Expert Group on Health systems performance assessment Presentation of the report on measuring performance of the integrated care and of the future work programme of the expert group Exchange of views Endorsement of the amendment to rules of procedure of the expert group - Main contents

Document date	16-01-2017
Publication date	17-01-2017
Reference	5169/17
From	General Secretariat of the Council
External link	original article
Original document in PDF

Council of the European Union Brussels, 16 January 2017

PUBLIC

(OR. en)

5169/17

LIMITE

SAN 11

NOTE

From: General Secretariat of the Council

To: Delegations

Subject: Expert Group on Health systems performance assessment

− Presentation of the report on measuring performance of the integrated care and of the future work programme of the expert group

− Exchange of views − Endorsement of the amendment to rules of procedure of the expert group

In view of the meeting of the Working Party on Public Health at Senior Level on 3 February 2017, delegations will find attached a document on the above-mentioned subject.

The draft final report of the HSPA Expert Group on Tool and Methodologies to assess Integrated Care and the HSPA Policy paper on reporting and Communication of HSPA findings will follow as addendums.

ANNEX

Expert Group on Health Systems Performance Assessment

Recent updates and next steps

• 1. 

  Objective of the discussion

The HSPA Expert Group Co-Chairs will report to the Council Working Party on Public Health at

Senior Level (WPPHSL) on ongoing work in the Expert Group.

The members of the WPPHSL are asked to guide the Expert Group in deciding the priorities the

Expert Group should focus on in the next steps of its work after 2017.

The present document describes possible priority areas and criteria suggested to select and prioritise them.

• 2. 

  Ongoing work and working methods in the Expert Group

2.1. Four strands of activity

In its first two years of activity the Expert Group has developed an approach that is based on the following four strands of activity:

• 1. 

  Annual work on priority areas (as described further in chapter 2.2); 2. Constant sharing of national experiences in HSPA and its components; every meeting of the Expert Group dedicates a section to the presentation and discussion of national experiences; 3. Tailored activities in individual countries; this activity started in 2016, with the workshop on integrated care measurement in Rome in April and the seminar on healthcare quality assessment in Ljubljana in September.

• 4. 

  HSPA advocacy; the Expert Group engages to drive political attention to HSPA, so that its results are actually used for sound policy-making. The recent HSPA Policy Paper on reporting and communication of HSPA findings – attached to this discussion paper – is an example of work the Expert Group could carry out in this strand of activity.

2.2 Priority areas

In September 2014, the Council Working Party on Public Health at Senior Level (WPPHSL)

endorsed the terms of reference for an Expert Group on health systems performance assessment 1 .

In the first meeting, in November 2014, the Expert Group decided to work on annual priority areas, aiming to analyse, compare and reflect on how one can evaluate the performance of the concerning subject. The Expert Group then brainstormed in small groups and had a plenary discussion to identify few key priorities, which was followed by an internal survey to rank them in order of importance. The results were the following:

1 Council document 12945/14, SAN337, SOC 606

According to those results, the Expert Group decided to start working in 2015 on tools and methodologies to assess quality of care. The findings of the group were presented in the report "So What? Strategies across Europe to assess quality of care", adopted by the Expert Group, reviewed

by the WPPHSL in February 2016 and published in April 2016 2 .

Integrated care, the second most voted topic in the survey, was selected as the priority area for the Expert Group in 2016. The findings of the work on the assessment of integrated care are presented in a report, which is presented in a draft final version to the WPPHSL meeting on 3 February.

After some discussion, effectiveness of care was not selected as the next priority, since the Expert Group agreed that this topic was already dealt with while assessing quality of care. On the other hand, the group saw primary care as having many synergies with integrated care, and decided therefore to deal with the two topics after each other. Primary care was therefore selected as the priority topic for 2017. The report on this subject would be expected to be finalised by early 2018.

The work on priority areas has been developed along three main lines of intervention, listed below. The Expert Group will replicate this approach in addressing future priority areas.

• A. 

  Presentation of experiences related to the priority area, followed by plenary discussion in the Expert Group;

• B. 

  Appointment of a sub-group of volunteers, in charge of tackling methodological issues and digging deeply in the analysis of the priority area;

• C. 

