israels largest healthcare organization. In these roles, he is responsible for strategic planning and development of novel organization-wide interventions for improving healthcare quality, reducing disparities, and introducing novel data-driven tools into practice to increase care effectiveness.

Prof. Balicer has been affiliated as faculty with the Ben-Gurion University since 2004, involved in research and teaching in the Epidemiology Department, and serves today as associate professor and track director in the faculty MPH program. He authored books, book chapters and over 100 peer-reviewed publications looking at various aspects of public health, quality improvement, and preventive medicine. In recent years, Prof. Balicers research is focused on two distinct themes - the study of extensive clinical databases and predictive modeling in health provision and

policymaking, and the study of emerging infectious diseases prevention and control.

Prof. Balicer serves as an Adviser to the Israeli Ministry of Health and as Member of the National Advisory Committee on Immunizations Practices and Infectious Diseases. He also serves as Secretary of the Israeli Public Health Physician Association, Secretary of the Israeli Chapter of the International Society of Pharmacoepidemiology and Outcome Research (ISPOR), and as executive committee member of the Israeli Society for Quality in Healthcare.

Financial and Organizational Challenges in Treating Multiple Chronic Conditions: The National Perspective

Abstract:The recent decades has seen a marked change in morbidity patterns in the developed world. The epidemiological transition from infectious diseases to chronic illness as the major cause of death that was the hallmark of the last century, is now further evolving towards an era of multimorbidity, in which the coexistence of multiple chronic diseases become the norm among adults at an increasingly younger age. Coexistance of multiple chronic diseases has detrimental synergistic effects on the individual, family, care providers and the healthcare system, that will be discussed.

The Israeli healthcare system has unique attributes that have allowed it to cope relatively well with the changes to date. Universal health insurance coverage, increased emphasis of strong accessible primary care services, selective early adoption of new technologies and long-term scope of membership with a single provider are an excellent starting point. Yet the epidemiological transition, coupled with a rapidly aging population (as is the case in Israel), cause an increasing strain.

5

In times of unmet shortages in funding and personnel availability that are expected to worsen further before they get any better, this strain has the potential to unbalance the system if current trends will ensue.

If a health system intends to do more (care) with less (resources) for a prolonged period of increasing needs, paradigms must shift. Israel has been a pioneer in some systematic aspects of advanced care for chronic illness, and has important lessons learned from these efforts. Through local examples of some challenges that were successfully met and others that yet remain unmet, we will discuss potential systematic changes that may drive health systems towards successful adaptation to the challenges ahead.

Haim Bitterman

Chief Physician.Clalit Health Services. Professor of Medicine. The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa. Israel.

Education and training: 1972: M.D. Hadassah and Hebrew University Medical School, Jerusalem. 1973: Internship: Soroka Medical Center. 1977-1982: Residency in Internal Medicine, Carmel Medical Center. Haifa, Israel. 1985-1987: Research fellowship in Cardiovascular Physiology. Department of Physiology, Thomas Jefferson Medical College. Philadelphia, USA. 2001: Visiting Professorship. Department of Cardiovascular Medicine. Stanford University, Palo Alto, CA, USA.

Appointments: 1989: Director, Department of Internal Medicine, Carmel Medical Center, Haifa. 1990: Senior Lecturer of Medicine. Faculty of Medicine, Technion, Haifa. 1997: Associate Professor of Medicine. Faculty of Medicine, Technion, Haifa: 2009: Professor of Medicine. Faculty of Medicine, Technion, Haifa. 1999-2004: Vice Dean, Faculty of Medicine, Technion, Haifa. 2000-2012: European Federation of Internal Medicine (EFIM) member of the administrative council. 2003-2009: Chairman

6


of Medicine, Carmel Medical Center, Haifa. 2005-2010: President of the Israel Association of Internal Medicine. 2009-: Clalit Health Services, Israel Chief Physician.

From the Bismarck Model to a Unique National Insurance Act: The Evolution of a Public Healthcare System in Israel.

Abstract:The history of current public healthcare systems starts in Prussia and the early German Confederation in the mid 19th century. A combination of genuine persuasion and shrewd real politics drove Otto von Bismarck, the conservative, aristocratic, iron chancellor to introduce old age pensions, medical care, accident insurance, and unemployment insurance the major backbones of a welfare country. The Bismarck healthcare model was based on a nationwide health insurance financed by compulsory income-based premiums, with universal access regardless of income. The insurance was managed by non-governmental non-profit sickness funds and its services and fees were tightly regulated by the government. This model preceded the development of the national health system model commonly named after Lord William Beveridge (1879-1963). The Beverigian model is a major constituent of a wide scale governmental social insurance and was the basis of the British national health system (NHS) in which healthcare is a public service provided and financed by the government through tax payments, providers can be government employees or contract private providers, and the government controls costs as the sole payer. The development of public healthcare in Israel can largely be characterized by evolving combinations and variations of the Bismarck model with elements of the Beveridge model. Waves of immigration at the dawn of the 20th centuries raised the need for a wide-scale medical coverage.

A work accident in which an agricultural laborer lost an arm was a final trigger to the establishment of the first mutual aid healthcare organization by the Labor Federation of Agricultural Workers in Judea (later known as Clalit Health Services) in 1911.

This initial endeavor evolved into a large scale country-wide healthcare coverage by Clalit that was based on a network of primary care clinics, specialist services, and hospitals. All four of Israels health plans, Clalit, Maccabi, Meuhedet, and Leumit, were formally established between the 1920s and 1940s and together with a network of governmental, other public, and Hadassah hospitals and medical centers constituted the Israeli public healthcare system. By the late 1980s 95% of the population was insured by one of the four health plans. In 1990 the government appointed the Netanyahu Commission to examine the function and effectiveness of the Israeli healthcare system. The committee called for legislation to introduce national health insurance (NHI), to ensure universal health coverage, provide free choice of health plans, define a minimum benefits package, define financing of the system, enhance government regulation of the health plans along dealing with conflicts created by the ministrys regulatory and planning role and its duties as an owner and operator of hospitals and medical services. Key recommendations of the Netanyahu Commission were dealt with in the ambitious NHI law that came into effect in 1995: Entitlement for a defined package of benefits, institution of capitation formula, national collection of premiums, mandatory acceptance of all applicants, and government commitment to funding of the benefits package. Thus, both the Netanyahu commission and the NHI law reinforced fundamental elements of the Bismarck and the Beveridgian models in Israeli healthcare. Regrettably, some of the progressive recommendations of the commission have not been fulfilled and some of the important determinations of the NHI law have subsequently been eroded.

