health in the 21st century - oecd · but a fifth of this spending is, at best, ineffective and, at...
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HEALTH IN THE 21ST
CENTURYPutting data to work for stronger health systems
The health sector faces a changing landscape and new challenges
Health spending is projected to continue to outgrow
national incomes
Health expenditure as a share of GDP, projection to 2030
4.6% 5.5% 6.2%
6.7%
6.7%
7.0%
7.0%
7.4%
7.5% 8.0%
8.1%
8.3% 8.8%
8.9%
9.1%
9.5%
9.7%
9.7%
9.9%
9.9%
10.2
%
10.4
%
11.3
%
11.3
%
11.4
%
11.6
%
11.7
%
12.0
%
12.0
%
12.1
%
12.2
%
12.3
%
13.0
%
13.0
%
13.1
%
13.3
%
14.5
%20
.2%
0%
5%
10%
15%
20%
2015 2030
% GDP
Source: OECD Health Division projections, 2019. StatLink 2 https://doi.org/10.1787/888934017196
But a fifth of this spending is, at best, ineffective
and, at worst, harmful
Source: OECD (2017) Tackling Wasteful; Spending in Health Care
• Adverse events occur in 1/10 hospitalisations, add between
13 and 17% to hospital costs and up to 70% could be avoided
• Geographic variations in rates of cardiac procedures (x3) and
knee replacements (x5) are for a large part unwarranted
• Up to 50% of antimicrobial prescriptions are unnecessary
• 12% to 56% of emergency department visits are inappropriate
• Administrative expenditure on health varies more than six-
fold, with no obvious correlation with performance
Ageing populations and rising NCD rates mean that
health and care needs are changing
Source: Barnett K, Mercer S, Norbury M et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional
study. Lancet 2012; 380 (9836): 37–43
And people (rightly) expect a health system designed
around their needs & preferences
… but health system are slow to change…
7
People want to take control of their own health
Source: Health in the 21st Century www.oecd.org/health/health-in-the-21st-century-e3b23f8e-en.htm
Intelligent use of data and digital technology can help
8
Many sectors have transformed themselves to
harness digital opportunities
This has resulted in:
Better products
Better services
More efficient
Big consumer surpluses
In health, the opportunities are clear
Effective, efficient and people-centered services• Faster access to critical information – effective, efficient care• More patient involvement, a better care experience• Clinical process optimisation (e.g. data-driven machine learning)
Better system management• Monitor performance• Allocate resources better• Ensure better planning and access to care
More accurate surveillance• Evaluate public health interventions• Faster detection and response to public health emergency• Inform policy
Power up research & innovation• Statistical power• Vast and varied datasets• ‘Real world evidence’ for assessing and developing better treatments
Health care is rapidly ‘digitising’ … which is good
Source: Health in the 21st Century www.oecd.org/health/health-in-the-21st-century-e3b23f8e-en.htm
But health systems remain “data rich -information poor”
Data are available but not linked regularly, missing
important opportunities
Source: Health in the 21st Century www.oecd.org/health/health-in-the-21st-century-e3b23f8e-en.htm
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2013 % of key national health datasets available 2019 % of key national health datasets available
2013 % of datasets regularly linked 2019 % of datasets regularly linked
Percentage of key data sets (a) available and (b) regularly linked, 2013 and 2019
Only a few countries are ready to re-deploy EHR data
for research and other purposes
Source: Health in the 21st Century www.oecd.org/health/health-in-the-21st-century-e3b23f8e-en.htm
Technical, operational and governance readiness to use EHR data, 2016
Routine health data are under-used in managing
medical technologies
Source: Health in the 21st Century www.oecd.org/health/health-in-the-21st-century-e3b23f8e-en.htm
Use of routine health data in pharmaceutical policy, 2018
70% of countries planning to allow
people to access their electronic medical record
43% of countries say that people
will be able to interact with their record
Too seldom people can interact with their own records
And the health workforce is not ready
30 to 70% of health professionals* report knowledge and skills shortages relating to digital tools and data analytics
Outdated day-to-day work processes do not enable the digital technology to add value
A digital tool is often a “black box” to a health worker or is not informed by workers’ and their patients’ needs
Skillsmismatch
Inadequate work
processes
Lack of involvement
* depending on category and country
18
ICT expertise is short supply compared to other
sectors
Source: Health in the 21st Century www.oecd.org/health/health-in-the-21st-century-e3b23f8e-en.htm
Investment in software and databasesas a % of GFCF
Unweighted mean across 12 OECD countries
More generally, health systems appear to under-
invest in information management
0
10
20
30
40
50
60
Software & databases % GFCF
0
0.5
1
1.5
2
2.5
3
ICT services % output
Non-residential gross fixed capital formation (GFCF) is a measure of spending on fixed assets.
Countries covered: Australia, Austria, Denmark, Finland, France, Italy, Japan, the Netherlands, Norway, Sweden, the
United Kingdom, and the United States.
Purchases of ICT services as a % of output
Unweighted mean across 12 OECD countries
19
Source: Health in the 21st Century www.oecd.org/health/health-in-the-21st-century-e3b23f8e-en.htm
A DIGITAL TRANSFORMATION RELIES ON A POLICY TRANSFORMATION
20
Digital transformation requires fundamental
institutional reform …. and investment
• Overarching, cross-sector digital strategy with a consolidated vision, plan and policy-framework 1. Strategy
• A legal and policy framework that enables data to be used and shared for agreed purposes but ensuring that individual privacy and data security
2. Governance
• Operational - workforce and the public to make the most from digital technology
• Institutional – data can be put to work to generate knowledge and action
3. Capacity
Efficiency
waste
= 400B
Additional health
= $200B
Direct benefits = $600B
~GDP of Poland
~8% OECD health expenditure
This can deliver considerable health and economic
dividends across OECD countries
Doubling what OECD countries invest in their
information systems would still deliver a 3-fold return
$ $$$x2
“The key barriers to building a 21st
century health system are not technological.
They are found in the institutions, processes and workflows forged long before the digital era.”
http://www.oecd.org/health/health-in-the-21st-century-e3b23f8e-en.htm
Barriers are not technological ….
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