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Health spending continues to rise inexorably, growing faster than the economy in most OECD countries. Most of this spending comes from the public purse. Given the recent economic downturn, countries are looking for ways to improve the efficiency of health spending. This publication examines current efforts to improve health care efficiency, including tools that show promise in helping health systems provide the best care for their money, such as pay for performance, co-ordination of care, health technology assessment and clinical guidelines, pharmaceutical re-imbursement and risk-sharing agreements, and information and communication technology.
Acronyms Executive Summary Chapter 1.How Much is Too Much? Value for Money in Health Spending -1. Introduction -2. Health care spending: developments over recent decades -3. Spending by type of health care services -4. The drivers of health care spending -5. Will financial sustainability be a problem in the future? -6. Is fiscal sustainability a problem now? -7. How can we ensure economic sustainability of health systems? -8. Conclusions. Chapter 2. Policies for Health Care Systems when Money is Tight -1. Introduction -2. Overview of policy options -3. Supply-side policies intended to restrain expenditure and increase cost efficiency -4. Demand-side issues and policies -5. Conclusions Chapter 3. Rational Decision Making in Resource Allocation -1. Introduction -2. The potential for enhanced efficiency -3. EBM and HTA offer opportunities to rationalise health care provision -4. Health technology assessment -5. The current use of technology assessment in OECD countries -6. The impact of health technology assessment -7. The future of health technology assessment -8. Conclusions Chapter 4. Improving Value for Money in Health by Paying for Performance -1. Introduction -2. Difficulty in defining and measuring quality of care -3. Pay for performance: a new paradigm -4. Getting the design right in P4P: multiple agent problem -5. Defining P4P -6. P4P programme design framework . -7. Rewarding providers -8. P4P programmes in OECD countries -9. Conclusions Chapter 5. Improving Co-ordination of Care for Chronic Diseases to Achieve Better Value for Money -1. Introduction -2. Changing burden of disease in OECD countries -3. Adapting health systems to meet the needs of the chronically ill -4. OECD care co-ordination survey -5. Models of care co-ordination -6. Disease management: a yet unproven tool for bending the cost curve -7. Improving the cost effectiveness of disease management -8. Achieving better returns from care co-ordination -9. Conclusions Chapter 6. Drawing all the Benefits from Pharmaceutical Spending -1. Introduction -2. Pharmaceutical spending in OECD countries -3. Reimbursement and pricing policies in OECD countries -4. Recent developments in reimbursement and pricing policies -5. Efforts to develop generic markets -6. Conclusions Chapter 7. Redesigning Health Systems with the Support of ICTs -1. Introduction -2. What ICT can (and cannot) do for health care -3. How can ICT improve value for money in health care -4. Use of electronic health records is slow with a few exceptions -5. More widespread adoption requires overcoming several challenges -6. ICT is the foundation for a wider approach to improving health system performance -7. Conclusions Bibliography