7

Mark Clarfield

Dr. Clarfield was brought up and educated in Toronto, receiving his MD from the University of Toronto in 1975. He went on the specialize first in Family Medicine, then Community Medicine and Public Health and finally in Geriatrics. Together with his wife, Dr. Ora Paltiel, also a physician (Haematology and Clinical Epidemiology), he moved to Montreal where he was with the Faculty of Medicine at McGill University from 1978-1992.

During that period, Clarfield was on staff at the Herzl Family Medicine Centre and then Chief of Geriatrics at the Sir Mortimer B. Davis Jewish General Hospital as well as head of the McGill University Division of Geriatric Medicine. As well, he was the Assistant Dean of Students at the Faculty of Medicine from 1989-92 and reached the rank of Professor. He maintains an adjunct status at McGill University.

In 1992 , he moved to Israel and from 1994-2001 he was Head of the Division of Geriatrics at the Ministry of Health in Jerusalem, after which he was appointed Head of Geriatrics at the Soroka Hospital, a 1,100 bed acute care institution and the Sidonie Hecht Professor of Geriatrics at Ben-Gurion University in Beer-sheva where he now works .

In 2009, he was appointed the Israeli Program Director of the Medical School for International Health at the Ben-Gurion University in collaboration with Columbia University.

Dr Clarfields research interests include Alzheimer disease and the related dementias, the organization of health care services, medical history and ethics. As well, he publishes medical humour, book reviews and miscellaneous pieces in various newspapers. A bit of a journalistic nudnik, he has published many letters to the editor in publications around the world.

Dr Clarfield is married with 3 children, none of whom seem to want to enter the field of medicine, despite the fact that he has not insisted that they become geriatricians. He enjoys several hobbies, including performing folk music with his band, The Unstrung Heroes.

Coping with the Financial and Organizational Challenges of the Delivery of Health Services to an Aging Population

Abstract:Given that I am not an economist but rather a geriatrician, this presentation deals primarily with the organizational changes which must be taken in order for a society to properly care for this growing population rather than the relevant financial aspects.I identify 7 diagnoses which describe the situation of todays older persons (especially the old-old[85+], frail subcategory) and offer some practical, implementable policy recommendations meant to deal with each challenge described.

They comprise the following: 1) the ongoing increase in the proportion of the elderly within the general population 2) poly-pathology with resultant polypharmacy so common especially among the old-old; 3) the under-recognized challenge to poor countries of the growing

8


elderly populations in the Less Developed Regions (LDRs) of the world; 4) the fact that much of the costs involved in the last year of life are not primarily a function of old age but rather of the process of dying. When young people die they also cost a lot . 5) the chaos and disorganization of health care systems which prevent us from utilizing known tools in order to care better for older people;6) good news: the encouraging but preliminary evidence that todays elderly persons are healthier than similar aged cohorts which preceded them; 7) bad news: ageism and the professional stigma involved with eldercare .

An optimistic line of attack will be taken for the following reasons: a) population ageing hardly justifies the catastrophist approach taken by so many in the field;b) it is a slow and steady process and we have some tools to deal with it; c) population aging should be viewed as the miracle it is: the end result of successful public health and societal processes which have so positively affected younger cohorts by preventing premature death .

Josep Figueras

Josep Figueras, MD, MPH, PhD (econ) Spanish, is the Director of the European observatory on Health Systems and Policies and head of the WHO European Centre on Health Policy in Brussels. In addition to WHO, he has served other major multilateral organizations such as the European Commission and the World Bank. He is a member of several advisory and editorial boards and has served as advisor in more than forty countries within the European region and beyond. He is member of APHEA board of accreditation; honorary fellow of the UK faculty of public health medicine, has twice been awarded the EHMA prize, and in 2006 received the Andrija Stampar Medal. He was head of the MSc in Health Services Management at the London School of Hygiene & Tropical Medicine and he is currently visiting professor at Imperial College, London. His research focuses on comparative health system and policy analysis and is editor of the European Observatory series published by Open University Press. He has published several volumes in this field, the last two: Health systems, health and wealth: assessing the case for investing in health systems (2012) and Health professional mobility and health systems (2011).

9

Privatization of Funding as a Response to the Financial Crisis

Abstract:Health Systems Response to the financial crisis in the EU: Should we increase private finance? In 2008, Europe saw the onset of the most severe economic crisis since the 1930s. This crisis has put major pressure on health and social budgets in many EU countries particularly in Southern and Eastern Europe. Health systems in those countries have responded with a wide array of cost containment measures which in some instances have taken the form of indiscriminate cost cuts across the board.

The presentation will outline the response of health systems across the EU paying particular emphasis to strategies acting on the demand either by rationing services including both statutory population coverage and/or package of benefits or by shifting costs to the individual users by for instance increasing cost-sharing for some statutory services. It will first analyze the likely impact of those measures on health service access and ultimately on health outcomes, inequalities and financial protection to then consider the scope for further privatization of funding. It will also assess the effects that these measures may have on future economic growth.

The presentation will show how the health systems response, particularly when addressing the public private funding mix is determined by many factors other than the evidence about what works and what doesnt. These include, for instance, shifting political values about the role of the social protection systems; major changes in European governance moving the locus of decision making to Brussels or the pervasive economic paradigm championing austerity and deficit reduction as the cure for all ills.

