OHE Consulting was commissioned by Eli Lilly and Company’s Global Public Policy department to identify and analyse inefficiencies and bottlenecks that undermine health care system sustainability and potential policy solutions to address them. We focused on Australia, Canada, France, Germany, Italy, Spain and UK. We found that the focus of health care policy thinking is on: removing perverse incentives; filling gaps in information to payers, health care professionals and patients; more/better chronic disease management and better coordination of care, especially between primary and secondary care; and better compliance with good practice guidelines. Our results confirm and reinforce some of the key inefficiencies that have been discussed in the literature. Some differences across countries emerge but there is considerable consensus, with a major focus on better integrated care, especially for chronic diseases. The findings imply a clear, high level health care policy agenda for tackling health system inefficiency. Our main findings were presented as a poster at the 9th HTAi Annual Meeting, Bilbao, 25-27 June 2012. We have reproduced that poster here as a slide presentation.

1. Health System Efficiency
and Sustainability
Jorge Mestre-Ferrandiz, Ruth Puig-Peiro,
Priya Sharma, Jon Sussex, Yan Feng
OHE Consulting
This work was funded by Eli Lilly and Company. The views expressed here
do not necessarily represent Lilly’s views.
Poster presentation
9th HTAi Annual Meeting, Bilbao, 25-27 June 2012

2. Background
OHE Consulting was commissioned by Eli Lilly and Company’s
Global Public Policy department to identify and analyse
inefficiencies and bottlenecks that undermine health care system
sustainability and potential policy solutions.
Our main findings were presented as a poster at the 9th HTAi
Annual Meeting, Bilbao, 25-27 June 2012. We have reproduced
that poster here as a slide presentation.

3. Introduction
• Payers continually seek to increase and improve the
outputs achieved by the health care system they
fund
• Current economic climate: increased pressure to
constrain costs and, with it, greater desire to
increase health system efficiency

4. Objectives: Scope of Work
• Evidence and analysis of inefficiencies and
bottlenecks
• Based on literature review and 2 rounds of
interviews with expert commentators
• Potential policy solutions to tackle inefficiencies
• 7 target countries: Australia, Canada, France,
Germany, Italy, Spain and the UK

5. Methods
• Selective literature review
• Interview programme with 15 independent
academic commentators (29 interviews across 7
countries in 2 rounds)
• Identified a long list of inefficiencies (including
‘unsustainabilities’) in the 7 countries’ health care
systems

6. Methods, cont’d
• Identified a short list of five key inefficiencies to be
explored further:
• Lack of primary/secondary care coordination
• Inappropriate use of resources because of
no/insufficient cost benefit analysis (CBA) to assess
how to spend health care budget
• Inappropriate use of resources because of weak or
perverse financial incentives to providers
• Inconsistent implementation of HTA/guidance
• Chronic disease management (CDM)

7. Results
• Among the independent commentators, unanimous
support for more chronic disease management
• With integrated care pathways, across primary and secondary care
combined with financial incentives
• Including patient education and mutual support initiatives
• With appropriate regulation to require and monitor implementation
• Prospect of cost savings from fewer exacerbations and consequent
hospital admissions as well as better care.
• Unanimous support for CBA/evaluation of health
care pathways and preventive interventions

8. Result, cont’d.
• Other frequently mentioned policies were:
• Electronic health records
• Information to patients to manage demand, improve
care coordination and support disease
management/self-care
• Clinical guidelines
• Very little evidence exists on the magnitudes of any
impacts of the different policies discussed to
address the key inefficiencies
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9. Conclusions
• The focus of health care policy thinking is now much
more on:
• Removing perverse incentives
• Filling gaps in information to payers, health care
professionals and patients
• More/better CDM and better coordination of
care, especially between primary and secondary care
• Better compliance with good practice guidelines

10. Conclusions, cont’d.
• Much can be gained from further emphasis on
chronic diseases management (CDM), even though
the idea has been around quite a long time
• Within CDM, the chronic care model (CCM) is one of the
most common models discussed internationally. Overall,
the evidence seems to suggest that CCM is cost-effective;
while evidence on this is limited, information is starting to
emerge
• The 7 countries explored in this study all are active in CDM
to some degree, albeit with significant differences across
them.

11. Conclusions, cont’d
• A number of challenges were identified with
implementing CDM initiatives
• Data collection and registries
• Lack of evaluation
• Engagement with health care professionals
• Support for patient self-management
• Incentives (financial and non-financial)
• The consensus is that more evaluation of CDM
programmes is needed

12. Key References
OECD. (2009) Achieving better value for money in health care. Paris:
Organisation for Economic Cooperation and Development.
Busse, R. et al. (2010) Tackling chronic disease in Europe: Strategies,
interventions and challenges. Observatory studies series No. 20.
Copenhagen: WHO Regional Office for Europe.
Nolte, E., McKee, M. and Knai, C. (2008) Managing chronic
conditions: An introduction to the experience in eight countries.
In Managing chronic conditions: Experience in eight countries.
Copenhagen: WHO Regional Office for Europe. 1-14.

13. To enquire about additional information and analyses, please
contact Jorge Mestre-Ferrandiz at jmestre-ferrandiz@ohe.org
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