Observatorio Europeo sobre Sistemas Sanitarios

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Observatorio Europeo sobre Sistemas Sanitarios

• Suszy Lessof
• Allicante, 26 May 2003
• European Observatory on Health Care Systems
• www.observatory.dk

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Contexto

• Desafios/retos sanitarios comunes
• Globalizacion de las presiones
• Escasa evidencia sobre la efectividad real de
  muchas politicas sanitarias
• La informacion disponible carece de relevancia
  para politicos sanitarios y agencias

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Respuestas

• Convergencia en las estrategias adoptadas
• Transferencia de modelos, reformas e ideas a
  traves de contextos socio-economicos, culturales
  distintos
• Reforma rica en ideologia pero pobre en
  conocimiento
• Politica sanitaria basada en la evidencia
• Observatorios

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Politica sanitaria basada en la evidencia
A new drug cannot be introducedwithout
exhaustive scientific trials, but we usually
introduce new ways of delivering health services
with little or no scientific evaluation If
health care system changes were submitted to the
same scrutiny as new drug evaluations, they would
probably not even be allowed to move from the
animal to the human experimentation stage.
Source Hiullman 1998
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Politica sanitaria basada en la evidencia

• De la torre de marfil academica
• Es necesaria mas investigacion
• El jurado todavia esta deliberando
• Demasiado pronto a comentar, .
• A la politica reactiva del dia a dia
• Agenda politica
• Electoral pressures - short termism, ideology
• Necesidad de resultados quick and dirty a corto
  plazo

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Un papel del Observatorios

• Analisis comprensivo - disponibilidad de
  informacion en areas claves
• Analisis riguroso - calidad scientifico
• Oportuno - timely
• Relevancia (pertinente, relacionado, apropriado)
  to policy makers needs
• Accesible - target dissemination /communication

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Un papel del Observatorios

• Cubrir el gap entre la evidencia y la politica
  sanitaria
• Regional
• Nacional
• Internacional

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Observatorio Europeo sobre Sistemas Sanitarios

• Organizacion Mundial de la Salud Oficina Europea
• Gobierno de Espana
• Gobierno de Noruega
• Gobierno de Grecia
• Banco Mundial
• Open Society Institute
• Banco Europeo de Inversiones
• London School of Economics and Political Science
• London School of Hygiene Tropical Medicine

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Mision del Observatorio Europeo

• El Observatorio Europeo sobre sistemas sanitarios
  apoya y promueve la politica sanitaria basada en
  la evidencia a traves del analisis comprensivo y
  riguroso de los sistemas sanitarios en Europa

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Principios centrales

• Cubrir el espacio entre la evidencia cientifica y
  las necesidades de los politicos sanitarios
• Analisis comparativo de la evidencia existente
• Desarrollo de lecciones practicas y alternativas
  en politica sanitaria

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Comparaciones internacionales

• Most countries are dealing with health care
  reforms as if each was on Mars. Few have tried to
  learn from others. (...) Instead of each country
  trying out its own experiments, they should be
  studying each others for ideas and pitfalls.
• The Economist (1991)

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Comparaciones internacionales

• International differences in health care systems
  and approaches to reform can provide analysts
  with a natural experiment, which, if rigorously
  analysed, can facilitate learning from other
  countries successes and failures.

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Actividades / Productos

• 1. Informacion por paises / Monitorizacion
• 2. Analisis
• 3. Diseminacion

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1.Informacion por paises / Monitorizacion

• Production of HiTs Sistemas Sanitarios en
  Transition perfiles por pais
• HiT Summaries
• Living HiTs
• Glossary (printed and on-line)
• HiT template revision wide consultation

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HiTs

• Analytical description of health systems
  organization, finance and delivery, and reforms
  in European countries
• Full coverage of region other key OECD
  countries
• Routine and systematic update every 2/3 years
• Approximately 20 profiles per year
• Use of common template and standard set of
  definitions
• Integrate quantitative data from existing
  databases
• WHO, OECD, World Bank, EUROSTAT
• Methodological challenges

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HiTs

• Wide usage
• Comparative analysis of experience across
  countries
• Develop options for reform
• Identify key experiences / in-depth analysis
• Facilitate country technical support
• Capacity building at country level
• Monitor content and implementation of reforms

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HiTs

• Have increasingly become the standard approach to
  look at health systems
• Accepted and used by other international
  organizations
• Widely used and replicated in other regions

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2. Analisis

• Key priority health system areas
• Systematic conceptual framework
• Comparaciones sub-regionales
• Meta-analytical research
• Synthesis of existing evidence
• Brings networks of experts

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2. Analysis / Estudios Analiticos

• El papel apropriado del hospital
• Regulacion del entrepreneurial behaviour
• Financiacion sanitaria options in Europe
• Republicas Centro-Asiaticas

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2. Analisis / Estudios underway

• Sistemas de Seguro Sanitario en Europa Occidental
• Paises en accesion en Europa del Este
• Effective purchasing (contratacion) for health
  care
• Primary care in the driving seat

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2. Analysis / Estudios underway

• Farmaceuticos
• Mental health
• Recursos Humanos
• Decentralizacion

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2. Analisis

• Uptake of results and positive response
• Builds on, complements and works with other
  organizations

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3. Diseminacion Engaging with policy makers

• Publicaciones
• HiTs
• Observatory OUP book series
• Policy briefs
• Newsletter Euro Observer
• Journal Eurohealth
• Translations
• Journal articles

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3. Diseminacion Engaging with policy makers

• Web and listserve
• 120,000 separate visitors in 2002
• Close to 1 million visits
• Over 100,000 downloads
• List serve approx 2,400 subscribers from 98
  countries

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3. Diseminacion Engaging with policy makers

• International expert conferences
• E.g. Annual sessions in EUPHA, EHMA, Gastein
• Participation in key networks
• National conferences country meetings
• Workshops and seminars for policy makers
• HiT and study launches

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Structure, organization and staffing

• Role of the Observatory partners
• Steering committee
• Project / matrix based management
• Secretariat / Research Directors
• Geographical hubs (30 staff FTE)

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Desafios y Lecciones

• De las grandes ideas de la reforma ..
• a la evidencia para la puesta en practica.
• Retos metodologicos
• Definicion
• Evaluacion de desempeño
• Medicion de impacto de los sistemas
• Retos de diseminacion
• Relevancia y objetividad

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Desafios y Lecciones

• Informacion como un bien publico
• Crear masa critica entre organizaciones para
  utilizar recursos limitados
• Colaboracion y partnership no es solo deseable
  sino tambien necesario

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The European Observatory

• Evidence for policy making
• Comparative approach
• Partnerships (technical, political,
  institutional)
• Expert and policy makers networks
• Focus on dissemination
• No normative / policy agenda
• Una filosofia fundada en la colaboracion