  Ad-hoc policy focus group to discuss in depth international and cross-country dimensions that are of particular relevance for the priority area. A more extensive use of this tool is envisaged in the future for in-depth analysis of variation in performance across countries.

2 http://ec.europa.eu/health/systems_performance_assessment/docs/sowhat_en.pdf

• 3. 

  The need to identify priority areas for post-2017

At its meeting in December 2016 the Expert Group had a brainstorming discussion on the next steps of its work in the post 2017 period and the content of that discussion is reported in the section

below. The WPPHSL meeting on the 3 rd of February is expected to guide the Expert Group in the

choice of priority areas for its work by prioritising and highlighting strategic aspects that the Expert Group should focus on.

3.1 Criteria to select priorities

The Expert Group identified some general criteria that could serve as a basis for the selection of priority areas, namely: relevance, feasibility, stewardship and reaction time. This selection is the outcome of the work carried out during the reflection process on effective, sustainable and responsive health systems, with inputs from the expert panel on effective ways on investing in

health. 3

Relevance

The work on a particular priority area is considered relevant when it produces positive effects on the health of the population, strengthens equity, and has a considerable economic impact. In particular, positive health effects may include reductions in mortality and morbidity, and improvements in the quality of life and wellbeing.

Economic impact could be evaluated on two sides at the same time: on the one hand, the selected priority area may affect the burden on public finances; on the other hand it may cause economic effects outside the health system (e.g. by rising productivity, improving employability, or reducing early retirement).

Furthermore, relevance could be considered also in the context of political agendas. Given the complexity of the political processes, topics that would not fulfil sound impact criteria could be brought at the highest attention of policy makers and therefore deserve in-depth analysis.

3 See the opinion of the expert panel on the Definition and Endorsement of Criteria to identify

Priority Areas when Assessing the Performance of Health Systems: http://ec.europa.eu/health/expert_panel/sites/expertpanel/files/002_criteriaperformancehealt hsystems_en.pdf

Feasibility

An area of intervention could also meet the feasibility criteria: it should be effectively possible to intervene to modify and improve the situation. Feasibility is essentially about the availability of sufficient existing tools and information that could allow the Expert Group to start working on the selected area. Few criteria to assess feasibility are presented in the following paragraphs.

Gaps between knowledge and practice – It mainly refers to the introduction of new medical technologies; but it can also refer to the adoption of new organisational models (e.g. integrated care, home care) or to innovative financing schemes.

Existence of experimented solutions – New measures are typically introduced locally before proving their added value, and then being adopted by other systems. The Expert Group proved to be effective in facilitating the exchange of solutions experimented nationally.

Significant variations between countries –The main reason for international comparable indicators to be in place is to highlight where significant variations between countries (or regions) take place, and to consequently call for their explanation and for actions to fill the gaps, possibly taking inspiration from areas that show the best performance levels.

Stewardship and reaction time

The formula of knowledge sharing promoted by the Expert Group helps identify solutions that are practically applicable in different contexts. These should take into account the issues of stewardship and reaction time.

Namely, stewardship is intended as the capacity of the Ministry of Health to initiate and lead the proposed interventions. Health-in-all-policies principle plays a major part in assessing stewardship; the Ministry of Health plays an essential role in bringing the topic on the floor and in steering the process of adoption of appropriate measures.

Finally, reaction time has two different dimensions. The first one is the time needed by policy makers to implement a specific measure aimed to tackle the area of intervention (e.g. the reduction of pharmaceutical prices takes less time than the construction of a hospital).

The second dimension concerns the time for the adopted measure to produce an impact, be it on population health or on economic variables (e.g. according to evidence, physician-dietician counselling has a much faster impact than all other measures in reducing obesity).

3.2. Possible priority areas for consideration and prioritisation in the WPPHSL on 3/02

This section presents some possible priority areas for the Expert Group after 2017 that meet the criteria identified above. The list – which is not exhaustive – contains both classic dimensions of performance (access, efficiency, etc.) and cross-cutting topics that do not belong to traditional performance frameworks (value-based healthcare, resilience).