Birger Forsberg

Institution Degree, year received

Karolinska Institutet, Stockholm PhD, Medical Sciences (Public Health), 2007

Karolinska Institutet, Stockholm Master of Medical Sciences/Public Health, 1994

National Board of Health and Social Welfare (Socialstyrelsen), Stockholm

Specialist, Public Health/Community Medicine, 1992

Karolinska Institutet, Stockholm Medical Degree, 1981

University of Lund, Sweden Bachelor of Science, 1974

Present positions:Lead Physician, Head, Unit for Health Development, Dept of Development, Stockholm County Council, Sweden. Associate Professor, Division of Global Health (IHCAR), Dept of Public Health Sciences, Karolinska Institutet (part-time position)

10


Key qualifications and experience: After training and work as a clinical physician, employed by WHO from 1985 to 1989 in Control of Diarrhoeal Diseases Progamme (CDD) and later as consultant to WHOs child health programmes on numerous occasions. Work experience from more than 25 countries as a consultant to various international organisations. In 2002-2009 regular World Bank consultant on interaction between the public and private sector in health care in Bangladesh, WB HQ Washington and India. Experience from leadership as CEO of a Swedish consulting company in international health (InDevelop Uppsala AB) 1994-98, Head of Division of Health Economics at Spri in 1999-2000 and Head of Division of Social Medicine at the Stockholm County Council 2001-2002 before taking up World Bank consultancy work. Worked in Swedish health services first as clinical officer, later as public health physician with focus on planning and evaluation, then as head of the Health Economics Unit at the Swedish Institute for Health Services Development (SPRI) and since 2001 as Lead Physician in the Stockholm County Council (SCC). Since 2002, lecturer and researcher at the Division of Global Health (IHCAR) at Karolinska Institutet with a focus on health systems issues (public private partnerships, sectorwide approach, communicable disease control). Coordinator of the research programme on the Role of the Private Sector in Health (PSP) at Karolinska Institutet which was in operation from 2002 to 2009. Twenty-six articles published in international journals and 25 in various Swedish journals.

The Role of the Private Sector in Healthcare Services Abstract:Much attention is given globally and nationally to the issue of public and private health financing and health care delivery. The debate on advantages and disadvantages with public versus private care has gradually shifted focus from system issues to quality issues. In parallel the proposed role of the state in health care delivery has changed from provision to steering and governance. Public sector control of financing is seen as essential by many to ensure equity in health service delivery while others emphasize the efficiency gains that private sector financing can offer as compared to public financing.

Swedish health services have traditionally been publicly financed and publicly provided. The private sector has overall been small and its dependence on public financing has been high. Since 2006 the national government aims to increase competition and efficiency in the health sector by encouraging private health care provision. In parallel, the private insurance sector has sought to establish a private health insurance market.

This presentation will discuss issues around public and private health care provision and financing from a study of the development of the private health care sector in Sweden, with a particular focus on Stockholm County, the largest regional health care authority covering 24% of the population in Sweden. The study is based on analysis of data from databases covering purchasing and utilization of health care services in the Stockholm County Council (SCC). The SCC finances an estimated 95% of health services in the region.

Private health care providers account for about 30% of costs of all publicly purchased health services in Stockholm. The proportion has remained relatively steady since 2003 with an increase of around 5% 2008-2011.

11

The main reason for the latter is the introduction from 2008 on-wards of a general accreditation system for ambulatory care providers (Vrdval), which has facilitated the establishment of clinics; private or public. This system will be expanded to many medical specialities in the coming years, something that may lead to an increase in private specialist care. Private providers are also established through public purchasing in disciplines such as geriatrics and psychiatry.

The highest proportion of private care in SCC today (60%) is found in primary care. Primary care only accounts for 16% of total health care costs though. All in all, private health care only accounts for around 10% of all health care provided in Sweden. Emergency hospitals account for around 40% of total health care costs. Efforts have been made for a long time to reduce this proportion, so far with limited success. Even though a new regional health care plan (Future Health Care) suggests many steps to shift patients from hospitals to clinics and primary care outside hospitals, investments will continue to be made in public hospitals, including the construction of a new university hospital (New Karolinska Hospital). No concrete plans exist for privatisation or contracting out of more emergency hospitals. Today, only one out of six publicly financed emergency hospitals is managed by a private company. Apart from that, the fully privately financed hospital sector is very small and its focus is on elective care. The private health insurance sector has grown but it is still not really taking off, much because people have good access to high quality public care. Long waiting times used to be a major sales argument for the private health insurance but the current government has been successful in stimulating the county councils (regional health authorities) to reduce waiting times.

All in all, this suggests that the growth of private care in Stockholm County, like in Sweden, will continue to be slow. Also, there are no plans to change the current health financing model which is based on a fixed (non-progressive) regional income tax rate.

The public debate on health care in Sweden is often focused on private care. This debate has generated an impression among the public that Swedish health services are undergoing rapid privatization. However, facts show that the private share of health care is small and that its growth is slow. An important reason for this is that a significant proportion of health care is provided through public hospitals. The developments in Sweden has also shown that privatisation may not lead to a dynamic market with high innovation force and entrepreneurial spirit. The major reason is the public funders inclination to control and regulate service provision through detailed contracts or agreements with the providers.

There are interesting lessons to learn from efforts in Sweden to reform the health care system. The fundamentals of the system have proven to be very resistant to change and we now see a tendency to consolidate the system rather than fundamentally change it. However, it may be to early to say if some of the changes made, such as the introduction of an accreditation system for providers, carry a seed to a system shift in the future.

The Swedish case will be put in an international context in the presentation and some general issues on health reform and the interaction between the public and the private sector will be presented for discussion.

12


Ronni Gamzu

Prof. Gamzu, 46, studied medicine at Ben-Gurion University of the Negev and at Tel Aviv Universitys Sackler Medical Faculty and also has a bachelors degree in law, a masters degree in business administration and a doctorate in medical research. He holds diplomas in both gynecology and medical administration. From 2002 up to the end of 2007, Prof. Gamzu served as Associate Director General for health economics in the Tel-Aviv Medical Center, and from 2008 as the director-general of Ichilov Hospital of the Tel Aviv Sourasky Medical Center., Prof. Gamzu has taken office as Director General of the Ministry of Health, Israel, since 2010.

