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28.1.2016
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Palvelutuotannon omistamisen eri mallit – miten muissa maissa?
Liina-Kaisa Tynkkynen, FT
Tutkijatohtori, Tampereen yliopisto/Tutkijakollegium
Erikoistutkija, Terveyden ja hyvinvoinnin laitos
“Private health-care
companies have several advantages over public
organisations (…) Europe should be proud of its
public-health services. But if it wants them still to be affordable in the future, it should allow more private companies into the mix. “
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YKSITYINEN VS. JULKINEN
KOLME MÄÄRITELMÄÄ
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Lähde: Tynkkynen 2013
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0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
Au
stra
lia (
2009
)
Au
stri
a
Bel
giu
m
Can
ada
Ch
ile (
2009
)
Cze
ch R
epu
blic
Den
mar
k
Esto
nia
Fin
lan
d
Fran
ce
Ger
man
y
Hu
nga
ry
Icel
and
Isra
el (
2008
)
Jap
an (
2009
)
Ko
rea
Luxe
mb
ou
rg
Net
herl
and
s
New
Zea
land
No
rway
(20
09)
Po
lan
d
Po
rtu
gal
Slo
vak
Rep
ub
lic
Slo
ven
ia
Spai
n
Swed
en
Swit
zerl
and
Turk
ey (
2008
)
Un
ited
Sta
tes
Current Health Expenditure by ICHA-HF Healthcare Financing, 2010
HF3: Rest of the world HF25: Corporations (other than health insurance)
HF24: Non-profit institutions serving households HF23: Private households out-of-pocket exp.
HF21-HF22: Private insurance HF12: Social security funds
HF11: General government (excl. social security) = Territorial government
Source: OECD.Stat 2012
Source: Schäfer et al. 2010
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SOURCE: Joumard et al. 2010. Health care systems: efficiency and institutions. ECO/WKP(2010)25, OECD.
Predominant modes for the provision of primary care services and outpatient specialists’ services (Paris et al. 2010)
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Public/private mix in the provision of hospital acute care (Paris et al. 2010)
MARKKINAT VERKOSTOT HIERARKIA
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COMMISSIONING
”EVERYTHING’S BEEN OUTSOURCED, WHAT’S LEFT FOR ME TO DO?...”
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From passive to strategic purchasing
”Which interventions should be purchased, how they should be purchased and from whom.”
MARKKINOILLE TULO
SOPIMINEN
HINNOITTELU JA KANNUSTEET
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Mode of payment and financing in primary care (OECD 2016)
SOURCE: OECD Health Statistics 2013, Health Systems Characteristics Survey 2012, and Secretariat's estimates. Information as of April 2014.
PREDOMINANT MODES OF PHYSICIAN PAYMENT
(Paris et al. 2010)
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Towards P4P ”Rewarding achievement of targeted performance measures”
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P4P-ohjelmien tavoitteita perusterveydenhuollossa
Ennaltaehkäisy
Kroonisten sairauksien hoito
Toiminnan tehokkuus
Asiakastyytyväisyys
IT-palveluiden käyttö
Source: Cashin et al. 2014
P4P-ohjelmien tavoitteita erikoissairaanhoidossa
Tietyt kliiniset tulokset
Hoidon tarkoituksen mukaisuus
Asiakaskokemus
Asiakastyytyväisyys
Source: Cashin et al. 2014
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LÄHDE: YHTEISKUNTAPOLITIIKKA 78 (2013):6
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”The challenge to policymakers in both publicly operated and social-health-
insurance-based health systems will be to ensure that these new arrangements evolve in socially as well as economically
appropriate directions.”
KIITOS! [email protected]
