"Governments have significant leverage"

The technical interoperability of eHealth services is one thing. But the structure of healthcare systems and payment schemes is at least as important for a broad acceptance of eHealth solutions. Within the framework of its health-IT project, the OECD analyses this field.

Published: 05/08

PORTOROZ, SLOVENIA - (HealthTech Wire) - “When it comes to healthcare systems, all OECD countries are struggling with questions of affordability and efficiency,” said Elettra Ronchi, coordinator of health-IT activities at the Organisation for Economic Cooperation and Development (OECD). This struggle is mirrored by a steady increase in healthcare spending: “There are big differences between the various countries, but the average percentage of GDP that OECD countries pay for their healthcare system is steadily growing.”

Information and communication technologies can be seen as a tool for increasing the efficiency of healthcare systems. But this is not self-selling: “In our view, it is necessary to realign the economic incentives. The governments have significant leverage here, as they are the major funders of healthcare provision,” said Ronchi. On average, 73 per cent of total healthcare spending in the OECD countries comes from public sources, be it tax money or money from public insurance companies. Even in the allegedly “private” US healthcare system, almost half of total healthcare spending is actually government spending.

For the OECD, the key to a broader acceptance of ICT solutions in healthcare is changes in the payment modalities. Economists argue strongly in favour of “pay for performance” schemes. These schemes make high-quality care financially attractive for the healthcare provider, and at the same time act as a catalyst for ICT usage, in particular in primary care. As an example, Ronchi highlighted the UK pay for performance scheme that was introduced in 2004: “25 per cent of the GP’s income is now related to a set of 146 evidence-based quality indicators. Since the introduction of the scheme, the quality of care has increased significantly in many areas – as has payment for GPs”.

More importantly from an eHealth-point of view: investment in IT and the use of IT tools has significantly improved: “A high quality ICT infrastructure and a high level of computerization have been absolutely critical to the success of this and other pay for performance schemes,” said Ronchi. The reason is that gathering and reporting quality-relevant data is much easier when it is done electronically.

So pay for performance schemes can support the deployment of eHealth solutions. Ronchi stressed that this is true not only for accounting software, but also for electronic medical records, since many quality-relevant medical data needs to be extracted from the medical documentation. “Merely paying for the technology and setting it up in the doctor’s office is not a good enough reason for doctors to decide to use ICT,” was Ronchi’s message to the European eHealth community that assembled in Portoroz. (PP)