Does One Size Fit All? In the Pursuit of the Best Healthcare Formula

Abstract:Global health financing policy is in transition. In 2010, about 950 USD were spent per capita around the world, a rise of 5% from 2009. This represented approximately 10.5 percent of global gross domestic product (GDP) spent on health care worldwide. Still, low and middle income countries that account for about 80 percent of the global population spend only 10 percent of this amount. These populations harbor the greatest (double) burden of diseases, thus their utilization and spending will grow. The financial crisis and subsequent fiscal austerity policies have created concerns that fuzzy and irresponsible reforms and cuts on health expenses may lead to short sighted decisions that will cause irreversible harm in the long view. Thusly,

now more than ever, global health financing policy makers face a great challenge to lead and point in the right direction for an improved design of a global health financing policy at the international and country levels.Healthcare financing, regulatory and service delivery models vary largely among countries. It has been mentioned elsewhere that as countries move to different stages of the income spectrum, their health financing profiles transition as well, pointing to the idea that there is no generic-benchmark model and appropriateness of any design should be assessed depending on economic, socio and cultural characteristics of a given country.

In 2010 the OECD has assembled new comparative data on health policies and health care system efficiency for its member countries. The aim is to better identify strengths and weaknesses of each countrys health care system and assess whether there is scope for improving value for money and the policy reforms that will boost efficiency. It concluded that there is no one-size-fits-all approach to reforming health care systems, hence, policymakers should aim for coherence in policy settings by adopting best practices from the many different health care systems that exist in the OECD and tailor them to suit actual circumstances.

The current paper will challenge the latter conclusion using the attributes from the 2010 comparative OECD data to claim that there is indeed in principle such one size, therefore, in designing healthcare systems, in any setting, most principles can be architected beforehand to improve efficiency, equity or productivity. Life expectancy at birth and total health expenditures per capita (PPP adjusted) were selected as outcome measures to illustrate the efficiency and productivity of the system. 17 of the overall attributes were selected by their significant effect on these outcome measures.

13

Jacob (Kobi) Glazer

Jacob (Kobi) Glazer received his Ph.D in Economics from the Kellogg School of Management at Northwestern University, in 1986. He is currently a professor of economics at the Faculty of Management, Tel Aviv University and the Department of Economics, Boston University. He is the Chair of the Master of Health Administration (MHA) program and the Academic Director of the Executive MBA programs at Tel Aviv University. In addition, he serves as the Head of the Kovens Institute for Health Systems Management and is the incumbent of the Issachar Haimovich Chair for Strategic Management at Tel Aviv University.

Glazers main areas of research are health economics, industrial organization and game theory. He has served as a consultant to many research projects funded, among others, by the NIH, NIA and the VA, in the US and to various organizations in Israel such as the Israeli Medical Association, the Israeli Ministry of Health and the Maccabi Healthcare Services. He is currently an Associate Editor of the Journal of Health Economics.

Why are Health Care Systems So Sick and why is it So Difficult to Cure Them?

Abstract:Health care systems may differ from country to country with respect to objectives or goals, but they all have one goal in common: that health services be provided efficiently. Indeed, in the last three or four decades a great deal of effort has been invested by policy makers and health care providers in improving the efficiency (as well as equity) of health systems. These efforts have been in various directions: organizational, structural, regulatory, legal and, in particular, economic, all with the intention of making the system more cost beneficial and/or cost effective. However, as numerous papers, studies and reports have demonstrated over the years, many of these attempts have been only partially successful, at best.

The main objective of this talk is to examine the hypothesis that even though health care is in many respects an economic good (i.e., scarce resources are required in order to provide it and both its providers and consumers are sensitive to financial incentives), the standard (economic) mechanisms, which often work quite successfully in promoting efficiency in other sectors, cannot work as successfully in the case of the health care market, due to its special (and even unique) characteristics. Among the mechanisms I will consider are: competition, rationing (of services and technologies), cost sharing and, most important, reimbursement schemes and quality reporting mechanisms. The special characteristic that, in my view, makes health care unique and to a great extent unmanageable, is the difficulty in achieving standardization. The most efficient treatment for each patient will generally depend on many patient-specific characteristics, some of which are observed by and known only to the doctor diagnosing the patient.

14


A patients efficient treatment is often determined by , among other things, his medical history, his comorbidities, other medications he is taking and other treatments he is receiving, his emotional, mental and cognitive state, his compliance history, the support he receives at home, his employment situation, the kind of job he does and so on. Under such circumstances, managing the doctor (and the patient) becomes an extremely difficult task, as it requires the manager to evaluate and reimburse the doctor on the basis of partial information that does not include some of the most relevant data.

In light of these very special characteristics of health care services, it is not at all clear that there exist mechanisms that can achieve full (or even close to full) efficiency and even if they do exist, they will be extremely difficult to define.

Orit Jacobson

CEO, MOR institute for medical data

Orit Jacobson, a senior health administrator and researcher, is the CEO of MOR institute for medical data own by Clalit Health Services.

Till 7/2012 was the deputy director general and director of the community health division of Clalit Health Services, the healthcare provider and insurer of more than half of the Israeli population. Dr Jacobson graduated the Nursing school of the Tel-Aviv Nursing School, specialized in intensive care, and later received her B.A. in nursing, M.A in labor studies, both the Tel-Aviv university, and a Ph.D. in health administration at the Ben-Gurion University, Faculty of Health Sciences.

Following nursing training, Dr Jacobson held senior management positions at the Tel-Aviv medical center, followed by 7 years at the ministry of health, as Director of Nurse Education in Israel. Dr Jacobson joined Clalit in 1997, and has held the roles of Chief Nursing Officer, Director of the Tel-Aviv District, and was appointed Director of community health in 2007.

Dr Jacobson has gained international experience in planning and implementing health programs, one example being a reform project in the community health system in Uzbekistan, collaborating with the US-Aid.

15

Dr Jacobson was been affiliated with the Tel-Aviv University shackler school of medicine until 2000, and serves as a guest lecturer in several academic institutes.

Dr Jacobson held several key public positions, including membership in the National Council of Health, in the Taub Center for Social Policy Studies in Israel, and several scientific councils by nomination of the Minister of Health.

Public/Private Mix in the Provision of Health Services: The Tension between Greater Care Co-ordination Across Providers, Increased Competition, and Freedom of Choice

Abstract:Most of the countries in the developed world are debating on issues arising from the structure and costs of their health systems, to include attempts to organize various reforms. However, until today no ideal model has been identified for a health system organization to effectively deal with the growing health care needs of the population and the increasing expenditure for health services.There are advantages and disadvantages, discussed in the literature, in combining private medicine (funded mainly through private, elective insurance policies) with public medicine.

