OECD Reviews of Health Care Quality

ISSN :
2227-0485 (online)
ISSN :
2227-0477 (print)
DOI :
10.1787/22270485
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These reviews examine the quality of health care in various countries, highlight best practices, and provide a series of targeted assessments and recommendations for further improvements to quality of care in the subject country.

 
OECD Reviews of Health Care Quality: Czech Republic 2014

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OECD Reviews of Health Care Quality: Czech Republic 2014

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Author(s):
OECD
Publication Date :
25 June 2014
Pages :
160
ISBN :
9789264208605 (PDF) ; 9789264208599 (print)
DOI :
10.1787/9789264208605-en

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This book presents a comprehensive review of health care quality in the Czech Republic. It finds that over the past 20 years, the Czech Republic witnessed the unprecedented gains in quality of health care and life expectancy and successfully transferred its Semaschko system into the modern accessible health care system with private-public mix of providers. Nevertheless the health care system in the Czech Republic still has some way to go to achieve the outcomes of the best performing OECD members. While some of the gap might be caused by the one of the lowest levels of health care expenditures among OECD countries (7.2% GDP in 2011) there are possibilities to improve the outcomes without incurring much of the additional costs.

The Czech authorities should reach a consensus on the development of quality of care and data infrastructure and aim for sustainable long-term initiatives undisturbed by the political cycles in both of these areas. While the adverse events reporting and voluntary accreditation are the good steps towards the accountability of the providers, the government should do more in this area, undertake the effort to broaden the accreditation process and include outpatient care and link public health authorities to the quality agenda of inpatient care. In the area of data infrastructure more data should be gathered, the process of data gathering should be streamlined and administrative burden for the providers lowered primarily via the merging the data-collecting agencies. Finally, without the active participation of health insurance funds and proper reimbursement mechanisms in place the quality agenda will not be perceived as the priority.

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    Foreword and Acknowledgements

    This report is the fifth of a series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care have led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

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    Acronyms and abbreviations
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    Executive summary

    This report reviews the quality of health care in the Czech Republic. It begins by providing an overview of the range of policies and practices aimed at supporting quality of care (Chapter 1), then focuses on three key areas: strengthening the data infrastructure underpinning health care (Chapter 2), screening and preventive health care (Chapter 3), and improving care for people with diabetes and metabolic syndrome (Chapter 4). In examining these areas, this report seeks to highlight best practices and provides recommendations to improve the quality of care in the Czech Republic.

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    Assessment and recommendations

    The Czech Republic has made significant progress in improving the quality of health care in recent decades. The reduction in case-fatality rate after a heart attack, for example, is amongst the steepest in the OECD, more than halving from 15.7% in 2001 to 6.8% in 2011. At the same time, the country has one of the lowest levels of health care expenditure among OECD countries, at 7.2% GDP in 2011. But compared to its peers, quality monitoring and quality improvement activities remain at a basic level. There is great emphasis on ensuring that minimum standards are met, whilst initiatives to encourage continuous quality improvement are less developed. An important explanatory factor is the relatively immature data infrastructure that underpins Czech health care. This prevents more detailed, transparent and continuous quality monitoring of clinical processes and patient outcomes. A linked and perhaps deeper driver concerns the fact that frequent and extensive changes of government officials appear to hinder the design and implementation of new quality improvement initiatives. To move to the next stage of continuous quality improvement, the Czech Republic needs to use health information better, in particular by publishing more measures of the outcomes of care. Greater consistency of vision, policies, and co-ordination across key bodies, including the various state offices and institutes for safety, quality and information, insurers and health care providers is also needed. The health system should also develop a more proactive approach to managing chronic diseases such as diabetes, through better primary and secondary prevention work.

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    Quality of care policies in the Czech Republic

    Life expectancy in the Czech Republic is higher than in several neighbouring countries and infant mortality rates are amongst the lowest in the OECD. Some indicators of the quality of care show very strong performance – 30-day mortality after acute myocardial infarction is below average and stroke 30-day mortality is only slightly above the OECD average. Yet other indicators are less reassuring – survival rates after a diagnosis of cancer, for example, are poor. This chapter reviews the policies and mechanisms in place to measure and improve the quality of health care in the Czech Republic. Accreditation of facilities is well developed and some specific initiatives, such as the national cancer registry, are also advanced. Nevertheless, compared with other OECD countries, other measures such as regular, open comparison of local quality indicators are less developed. The Czech Republic’s foremost aim should be to move to a quality architecture that allows the continuous, detailed and transparent measurement of health service performance. A more sophisticated data infrastructure will be needed to achieve this, as well as greater consistency of vision, policies and co-ordination across central government authorities.

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    Health data infrastructure in the Czech Republic

    This chapter examines the extent to which data infrastructure contributes to quality improvement in the Czech health care system. The quantity of data gathered thorough the health care system is substantial and there are areas in which Czech Republic excels, such as the National Cancer Registry. Overall, institutional fragmentation of data gathering, insufficient emphasis on analysis and lack of data on health outcomes hampers the ability of this information to contribute substantially to gains in efficiency and quality of care. The Czech authorities should streamline the data gathering process and set up systems for data linkage, anonymisation and sharing, whilst focusing on in-depth data analyses as a way to drive more effective quality measurement and improvement. Addressing the balance between personal data protection and effective usage of data in a systemic way is also necessary. More active involvement from patients’ organisations will also be important.

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    Screening and prevention programmes in the Czech Republic

    The Czech Republic has established a range of preventive health care initiatives and has made substantial progress in reducing mortality from cancer and from cardiovascular disease. Yet, not all the outcomes linked to the prevention and early diagnosis programmes are reassuring – indeed the country faces a substantial epidemiological challenge in terms of increasing rates of smoking, obesity and alcohol abuse, even among children. There are also governance challenges. In particular, a biennial universal general health check is unlikely to offer value for money and not enough is known about adherence to guidelines for secondary prevention of stroke and heart attacks. A priority therefore is to develop the information infrastructure underpinning preventive health care. Where value for money cannot be demonstrated, consideration should be given to dropping programmes such as general health checks and redirecting this investment to other health care activities. At the same time, the low rates of uptake of interventions proven to reduce mortality – such as cancer screening – point to the need to widen access to professionals and the public and incentivise both to engage in preventive health care more actively.

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    Diabetes care in the Czech Republic

    The Czech Republic has in place a comprehensive care approach for diabetes, which covers primary prevention, screening and diagnosis, management and treatment, and response to complications, backed up by a national diabetes plan, and a range of clinical guidelines. The measures that the Czech Republic has been taking appear to have delivered some positive improvements, as complication rates for diabetes have dropped in some areas. Nonetheless, in the face of a rising prevalence of diabetes, strengthening of care approaches is needed, particularly around prevention. If implemented effectively, efforts to tackle risk factors for diabetes, notably obesity, can be cost-saving in the long run. To respond to this growing burden, and to provide higher quality care for current diabetes patients, some shifts in the organisation of care will be needed: GPs should take on a greater role in managing diabetes; well co-ordinated and patient-centred care should be prioritised; and patient education and self-management should be promoted.

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