Access

Access to healthcare was selected as a priority area in the first brainstorming discussion of the

Expert Group. It may still be considered a priority, for instance for the relevance it may play in the EU Social Pillar. In carrying out its work, the Expert Group could build on the recent opinion of the

expert panel on access to health services in the EU 4 and to the work carried out by the Social

Protection Committee in the field of access to health systems. 5

Efficiency

Efficiency was not selected as a main priority topic in the first round of brainstorming, however in the last couple of years some efforts was made to improve our understanding of this domain. For

instance the MACELI report on comparative efficiency of health systems 6 , the European Economy report on efficiency estimates of healthcare systems 7 , the study on Health System Efficiency from the European Observatory 8 , and the OECD study on Tackling Wasteful Spending on Health. 9 The

Expert Group could build on the synergies with the work already done.

4 http://ec.europa.eu/health/expert_panel/sites/expertpanel/files/015_access_healthservices_en.pdf

5 See for instance the SPPM thematic review “Towards better health through universal access to health

care in the European Union”, available at: http://ec.europa.eu/social/main.jsp?catId=758

6 http://ec.europa.eu/health/systems_performance_assessment/docs/2015_maceli_report_en.pdf 7 http://ec.europa.eu/economy_finance/publications/economic_paper/2015/pdf/ecp549_en.pdf 8 http://www.euro.who.int/__data/assets/pdf_file/0004/324283/Health-System-Efficiency-Howmake-measurement-matter-policy-management.pdf?ua=1

9 http://www.oecd.org/publications/releasing-health-care-system-resources-9789264266414-

en.htm

Outcome-based, value-based healthcare

This topic is gaining relevance in the policy agenda of several stakeholders; see for instance the

recent report of the Economist Intelligence Unit 10 or the consensus document on the Value of

Health, Improving Outcomes 11 . At institutional level however, the reflection on this topic is not so

developed; the Expert Group may be the catalyst for a high-level discussion.

Patient centeredness

One of the recommendation of the "So What?" report states that: "in future, greater attention should be given to the assessment of patient experiences, such as patient reported experiences and patient reported outcomes". In addressing this topic, the Expert Group may build on the synergies with the forthcoming OECD work on patient reported indicator survey (PaRIS).

Equity

Despite general agreement the equity is an important objective of health systems, there is little consensus as to what is meant by equity and how it relates to other concepts such as equality and fairness. Equity, and inequalities, can be assessed along different dimensions (outcomes, access, etc.). The Expert Group could build a shared base for a better understanding of this concept and how to assess it.

Resilience

Resilience is defined in the Commission Communication on health systems 12 as the ability of the

system to adapt effectively to changing environments, tackling significant challenges with limited resources. To date there is no agreed framework to assess the degree of resilience of a health system. The Expert Group could start reflecting on this, on the basis of the resilience factors proposed by the Communication, and of the analysis presented in the recent Health at a Glance

Europe 2016 13 .

10 https://www.eiuperspectives.economist.com/sites/default/files/ValuebasedhealthcareEurope.pdf

11 http://www.eu-patient.eu/globalassets/policy/patientssafety/value-of-health-consensus

href="http://www.eu-patient.eu/globalassets/policy/patientssafety/value-of-health-consensus-document.pdf">document.pdf

12 http://ec.europa.eu/health/systems_performance_assessment/docs/com2014_215_final_en.pdf 13 http://ec.europa.eu/health/state/glance/index_en.htm

Possible topics suggested by the experts, in addition to those presented in the paper, were: the use of HSPA results in health policy making; health care effectiveness; health care digitalisation and how this affects the provision of care; relations between fiscal sustainability and access, quality and equity of care; transition from a disease-related approach to positive health care; access to pharmaceuticals; disease prevention.

• 5. 

  Question for discussion

The members of the Council Working Party on Public Health at Senior Level are asked to:

• 1. 

  Provide their views on the draft final report on Tools and Methodologies to assess the

  Performance of Integrated Care. In particular the WPPHSL is asked to comment the conclusions of the report;

• 2. 

  Take note of the HSPA Policy Paper on Reporting and Communication of HSPA Findings;

• 3. 

  Provide their views and suggestions on the priority areas they would you like the Expert

  Group on HSPA focus on in 2018 and 2019.