Among the main advantages: private medicine allows to expand the scope of health services available to the public but not at the expense of public health budgets; it maintains the privacy of the consumer and his/her freedom to choose between services- which increases the competition between health service providers resulting in an improvement and increased effectiveness in the services provided.Among the main disadvantages: private medicine may hurt the principle of social equality in the receipt of services, especially if the insurance policies places restrictions on eligibility based on morbidity risks (cream skimming);

it results in better health services for the rich, and a lower level of services for those who cant afford private insurance; Privet medicine may also lead to overuse of health services (moral hazard), which in turn will increase the burden to the providers and increase the national expenditures on health care.

In a world where the life expectancy is continuously rising, health systems major goal is the prevention and management of chronic NCDs. Our objective here is how to build a system which allows for integration and coordination of health care management to promote high quality health services, effective decision-making and focus on populations in need.

In health systems which combine public and private medicine, there is rising difficulty in achieving integration and coordination of the health care management. Even in Denmark, who is leading a reform emphasizing the integrative care, there is still a long way. As private medicine is taking a larger share of the health services provided, we may be seeing health management increasingly divided and less integrated.

This discussion will focus on how to reach integration and coordination in a combined (private and public) health system. The Israeli health system model will serve as a platform for this analysis addressing the issues arising from these two systems living side by side, specifically dealing with chronic illnesses.

16


Hans Maarse

Hans Maarse (1948) is political scientist by profession with a chair in Health Care Policy Analysis at the Faculty of Health, Medicine and Life Sciences of the University of Maastricht. His main interests are: health care financing, health care governance and international comparative analysis of health care systems. In 2011 he published a study on the market reform possibilities in Dutch health care. In 2005 he edited a book titled Privatisation in European health care. Furthermore he (co)authored many articles and book chapters on a variety of topics including European decision-making on tobacco advertising and data exclusivity in pharmaceutical research, solidarity and individual responsibility, the market reform of Dutch health care and, recently, mergers and acquisitions in Western European health care.

National Health Reforms Intentions, Obstacles and Implementation

Abstract:The Netherlands has a long history with a public-private mix in health care. Health care is mainly delivered by private not-for-profit organizations and individual providers with private practice. This basic model is not only

applied in health care but also in long-term care. Public provision of health care is limited and mainly found in public health. For-profit hospital care and long-term care have always been forbidden. At present there are initiatives to open the possibility of for-profit hospital care (mainly to attract private capital), but under various restrictive conditions. For-profit medicine is still politically heavily contested in the Netherlands. At the same time, however, there are various examples that the dividing line between not-for-profit and for-profit is becoming ever more blurred.

The reform of health insurance in 2006 significantly altered the public-private mix in health care financing. Before 2006 about 63 percent of the population was covered by a social health insurance scheme carried out by the sick funds. The remaining 37 percent had to resort to private substitutive health insurance, but it is important to note here that private health insurance included a rather heterogeneous set of insurance schemes ranging from pure private to quasi-public schemes. For instance, the insurance scheme of civil servants was classified as private. Furthermore, there were various state regulations in place to guarantee (vulnerable) groups which could not enroll in the sick fund scheme access to health insurance. So, here too, the distinction between public and private was blurred and even more so, because sick funds were also active on the market of private substitutive health insurance (by means of a separate organization).

The 2006 health insurance reform put an end to the dividing line between social and private health insurance. Both schemes were integrated into a single mandatory scheme (HIA) covering the entire population. The scheme is implemented by health insurers which may be either for-profit or not-for-profit. For internal political reasons the new health insurance scheme is set up as a scheme under private law (a fundamental difference with the former sick fund scheme), but at the same time there are many public regulations to ensure both risk solidarity and income solidarity. The private set-up has

17

created many interesting problems, because of EU regulations on private insurance. These regulations allow for specific public regulations to serve the public good, but only if they are necessary and proportional. The fundamental question is of course whether the public regulations in HIA meet the test of necessity and proportionality. Though the news scheme is a scheme under private law, it can nevertheless best be qualified as a quasi-public or even public scheme because of the many state regulations in place to ensure public interests and its mandatory structure. The paradox of the privatisation of health insurance in 2006 was, that the public fraction in health care financing measured as a percentage of the GDP jumped from 7,1 to 8,6 percent. This is clear evidence that the public-private distinction is not very helpful in health insurance.

The 2006 reform did not directly affect the Exceptional Medical Expenses scheme which mainly covers long-term care. The AWBZ is a second mandatory social health insurance scheme covering, in contrast with the former Sick Fund scheme, all legal residents of the Netherlands. Much of the current policy debate centers on the reform of this scheme. Three key developments can be distinguished. First, many services covered by AWBZ will or already have been shifted to the benefit package of HIA to foster a more integrated supply of health services. Second, a number of services including domiciliary services have been transferred from the benefit package of AWBZ to municipalities on the assumption that municipalities are better than insurers capable to offer an integrated set of health services and health-related social services to their inhabitants. The transfer has far-reaching implications because the rights-based structure of the AWBZ has been replaced with a provision-based model. Finally, there is a political debate on the benefit package of the AWBZ. Because of concerns on its future sustainability the overall trend is that it will be less generous and that users must pay more out-of-pocket for long-term care. Fundamental decisions still must be taken, but my expectation is that the trend will be in the direction of privatisation and marketization.

One can observe interesting developments on the health insurance market. This market has become concentrated; now four health insurance concerns have a total market share of about 90 percent. Competition has also become fiercer. In 2006, the year of the insurance reform, consumer mobility was very high. Some 18 percent of the population shifted to another insurer. Since then mobility dropped to 3,6 percent in 2010, but it tends to increase. It was 6 percent in 2012. Consumers become more price-sensitive. An important instrument in the competition game is complementary health insurance which in the Netherlands covers services not or no longer covered by the basic health insurance scheme (the so-called exclusion model). By directing their complementary programs at specific target groups, insurers hope to gain market share. Complementary health insurance (which is a truly private scheme) may develop as an instrument for implicit risk selection which may undermine the open enrolment obligation in basic health insurance. Insurers also advertise with low-priced pre-selected provider policies which are only attractive to persons who consider themselves as healthy and have no small children.

