Health Reform

Meeting the Challenge of Ageing and Multiple Morbidities

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When the OECD was founded in 1961, health systems were gearing themselves up to deliver acute care interventions. Sick people were to be cured in hospitals, then sent on their way again. Medical training was focused on hospitals; innovation was to develop new interventions; payment systems were centred around single episodes of care.  Health systems have delivered big improvements in health since then, but they can be slow to adapt to new challenges. In particular, these days, the overwhelming burden of disease is chronic, for which ‘cure’ is out of our reach. Health policies have changed to some extent in response, though perhaps not enough.  But the challenge of the future is that the typical recipient of health care will be aged and will have multiple morbidities.  This book examines how  payment systems, innovation policies and human resource policies need to be modernised so that OECD health systems will continue to generate improved health outcomes in the future at a sustainable cost.

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The impact on health systems and their development

This chapter provides an overview of the descriptive epidemiology of multimorbidity in terms of its prevalence and distribution within the population and its associations with mortality, functional status and quality of life, and health services use and healthcare quality and safety. The analysis draws on both the published literature and on data about the prevalence of 40 long term conditions from 1.75 million primary care patients in Scotland. The implications for health service organisation and the measurement of health system performance for people with multimorbidity are discussed.


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