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There is widespread evidence that a better access to markets contributes to raising income levels. However, no quantification of the impact of distance to markets has been made on the basis of a sample restricted to advanced — and therefore more homogeneous — countries. This paper applies the framework developed by Redding and Venables (2004) on a panel data covering 21 OECD countries over 1970-2004, and shows that, relative to the average OECD country, the cost of remoteness for countries such as Australia and New Zealand could be as high as 10% of GDP. Conversely, the benefit for centrally-located countries like Belgium and the Netherlands could be around 6-7%. Second, the paper explains why the key estimated parameter in the Redding-Venables model is biased upwards in cross-section samples that mix both developing and developed countries, because of the inability to adequately control for heterogeneity in technology levels across countries. The paper also provides a detailed discussion of the links between the ?death-of-distance? hypothesis, the evolution of transport costs and that of the elasticity of trade to distance.

This paper addresses the question of whether and how long-term financial trends may have modified the transmission mechanism from monetary policy decisions to economic activity. The focus is on longterm changes, abstracting from the disruptions created by the 2007-08 financial turmoil which are temporarily affecting the transmission mechanism. The first series of findings is that a number of factors have worked to strengthen the transmission of monetary policy, including more competitive financial markets, higher household indebtedness, greater diversity in the supply of financial products, greater financial integration and more responsive asset pricing mechanisms. However, other factors appear to have simultaneously gone in the direction of weakening transmission of domestic policy, including greater external financial influences, lower exchange-rate pass-through and a broad-based shift towards fixed-rate assets and liabilities. On balance, monetary policy appears to remain a powerful tool for guiding aggregate demand, but a number of changes that have worked to support the strength of transmission have also increased risks to financial stability.

Many schools around the world are struggling in the face of reduced funding and fluctuating enrolments. Often, the solution to this unhappy equation is quite simply to shut down facilities. But when all the costs of closing a school are considered – financial, material and human – implementing this policy calls for caution.

Most adolescents desire strong social ties and value acceptance, care and support from others. Many adolescents find friends and caring adults among members of the school community. As students go through a decisive period of their lives, discovering and redefining their identity, a strong sense of belonging at school can help them feel secure, and can support their academic and social development. Adolescents who feel that they are part of a school community are also more motivated to learn and, as a result, more likely to perform well at school.

But in recent years, many traditional communities formed around shared physical spaces – neighbourhoods, workplaces or schools – have been profoundly affected by advances in technology. How did students’ feelings of belonging at school change over a period in which online friendships and social networks were growing in importance?

This paper reports on the progress in the research and development of the set of patient safety indicators developed by the Health Care Quality Indicators project. The indicators presented here have been recommended by an expert group for further consideration in international reporting on the quality of care on the key dimension of safety. The indicators have been selected by expert consensus, undergone validity testing and have been tested for comparability. While concern remains related to differences in coding and reporting from administrative hospital databases, the rigour with which the indicator work has been undertaken has resulted in the improved ability of countries to report on the quality of care. The work on the development of the patient safety indicators highlights the technical progress made in constructing measures and the ongoing need for methodological improvements. The indicators reported here should not be considered as making inferences on the state of patient safety in countries, but are intended to raise questions towards improving understanding of the reported differences.

The OECD Health Care Quality Indicator (HCQI) Project was started in 2001. The long-term objective of the HCQI Project is to develop a set of indicators that can be used to raise questions for further investigation concerning quality of health care across countries. It was envisioned that the indicators that were finally recommended for inclusion in the HCQI measure set would be scientifically sound, important at a clinical and policy level and feasible to collect in that data would be available and could be made comparable across countries. It was also envisioned that the indicators would not enable any judgement to be made on the overall performance of whole health systems. In essence, they should be used as the basis for investigation to understand why differences exist and what can be done to reduce those differences and improve care in all countries.

This paper represents an attempt to set out a conceptual framework for the OECD’s Health Care Quality Indicator (HCQI) Project. Two main issues are tackled: what concepts, or dimensions, of quality of health care should be measured and how, in principle, should they be measured. The need for a conceptual framework for the Project was expressed by a large group of participating countries. In interviews by the OECD Secretariat with member countries in April and May 2005, country experts and delegates to the Group on Health reiterated the need for a framework for the OECD’s health care quality work. Countries stated that the framework should be: a) based on country experience and b) could be used to guide both current and future work by the OECD in health care quality measurement and monitoring.

This report is an update to the OECD Health Working Paper No. 22, Health Care Quality Indicators Project: Initial Indicators Report that was based on data collected between 2003 and 2005 and released in 2006. That report presented the OECD’s initial work on developing a set of health care quality indicators that could be used to raise questions about differences in quality of care across countries. The 2006 report covered 21 “initial indicators” with data provided by 24 countries. It identified 17 of these indicators as being fit for international comparisons of which 4 were identified as needing further work. Following the release of that report in March 2006, the OECD undertook a second round of data collection on the initial indicator set and also gathered data for the first time on new indicators in a questionnaire sent to participating HCQI countries. This paper reports on the results of that second round of data collection. Data is presented here on an augmented indicator set considered fit for the purpose of making international comparisons on quality of health care. The data is comprised of 19 indicators (17 initial indicators plus 2 new ones). The paper also presents the data provided on 7 other indicators that are not yet considered fit for international comparison. In this round of data collection, data were reported by 32 countries...