The agency role of health insurers is also changing. Insurers position themselves as representative of their customers in contracting with provider organizations, but the problem is that they have to serve their customers as premium payers as well as patients. Though selective contracting is still in its initial stage, various insurers are engaged in selective contracting by no longer contracting hospitals which do not meet their quality standards in terms of structure, volume (number of operations) and patient satisfaction. One can observe an interesting powering game between insurers and provider organizations (in particular hospitals) that has not been settled yet. Increasingly, insurers seek to act as an effective countervailing power relative to provider organizations. This is the role the government has assigned to them. Furthermore, insurers have been successful in negotiating lower prices for generic drugs. Some of them report price decreases up to even 90 percent.

18


Alan Maynard

Alan Maynard is a Professor of Health Economics in the Department of Health Sciences and the Hull York Medical School, University of York, England. He was Founding Director of the Centre for Health Economics at York (1983-1995) and Founding Editor of the journal Health Economics (1992-).

He has been involved in NHS management for nearly 30 years, being Chairman of York Hospitals NHS Foundation Trust (1997-2010) and currently is Chair of the Vale of York Clinical Commissioning Group (2012- ). He was awarded the OBE for services to the NHS in 2009.He has published over 200 papers in medical, economics and health policy journals and written and edited a dozen books, He has worked as a consultant in over 20 countries for the World Bank, the World Health Organisation, the UK Department of International Development and the European Union. Most recently this work has focused on rural health care reform in China (e.g.Yip et al, Lancet, 2012).

As an aging consumer of health care he continues to be fascinated and frustrated by the reluctance of policy makers and managers (clinical and non-clinical) in health care systems to be evidence rather than faith based!

Prevention is Better than Cure: Wheres the Evidence?

Abstract:Monolithic health care systems, public and private, are inefficient and inequitable. Some aspects of health care exhibit flat of the curve characteristics i.e. diminishing and zero health gains from additional investment. In part this may be due to over-diagnosis and the unnecessary medicalisation of the population. All aspects of health care appear to exhibit clinical practice variations, some of which may be warranted but much of which is said to be inefficient and wasteful. Problems with safety and the lack of outcome measures have pre-occupied health care policy makers for decades. Technological change compounds these problems by adding to funding pressures while marginal and redundant services are not de-commissioned. The lack of resolution of these inefficiencies offers clear signals that the rate of return to health care investment may be low

But is it better to invest in prevention rather than cure? Many inputs produce health outputs. But what is the relative cost effectiveness of competing interventions in education, housing, nutrition, safety, policing and crime reduction, and social security? Do investments to reduce the consumption of fatty and sugary foods, smoking, illicit drugs and alcohol give a better rate of return than hiring more physicians and increasing pharmaceutical expenditure?

If a broader picture is taken of investment in the production of health, where would you put your money? Or are both health care and preventive investment activities stymied by policy makers preference for faith rather than evidence based policy making?

19

Francesco Paolucci

Francesco Paolucci is an economist and Reader/Fellow at the Australian National University (Australia) and at the University of Northumbria Newcastle (United Kingdom). Prior to taking up his current posts, he held academic appointments at the Institute of Health Policy and Management at the Erasmus University of Rotterdam (The Netherlands) at the Institute of Health Economics and Management at the University of Oslo (Norway), and at the Department of Economics at the University of Bologna (Italy) and at the Management Centre Innsbruck (Austria). His research interests include primarily regulated competition in health insurance markets, aged and long term care financing and insurance, risk equalisation and risk selection, international comparisons of health care systems, law and economics of competition policy in the health care sector, and preferences elicitation and priority setting. Dr Paoluccis work has been published extensively in health policy and economics journals and recently Springer published his book entitled Health Care Financing and Insurance: Options for Design. He has been a longstanding member of the Risk Adjustment Network (RAN) and of scientific committees international health economics associations (iHEA, ECHE, AES, ASHE, AIES).

The Interface Between Voluntary Private Health Insurance and a Mandatory Public Health Insurance; Challenges, Opportunities and Options for NationalPolicy Design

Abstract:Since 1960 medical care expenditures have more than doubled worldwide as a share of GDP. OECD countries have experienced an average annual increase in per capita health care costs of 3.5% during the period 19902001 and of 4% during the period 200-2009 (OECD, 2011), outpacing the average annual economic growth during the same period by more than 50%. The major driving forces behind the continuing rise in health care costs are medical technology, health care services price-inflation, and the aging of the population. Policymakers have expressed the view that continued increases in health care spending may be unsustainable, particularly in light of current and projected government budget deficits, and thereby threaten the achievement of efficiency and affordability goals. For decades, governments have been seeking suitable solutions to finance the rising health care costs, given the increasingly constrained collective resources. In the attempt to find a balance between affordability and efficiency goals, a great variety of mixes of different sources of health care financing have emerged across countries combining out-of-pocket spending, voluntary private health insurance, and collective funding (tax-based financing or social health insurance).

On the one hand, policymakers have been focusing on achieving universal access to health care services by establishing and gradually expanding mandatory coverage for a uniformly predefined set of services to the entire population. On the other hand, along with the gradual expansion of mandatory coverage to achieve equity, health care reforms in most OECD countries have aimed at containing the collective financing of health care by increasing the share of individual financial responsibility for financing health care spending. Shifting (parts of) the costs of health care away

20


from collective to individual responsibility led to an increase in the demand for voluntary private health insurance, and thereby to a proliferation of several intertwined health care financing schemes. In particular, most OECD countries have limited the comprehensiveness of schemes providing universal mandatory basic health care coverage by allowing individuals to increasingly rely on voluntary basic or supplementary health care financing schemes.

Since the beginning of the 1990s, the role of supplementary health care financing in terms of share of total health care financing or in terms of percentage of insured has increased in several OECD countries. In terms of share of mandatory public insurance, supplementary insurance spending doubled in Germany, Israel and the Netherlands, mainly because of government policies that focused on reducing collective health care financing and aimed at increasing insurance coverage for out-of-pocket expenditures. While representing only a small share of total health care financing, on average supplementary insurance covers 60% or more of the population in OECD countries. The share of individuals purchasing supplementary insurance has increased over the last decades particularly in Germany (from 8 to 12%), Israel (from 46 to 70%) and Switzerland (from 62 to 73%) and it is steadily high in the Netherlands (92%). Other countries such as Australia, France and Ireland, in the attempt of containing collective financing have been increasingly relying on voluntary duplicative private insurance for basic services (e.g. public hospital services). Although the share of voluntary duplicative insurance expenditures as a percentage of mandatory coverage spending has been fluctuating, the percentage of the population buying it has increased in Australia (from 30 to 50%) and Ireland (from 35 to 50%) and is remarkably high in France (92%).

