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Performance budgeting & measurement systems - Anne-Gisèle Privat & David Bernstein, France

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This presentation was made by Anne-Gisèle Privat & David Bernstein, France, at the 7th meeting of the Joint OECD DELSA/GOV Network on Fiscal Sustainability of Health Systems held at the OECD Conference Centre, Paris, on 14-15 February 2019

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Performance budgeting & measurement systems - Anne-Gisèle Privat & David Bernstein, France

  1. 1. « Quality and Efficiency Programs » : Social and Health Indicators for Social Security performance budgeting in France OECD 7th Meeting of the OECD Joint Network of Senior Budget and Health Officials Anne-Gisèle Privat, Project manager, Ministry of Health David Bernstein, Economist, Ministry of Health February 13th 2019 Ministère des Solidarités et de la Santé Ministère de l’Action et des Comptes publics
  2. 2. 2 Summary Direction de la sécurité sociale Social Protection in France and the Yearly Social Security Law 1 « Quality and Efficiency Programs », indicators tied to the Social Security Law 2 Focus on the healthcare objectives and indicators3 Discussion and debates in France on the subject  Need for an overview of OECD countries’ experiences 4
  3. 3. Direction de la sécurité sociale 3 1. Social Protection in France and the Yearly Social Security Law  Social Security including healthcare is historically a bismarckian system (occupation- based)  For healthcare, historical occupational-based funds (agriculture, salaried and independent workers) still exist but healthcare coverage is now universal and unified  In 1996, institution of the Yearly Social Security Law presented by the Government to Parliament in October for the following year - The law forecasts the financial trajectories for Social Security domains (health, family, pensions, work injuries) and the policies that enable them - For healthcare, a particular instrument called “Objectif National des Dépenses d’Assurance Maladie” (National Objective of Healthcare Expenditures) is voted (200 billion euros for 2019, + 2,5%)  Final stage of a historical process of increasing regulation and financing of Social Security (originally private) by the State ?
  4. 4. Direction de la sécurité sociale 4 1. Social Protection in France and the Yearly Social Security Law Parliament votes on an absolute figure. The sum voted has never been overshot since 2010
  5. 5. Direction de la sécurité sociale 5 1. Social Protection in France and the Yearly Social Security Law
  6. 6. Direction de la sécurité sociale 6 2. « Quality and Efficiency Programs », indicators tied to the Social Security Law  The Social Security Law and the ONDAM are presented by expenditure category, not by objectives/programme  The « Quality and Efficiency Programs », implemented by the law (« loi organique du 2 août 2005 relative aux lois de financement de la Sécurité sociale »), in existence since 2008, aim to give a more programmatic view of the Social Security/healthcare budgets - They are directly inspired by the similar mecanisms set up, since 2006, for the State budget (« loi organique relative aux lois de finances »), objectives and indicators issued in the « Programmes annuels de performance and rapports annuels de performance »  Aims of the « Quality and Efficiency Programs »: - Provide transparent reporting on the quality and outcomes of Social Security organizations - Improve clarity of public policies by informing all decision makers and stakeholders : members of Parliament, workers’ unions, Social Security funds… - Contribute to policy evaluations by measuring the performance of social and healthcare policies
  7. 7. Direction de la sécurité sociale 7  Contributions by 20 different organizations in the process (Social security organizations, administrations, agencies)  6 themes: 4 corresponding to the various social risks covered by Social Security + 1 on disability and long term care+1 separate theme on financing o Healthcare o Pensions o Occupational Risks o Family support o Disability and long term care o Financing issues  Each section/theme includes the following structure : o A strategy presentation (6 to 10 pages), that evaluates the previous year’s achievements and outlines the Government’s main policy objectives to address existing target gaps o Context indicators (economic context, demography, social and health) o Performance indicators, each with targets, comments and methodologies 2. « Quality and Efficiency Programs »: a social and healthcare dashboard
  8. 8. Direction de la sécurité sociale 8 1. Provide equal access to care 2. Develop prevention 3. Improve quality 4. Reinforce efficiency 5. Ensure financial sustainability of healthcare accounts Health care 3. Focus on the healthcare objectives and indicators 5 themes
  9. 9. Direction de la sécurité sociale 9  An instrument to monitor the performance of the healthcare social security system  52 indicators (68, including sub-indicators): - 17 in the section entitled « context » (21, including sub-indicators) Context indicators include some international benchmarking - 35 in the section entitled « objectives » (47, including sub-indicators)  Available online: http://www.securite-sociale.fr/IMG/pdf/maladie_0310.pdf  9 organizations contribute to their creation : 3. Focus on the healthcare objectives and indicators
  10. 10. Direction de la sécurité sociale 10 3. Focus on the healthcare objectives and indicators Equal access (example)
  11. 11. Direction de la sécurité sociale 11 3. Focus on the healthcare objectives and indicators Prevention (example)
  12. 12. Direction de la sécurité sociale 12 3. Focus on the healthcare objectives and indicators Quality of care (example)
  13. 13. Direction de la sécurité sociale 13 3. Focus on the healthcare objectives and indicators Efficiency (example)
  14. 14. Direction de la sécurité sociale 14 3. Focus on the healthcare objectives and indicators Efficiency (example)
  15. 15. Direction de la sécurité sociale 15 3. Focus on the healthcare objectives and indicators Financial sustainability (example)
  16. 16. Direction de la sécurité sociale 16 4. Discussion and debates in France  On the + side :  The instrument is used during debates in Parliament in order to evaluate the success of policies concerning Social Security healthcare  Used by Social Security organizations to give context and evaluate impact of the new Social Security Law  The preliminary synthesis outlines the Government’s strategy when presenting the Social Security Law  A recent online user survey showed that they were read in a variety of professional circles (journalists, academics, political representatives…)  On the - side :  Too many indicators: optimal number of indicators ? Choice of indicators ? Delay in indicator production ?  A « gap » between budget-setting and indicators : indicators do not reflect directly budgetary choices and trade-offs.  Questions to the floor : Do such systems/instruments exist in your countries, to inform lawmakers/policymakers ? Are there debates on their usefulness ?
  17. 17. Direction de la sécurité sociale 17 Financing issues
  18. 18. Direction de la sécurité sociale 18 Financing issues

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