Observatorio Europeo sobre Sistemas Sanitarios Suszy Lessof Allicante, 26 May 2003 European Observatory on Health Care Systems

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

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

A new drug cannot be introduced…without 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 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 Politica sanitaria basada en la evidencia

Un papel del Observatorios Analisis comprensivo - disponibilidad de informacion en areas claves Analisis riguroso - c alidad scientifico Oportuno - timely Relevancia (pertinente, relacionado, apropriado) to policy makers needs Accesible - target dissemination /communication

Un papel del Observatorios Cubrir el gap entre la evidencia y la politica sanitaria –Regional –Nacional –Internacional

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 Banco Europeo de Inversiones London School of Economics and Political Science London School of Hygiene & Tropical Medicine

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

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

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) 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.

1. Informacion por paises / Monitorizacion 2. Analisis 3. Diseminacion Actividades / Productos

Production of HiTs Sistemas Sanitarios en Transition; perfiles por pais HiT Summaries Living HiTs Glossary (printed and on-line) HiT template revision wide consultation 1.Informacion por paises / Monitorizacion

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 challengesHiTs

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 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 HiTs

Key priority health system areas Systematic conceptual framework Comparaciones sub-regionales Meta-analytical research Synthesis of existing evidence Brings networks of experts 2. Analisis

El papel apropriado del hospital Regulacion del entrepreneurial behaviour Financiacion sanitaria : options in Europe Republicas Centro-Asiaticas 2. Analysis / Estudios Analiticos

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

2. Analysis / Estudios underway Farmaceuticos Mental health Recursos Humanos Decentralizacion

Uptake of results and positive response Builds on, complements and works with other organizations 2. Analisis

3. Diseminacion Engaging with policy makers Publicaciones HiTs Observatory OUP book series Policy briefs Newsletter: Euro Observer Journal: Eurohealth Translations Journal articles

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

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 3. Diseminacion Engaging with policy makers

Structure, organization and staffing Role of the Observatory partners Steering committee Project / matrix based management Secretariat / Research Directors Geographical hubs (30 staff FTE)

Desafios y Lecciones 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

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

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