This presentation will focus mainly on the interactions between voluntary and mandatory health insurance schemes and on the consequences for efficiency and affordability of shifting (parts of) the costs of health care from mandatory basic health care financing schemes to voluntary health

care financing schemes. In some countries (i.e. Belgium, Germany, Israel, the Netherlands and Switzerland) voluntary insurance covers services excluded from a mandatory basic package of services offered by competing insurers or sickness funds, i.e. it fulfils a supplementary role. If voluntary supplementary insurance is combined with basic insurance or is offered by the same entities or their affiliates, it may be used as a tool for risk-selection in a competitive mandatory public insurance market. In other countries, such as Australia, Ireland, and Spain, subsidised voluntary health insurance covers services already covered (duplicative) by the national mandatory public insurance scheme (i.e. public hospital services) for which it provides faster access, better (perceived) quality and increased choice of providers. As the main policy motivation for subsidising voluntary duplicative insurance in these countries has been to reduce the pressure on public finances, concerns have been raised in relation to the effectiveness in containing public health spending, the potential instability in public sector waiting times and distortions in providers incentives, moral hazard (caused by potential over-insurance) and the emergence of a two-tier system. The expansion of voluntary basic and/or supplementary health insurance may therefore have serious consequences for both the efficiency and affordability of basic health care services.

21

Bruce Rosen

Dr. Bruce Rosen is the Director of the Smokler Center for Health Policy Research at the Myers-JDC-Brookdale institute. He received his BA from Harvard College and his DSc from the Harvard School of Public Health. Dr. Rosens research has focused on the areas of financial incentives, vulnerable populations, quality monitoring, and the evaluation of major national policy changes.

Throughout his career, Dr. Rosen has emphasized the need to link research with policy development, and to bring international expertise to bear on Israeli health policy issues. To further these objectives, he organizes an annual US-Israel health policy symposium, created an internet-based discussion group on Israeli health policy consisting of 300 experts from around the world, published a series of papers on what other countries could learn from Israeli health care, and helped establish the Israel Journal of Health Policy Research which he now co-edits.

Private Financing and Private Delivery in Israel and in Other Countries: Time for a More Integrated Approach?

Bruce Rosen1 and Ronni Gamzu21Myers-JDC-Brookdale Institute; 2Ministry of Health

Abstract:The rich scholarly literature on the public-private mix in health care makes a sharp distinction between the mix for financing and the mix for service provision. This conceptual distinction was an important corrective to the general publics tendency to confuse the two topics. However, over time the conceptual distinction has developed into a rigid cognitive and analytic separation, which has obscured important interactions between private financing and private provision. Using the Israeli health system as an illustrative case study, we argue that increased private financing can promote increased private provision, and vice versa. Moreover, we argue that a more integrated approach is vital for a fuller understanding of the causes and effects of privatization. Adoption of a more integrated approach also has important policy implications for countries that are considering interventions to constrain and/or shape privatization trends.

22


Giuseppe Ruocco

Title of qualification awarded Degree in Medicine and Surgery

Other qualifications and training experience Specialization in Internal Medicine Previous professional experienceHead of the Directorate for European and International Relations Ministry of Health (2010 - 2012)Head of the Directorate General for Medicines and Medical Devices Ministry of Health (2008 - 2010)Vice Head of the Directorate General for Medicines and Medical Devices Ministry of Health (2005 2008)Director of Office III of the Directorate General of Medicines and Medical Devices Ministry of Health (2004 2008)Director of Office II of the Directorate General for Prevention Ministry of Health (2003 2004)Director of Office III of the Directorate General for Prevention Ministry of Health (2003)

Director of Office VII of the Directorate General for Prevention Ministry of Health (2001 2003)Director in the Directorate General for Prevention Ministry of Health (2000 2001)Director of the Maritime Health Office La Spezia, Ministry of Health (1998 2000)Medical Director of Health Unit Fiumicino Airport, Ministry of Health (1984 1998)Representative for Ministry of health in Airport Commission

Additional informationMember and Chairman of various commissions, among which: PurchasingfortheDepartmentofcivilprotection Monitoringofagreementswiththeministryofhealth RevisionofcriteriaforpermanentdisabilityINAIL RevisionoftheroadcodeMinistryofTransportCollaborated on articles for various scientific journalsResponsible for the publication of a volume on medical devices (2 editions) and various other publications for the Ministry of HealthOrganizer of various courses, seminars and workshops, for health opera-tors in the medical devices and biocides sector, and of national conferences on medical devices.

Containment of the Health Expenditure in Italy

Abstract:The Italian National Health System is the public system which guarantees promotion of health, prevention, care and rehabilitation to all Italian citizens.In time of crisis its necessary to rethink health model and the organization of health services and deal with the true challenge, to reconcile the public health service with dwindling resources and the protection of rights (first of all, the right to health).

23

To this purpose, there are many possible ways to explore, and effective and equitable solutions to find, for example by capitalizing on the internal changes in the health services.So, we must act on care professionals, managers and providers approach to the management of the System.Attention has to be paid to health care continuity, by delivering a higher rate of care through territorial services with a related reduction of hospitalisation.At the same time a more efficient organisation of both these services has to be assured to speed hospital stay up , for the better use of primary care, optimizing the use of devices and drugs, etc.).In this scenario its necessary to adopt actions for a more effective use of financial resources.With this aim, many financial interventions have been adopted in Italy in last years.In the presentation the different measures, adopted by the Italian Government at national and regional level, are described and evaluated starting from description of the health financing in the last ten years. In Italy the financing of health system is strictly linked to GDP and lower than in the UE-15. In the second part of the presentation the total health expenditure, the main actions for the control of expenditure, the trend in the last ten years are examined and the Pact for health 2010-12 among the Central State and the Regions is described. The Pact is aimed to agree on the strategic choices for a 3-years period and on the identification of some priority goals, and areas for action.

