#1COSTA RICA HEALTH SYSTEM PERFORMANCE REVIEW »OECD BETTER POLICIES FOR BETTER LIVES#2An outlier in the region... • Long-standing committment to universal, publicly-funded health care . Middle-income country, but spending on health. (as share of GDP) exceeds OECD average Life expectancy at birth exceeds that of many OECD members. But broader context is challenging ... Population is ageing rapidly Labour market is increasingly informal Socioeconomic inequalities are widening#3Much to praise in the health system ... || • Well-established primary care infrastructure • Ambitious reforms to deliver integrated care • Extensive inter-sectoral working Effective dialogue with service users · Unified digital health record#4but major concerns as well + ● • Governance: Attempts at some key reforms have failed DRG accounting. hospital accreditation and health technology assessment not routine traditional fee-for-service and salary payment mechanisms predominate#5but major concerns as well Access and quality Some key performance measures are poor • Long waiting times for elective surgery Door-to-needle times after heart attack worsening#6but major concerns as well Efficiency and sustainability Health care spending is increasingly rapidly rising by 7% a year (2011-2015), mainly accounted for by workforce salaries - rising by 6% annually#7» A mixed picture on population health... Life expectancy at birth, is close to OECD average... ... but at 65, it is only 7.3 yrs, compared to 19.5 yrs OECD average Smoking rates and alcohol consumption are lower than OECD average... ... but more than half the population overweight, and physically inactive.#8and the need for complex care will grow Chronic disease is widespread - ... 8.5% of adults have diabetes, vs. 7.0% in the OECD. Dementia OECD Costa Dementia is expected to rise rapidly... prevalence Rica per 1000 pop'n 2017 14.8 9.3 2037 23.1 20.4#9A relatively expensive health care system $ о 9.1% GDP spent on health ... exceeding 9.0% OECD average! Out-of-pocket payments comprise 25% of total financing vs. 20% in the OECD, ... and going up#10nevertheless, much fewer resources Availability OECD Costa per 1 000 pop'n Rica + Doctors 3.3 2.1 Nurses 8.9 3.1 Hospital beds 4.8 1.2 Risk of a two-tier system? ... which drives long waiting times. 30% of population use private providers at least once a year. ... 50% of population want to stop contributing to CCSS.#11Budgetary discipline is poor Spending (millions Costa Rican Colones, nominal values) AAGR, 2010 2011 2012 2013 2014 2015 2010-2015 ACUTE CARE HOSPITALS Total 596 435 659 720 710 057 752 589 806 089 878 382 8.1% ...of which, operational spending 592 006 652 730 705 943 746 851 798 708 866 441 7.9% ...of which, salaries 420 578 453 677 479 338 516 333 548 532 586 605 6.9% PRIMARY CARE Total 259 454 278 924 291 415 318 999 331 572 357 409 6.6% ...of which, operational spending 256 557 276 365 289 873 316 645 328 660 354 001 6.7% ...of which, salaries 160 935 174 235 180 566 197 956 210 821 225 992 7.1%#1275 70 65 60 Brazil Costa Rica¹ United States Australia¹ Japan Iceland¹ Sweden¹ Finland1 Canada Israel¹ Norway¹ Portugal¹ age-standardised net survival (%) New Zealand¹ France Netherlands¹ Belgium¹ Korea¹ Switzerland Denmark¹ Germany Italy United Kingdom¹ 2000-2004 and 2010-2014 Breast cancer five-year net survival, Spain 100 95 90 85 80 OECD31 Austria¹ Slovenia¹ China 92.6 91.2 90.2 89.5 89.4 89.1 88.8 88.5 88.2 88.0 87.7 87.6 87.6 86.7 86.6 86.4 86.3 86.2 86.1 86.0 86.0 85.6 85.4 Quality: some excellent outcomes Confidence Interval 2010-2014 185.0 84.8 83.5 83.2 Czech Rep. Estonia¹ Poland¹ Slovak Rep. Chile Lithuania¹ Colombia Russian Fed. Latvia¹ Turkey Ireland¹ 82.2 1 2000-2004 2010-2014 82.1 82.0 81.4 76.6 76.5 75.5 73.9 173.5 72. 70.8 India 66.1#13100 90 80 70 60 50 40 30 20 10 0 ...others more troubling 96.4 96.3 ❤95.2 ••93.4 91.9 91.5 • 90.8 ● 89.7 ●●89.6 ●●88.3 88.0 ●• 87.3 86.9 ● 86.8 • 83.3 ●●82.3 81.5 Norway Denmark Netherlands Canada Sweden United Kingdom Switzerland Israel Germany Belgium Hungary Austria New Zealand Finland Estonia % of hip fractures operated on nearest year) within 48hr, 2005 and 2015 (or Ireland Czech Rep. OECD21 Lithuania Slovenia ●●80.6 • 69.4 2005 ► 2015 • 66.7 53.2 48.4 46.5 46.0 •-•24.9 Italy Spain Portugal Latvia Costa Rica#14>> + Key recommendations Reform health system governance by - strengthening external scrutiny of CCSS objectives and performance; and - increasing participation in international benchmarking initiatives.#15Key recommendations ୧ Improve access and quality by - expanding the supply of the health care workforce; - allowing choice of provider; and, - reinstituting performance management in hospitals.#16Key recommendations Strengthen efficiency and financial sustainability by - more robust controls on public expenditure; -reforming payment systems; - systematising HTA; and, - increasingly funding health care from the general government budget.#17>> In summary... OECD Reviews of Health Systems COSTA RICA 2017 A health system with many examples of good practice that other systems could learn from. ...but significant reforms needed to better monitor and improve performance. OECD#18Stay in touch! Just released: ☑ By email [email protected] Health at a Glance 2017 OECD INDICATORS [email protected]; [email protected] »OECD On Twitter On our website @OECD_social www.oecd.org/health Note: The charts in this presentation are from Health at a Glance 2017 and are available via the Statlinks within the publication. 18