The paper reviews trends in health-care expenditure and assesses the main forces underlying the increase since 1960. It then describes and evaluates various health-care reforms. The report argues that top-down budget controls appear to have had some success in reducing the growth in health-care spending but, to be sustainable, they need to be supported by microeconomic reforms. Significant improvements in micro-efficiency and effectiveness can be obtained by improving incentives facing health-care providers. Policy developments in a few leading countries suggest that a system where funders/insurers act as purchasers, contracting with competing health-care providers, is a promising model for reform. A statistical annex assesses whether differences in institutional arrangements for funding and providing health care explain international differences in health expenditure ...

The Netherlands, as other OECD countries, faces the challenge of providing high quality health and long-term care services to an ageing population in a cost-efficient manner. In the health care sector, reforms have aimed at introducing more competition. Despite major changes and some positive effects, the reforms run the risk of getting stuck in the middle between a centralised system of state-controlled supply and prices and a decentralised system based on regulated competition, providing insufficient incentives for provision of quality services and expenditure control. The main challenges are to complete the transition to regulated competition in health care provision, to strengthen the role of health insurers as purchasing agents and to secure cost containment in an increasingly demand-driven health care sector. In 2012, reforms expanded the role of the market in the hospital sector and reinforced budget controls. Both measures are not consistent and may jeopardize both objectives. More competitive markets require, at least, provision of good quality information, appropriate financing and better efficiency incentives. In view of population ageing, current policies mean that the cost of long-term care is set to more than double over the coming decades. Insufficient incentives for cost-efficient purchasing of long-term care should be addressed. However, the government?s plan to transfer long-term care purchasing to health insurers is unpromising unless additional measures ensure that insurers bear the associated financial risks. In addition, home care should be further encouraged at the expense of institutional care, while screening and targeting should be improved. This Working Paper relates to the 2012 OECD Economic Survey of the Netherlands (www.oecd.org/eco/surveys/Netherlands.

The health status of the Japanese is one of the best in the world. The healthcare system has no doubt contributed to this, though the current state of research in health economics does not permit the determination of the extent of such contribution. The Japanese system, based on social insurance, has provided both basic care and free choice of doctors to every citizen at affordable costs. It has, however, become increasingly clear that the Japanese system has failed to allocate resources properly, ensure financial equity and adapt to changing patterns of demand. This paper first explains how a system that once seemed to function well has become inappropriate, then how policies have tried to overcome some of the problems. The paper concludes with key considerations shaping future reform ...

In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance. It then suggests two sets of reforms likely to improve the US health-care system. The first is a package of reforms to achieve close to universal health insurance coverage. The second set of reforms relates to payment methods and coverage decisions within the Medicare programme to realign incentives and increase the extent of economic evaluation of different medical procedures.

This paper presents a set of indicators to assess health care system performance. It also presents new comparative data on health care policies and institutions for OECD countries. This set of indicators allows the empirical characterisation of health care systems and the identification of groups of countries sharing similar health institutions. It also helps to uncover strengths and weaknesses of each country’s health care system and assessing the scope for improving value-for-money. The empirical analysis suggests that there is room in all countries surveyed to improve the effectiveness of health care spending; there is no health care system that performs systematically better in delivering cost-effective health care – big-bang reforms are therefore not warranted; increasing the coherence of policy settings, by adopting best policy practices within a similar system and borrowing the most appropriate elements from other systems will likely be more practical and effective to raise health care spending efficiency.

Poor people lack access to health care with a negative impact on their dignity, human capital formation and their risk-management options. Recently an emerging movement of community-based health insurance schemes has attracted the attention of policy makers and researchers as it seems that these schemes target the poor more efficiently. Taking the example of community-based health insurance schemes in rural Senegal this paper identifies the factors explaining participation in these schemes. Using household survey data of non-members and members, we found that household income, religion, village characteristics and the belonging to a certain ethnic group exert the strongest influence on the probability of participation. From these findings, it follows that i) although the schemes reach the “poor” in general, the “poorest of the poor” within the villages find it financially difficult to participate; ii) social exclusion due to religion or ethnic group might persist. Several options ...

OECD health-care systems confront the dual challenge of containing costs and maximising the health of their populations. The effectiveness of health-care provision in fostering longer and healthier lives is therefore of fundamental importance. In order to respond to these challenges, policy makers are demanding more and better information on health outcomes.

Therefore, this paper presents a summary of the current state-of-the-art in health outcome indicators for monitoring population health status and for evaluating the performance and effectiveness of various health policies and medical-care interventions. The paper begins by developing a framework for classifying the range of indicators that have been put forward to measure health outcomes. It then illustrates the potential value of different indicators for policy making within this framework and describes some recent trends in health status in OECD countries ...

The global economic crisis which began in 2008 has had a dramatic effect on health spending across OECD countries. Estimates of expenditure on health released back in 2012 showed that, for the first time, health spending had slowed markedly or fallen across many OECD countries after years of continuous growth. As a result, close to zero growth in health expenditure was recorded on average in 2010. Preliminary estimates suggested that the low or negative growth in health spending was set to continue in many OECD countries in following years...

Health spending slowed markedly or fell in many OECD countries recently after years of continuous growth, according to OECD Health Data 2012. As a result of the global economic crisis which began in 2008, a zero rate of growth in health expenditure was recorded on average in 2010, and preliminary estimates for 2011 suggest that low or negative growth in health spending continued in many of the countries for which data are available.