Then the actions adopted by Italy to contain the expenses in many different fields are described: pharmaceuticals, services and goods, medical devices, personnel, specialized care, hospital care.In its final part, the presentation gives some details on the so called Return Plans which have been adopted in Regions whose balance was negative.

These Regions were obliged to adopt a 3-years Plan with provision for actions on hospital and territorial assistance, emergency services, laboratory network, relations with private providers, territorial pharmaceuticals assistance and care safety and at the same time with provisions for a better use of resources (personnel, goods and services, system governance).

24


Richard Saltman

Professor of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia

EducationB.A., Dartmouth College, 1969 M.A., Stanford University, 1971 Ph.D., Stanford University, 1980

Biographical SketchRichard B. Saltman is Professor of Health Policy and Management at the Emory University School of Public Health in Atlanta, Georgia. He was a co-founder of the European Observatory on Health Systems and Policies in Brussels in 1998, and is currently Associate Director of Research Policy and head of the Atlanta hub. He is also a co-founder and co-director of the Swedish Forum for Health Policy, based at the Vardal Foundation in Stockholm. He is an Adjunct Professor of Political Science at Emory University, a Visiting Professor at the London School of Economics and Political Science, and Visiting Professor at the Braun School of Public Health at the Hebrew University in Jerusalem. From 1991 to 1994, he was Director of the Department of Health Policy and Management at Emory.

He holds a doctorate in political science from Stanford University. He has published 18 books and over 130 articles and book chapters on a wide variety of health policy topics, particularly on the structure and behavior of European health care systems, and his work has been widely translated. In 1987 and again in 1999, he won the European Healthcare Management Associations annual prize for the best publication in health policy and management in Europe. His volumes for the European Observatory book series published by McGraw-Hill Education have been short-listed for the Baxter Prize by the European Healthcare Management Association in 2002, 2004 and 2006.

Health Policy Challenges in an Era of Permanent Austerity

AbstractPolicymaking options in a health system necessarily reflect the fiscal carrying capacity of the national economy. Economic growth can underwrite policy possibilities that are less feasible in the face of economic stagnation or contraction. The onset of the 2008 financial crisis, and the subsequent low and/or negative growth rates in many industrial countries, thus raises major challenges for health policymaking going forward.

This presentation assesses three dimensions of the present health policy picture. First, it considers the degree to which the economic context has changed in developed countries since 2008, and what economic indicators suggest about likely economic growth in the medium term future. Second, it reviews pre-2008 efforts to re-structure health system organization, reflecting prior efforts to improve both the quality and efficiency of health system delivery. Third, the presentation raises some uncomfortable policy issues that emerge from the apparent new normal of slowing economic growth and the imposition of longer-term austerity across developed country health systems.

25

Mordechai Shani

The Israel Prize committee (the most prestigious prize in Israel) for 2009 said that it was awarding Prof. Shani for a lifetime of exemplary public service, and for being the guiding light and father figure for medicine and the health system of Israel.

Prof. Shani was central to the establishment and development of the Sheba Medical Center; the reorganization of Israels psychiatric services; the founding of the school for health policy at Tel Aviv University; the drafting and passage of Israels national health insurance policy and legislation; and the founding of many medical research institutes and scientific foundations (that have produced hundreds of scientific studies); and the mentoring of generations of doctors at Sheba.

In all these capacities, and through his tenures as director general of the Israel Ministry of Health, Prof. Shani had an enormous impact on the health and welfare sectors in Israel, and specifically on the care for Israels weakest strata and most vulnerable populations, in Israels peripheral areas and all across the country. He is an enormously impressive and accomplished man by any international standard; the natural and undisputed leader of Israels health system.

Nobody has had a greater influence than him, concluded the prize committee in its formal award citation.

Professor Mordechai Shani, was director general of the Sheba Medical Center at Tel Hashomer for 33 years; served two terms as director general of the Ministry of Health; was the architect of the 1994 reform of Israels health system; was a key player in the creation of the landmark Patients Bill of Rights; was co-founder of the Alut Israel Association for Autism; founded Israels National Institutes of Health, known as the Gertner Institute for Health Policy and Epidemiology, at Sheba; was chairman of the all-powerful Pharmaceuticals Approval Council in the Ministry of

Health; and founded the Ziering National Center for Newborn Screening. Furthermore, for the last 17 years Prof. Shani has been leading a reorganization of the mental health services in Israel. Today, he heads the Tel Hashomer Research Foundation among many other activities. The Israel Prize committees formal review of Prof. Shanis career accomplishments (in Hebrew) runs five pages long!

For the past eight years Prof. Shani has been devoting his time to research in the field of e-Health combined with disease management.

26


Innovations in the Israeli Health Care System

Abstract: Israel shows clear advantage of E.M.R. in a world which tries to achieve integration and coordination of the different components of the system.

However in three aspects, the use of electronic data is taken one step forward. One approach is using DATA MINING of the electronic data, using clinical algorithms to obtain a forecast for the severity of diseases.

The system enables us to assess the MORBIDITY SCORE of the patients allocated to physicians.

Another use of the electronic medical data is to use electronic alerts with a CONSUMER ORIENTED APPROACH.

Israel has achieved large success in disease management of DIABETES with strong effect on CHF and COPD.

We describe establishment of a call center which will deal with 10000 chronic patients in one of our H.M.O.s.

An interesting field of innovation relates to rehabilitation, in which we provide a means for long term rehabilitation aside from hospitals and clinics.

We describe a Tele-Motion-Rehab System and Tele Rehabilitation program to improve language skills for people who have had brain damage.

27

PROGRAM & ABSTRACTS

www.ortra.com

Ortra Ltd. - Conference Official Travel AgentEmail: [email protected] Tel: +972-3-6384444 Fax: +972-3-6384455

JOINT CONFERENCE OF THE OECD AND THE MINISTRY OF HEALTH ISRAEL

F INANCING MODELS OF HEALTHCARE SYSTEMSTEL-AVIV, OCTOBER 22-23, 2012

ortra ltd. - conference official travel agent email: info ... · society of pharmacoepidemiology...

Documents