OECD Reviews of Health Care Quality CzECH REpubliC Raising stanDaRDs OECD Reviews of Health Care Quality At a time when ever more information is available about the quality of health care, the challenge for policy makers is to better understand the policies and approaches that sit CzECH REpubliC behind the numbers. The Czech Republic is the fifth country report, following Denmark, Israel, Korea and Sweden, in a new OECD series evaluating the quality of health care Raising stanDaRDs across OECD countries – whether care is safe, effective and responsive to patients’ O E needs. OECD Reviews of Health Care Quality examine what works and what does not C work, both to benchmark the efforts of countries and to provide advice on reforms to D R improve quality of health care. This series of individual country reviews will be followed e by a final summary report on the lessons learnt for good policy practices. vie w Contents s o Executive summary f H e Assessment and recommendations a lt h Chapter 1. Quality of care policies in the Czech Republic C a Chapter 2. Health data infrastructure in the Czech Republic r e Chapter 3. Screening and prevention programmes in the Czech Republic Q u a Chapter 4. Diabetes care in the Czech Republic lit y C z www.oecd.org/health/qualityreviews E C H R E p u b l iC R a is in g s t a n Consult this publication on line at http://dx.doi.org/10.1787/9789264208605-en. D a R This work is published on the OECD iLibrary, which gathers all OECD books, periodicals D s and statistical databases. Visit www.oecd-ilibrary.org for more information. isbn 978-92-64-20859-9 9HSTCQE*caifjj+ 81 2014 05 1 p OECD Reviews of Health Care Quality: Czech Republic 2014 RAISING STANDARDS ThisworkispublishedontheresponsibilityoftheSecretary-GeneraloftheOECD. Theopinionsexpressedandargumentsemployedhereindonotnecessarilyreflect theofficialviewsoftheOECDorofthegovernmentsofitsmembercountries. Thisdocumentandanymapincludedhereinarewithoutprejudicetothestatusof orsovereigntyoveranyterritory,tothedelimitationofinternationalfrontiersand boundariesandtothenameofanyterritory,cityorarea. Pleasecitethispublicationas: OECD(2014),OECDReviewsofHealthCareQuality:CzechRepublic2014:RaisingStandards,OECD Publishing. http://dx.doi.org/10.1787/9789264208605-en ISBN978-92-64-20859-9(print) ISBN978-92-64-20860-5(PDF) Series:OECDReviewsofHealthCareQuality ISSN2227-0477(print) ISSN2227-0485(online) The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities.TheuseofsuchdatabytheOECDiswithoutprejudicetothestatusofthe Golan Heights, East Jerusalem and Israeli settlements in theWest Bank under the terms of internationallaw. Photocredits:Cover©ArtGlazer/GettyImages. CorrigendatoOECDpublicationsmaybefoundonlineat:www.oecd.org/about/publishing/corrigenda.htm. ©OECD2014 Youcancopy,downloadorprintOECDcontentforyourownuse,andyoucanincludeexcerptsfromOECD publications,databasesandmultimediaproductsinyourowndocuments,presentations,blogs,websitesand teachingmaterials,providedthatsuitableacknowledgmentofthesourceandcopyrightownerisgiven.All requestsforpublicorcommercialuseandtranslationrightsshouldbesubmittedtorights@oecd.org.Requests forpermissiontophotocopyportionsofthismaterialforpublicorcommercialuseshallbeaddresseddirectly totheCopyrightClearanceCenter(CCC)[email protected]çaisd'exploitationdudroitde copie(CFC)[email protected]. 3 FOREWORD – Foreword This report is the fifth of a series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care have led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives. The Czech Republic has made significant progress in improving the quality of health care in recent decades. The reduction in case-fatality rate after a heart attack, for example, is amongst the steepest in the OECD, more than halving from 15.7% in 2001 to 6.8% in 2011. But compared to its peers, quality monitoring and quality improvement activities remain at a basic level. There is great emphasis on ensuring that minimum standards are met, whilst initiatives to encourage continuous quality improvement are less developed. The relatively immature data infrastructure that underpins Czech health care is a key factor preventing more detailed, transparent and continuous quality monitoring of clinical processes and patient outcomes. To move to the next stage of continuous quality improvement, the Czech Republic needs to use health information better, in particular by publishing more measures of the outcomes of care. Greater consistency of vision, policies, and co-ordination across key bodies, including the various state institutes for safety, quality and information, insurers and health care providers is also needed. The health system should also develop a more proactive approach to managing chronic diseases such as diabetes, through better primary and secondary prevention work. OECD REVIEWS OF HEALTH CARE QUALITY: CZECH REPUBLIC © OECD 2014 4 – ACKNOWLEDGEMENTS ACKNOWLEDGEMENTS This report was managed and co-ordinated by Ian Forde. The other authors of this report are Jan Alexa, Emily Hewlett and Niek Klazinga. The authors wish to thank Francesca Colombo, Mark Pearson and Stefano Scarpetta from the OECD Secretariat for their comments and suggestions. Thanks also go to Marlène Mohier and Lucy Hulett for editorial support and to Nelly Biondi for statistical support. The completion of this report would not have been possible without the generous support of the Czech authorities. This report has benefited from the expertise and material received from many health officials, health professionals, and health experts that the OECD review team met during a mission to the Czech Republic in September 2013. These included Dr Martin Holcát and his advisors and officials at the Ministry of Health; experts from the Institute of Biostatistics, health insurance funds, regional hospital association and cancer screening programmes; staff and patients at the Jihlava Diabetes Centre; the Purkinje Medical Society, Czech Nursing Association and Czech Pharmacists’ Chamber; Drs Tomáš Edelsberger, Zdeněk Hřib, Pavel Hroboň, Zorjan Jojko, David Marx, Bohumil Seifert František Vlček, Miloš Voleman as well as Martina Mahútová for their expertise on various aspects of the Czech health care system; and Jiří Hlaveš and Jana Petrenko for their knowledge of patients’ priorities. The review team is especially thankful to Jan Čeněk, Eva Sobotkova and Jan Ruzicka at the Ministry of Health for their help in setting up the mission and co-ordinating responses to a questionnaire on quality of care policies and data. The report has benefited from the invaluable comments of the Czech authorities and experts who reviewed an earlier draft. OECD REVIEWS OF HEALTH CARE QUALITY: CZECH REPUBLIC © OECD 2014 5 TABLE OF CONTENTS – Table of contents Acronyms and abbreviations ............................................................................. 9 Executive summary ........................................................................................... 11 Assessment and recommendations .................................................................. 15 Building a quality architecture to support continuously improving care ........ 18 Strengthening the data infrastructure .............................................................. 22 Better quality in screening and preventive health care .................................... 27 Improving care for patients with diabetes and metabolic syndrome ............... 32 Chapter 1. Quality of care policies in the Czech Republic ............................. 41 1.1. Introduction .............................................................................................. 42 1.2. Design, costs and outcomes in the Czech health care system .................. 42 1.3. Governance for quality of health care in the Czech Republic .................. 48 1.4. Assuring the quality of inputs to the Czech health care system ............... 53 1.5. Patient safety policies ............................................................................... 58 1.6. Health system standards and guidelines ................................................... 58 1.7. Managing health system improvement ..................................................... 59 1.8. Strengthening the role and perspective of the patient .............................. 60 1.9. Conclusion................................................................................................ 62 Note ................................................................................................................. 63 Bibliography .................................................................................................... 64 Chapter 2. Health data infrastructure in the Czech Republic ....................... 65 2.1. Introduction .............................................................................................. 66 2.2. Overview of data collection ..................................................................... 66 2.3. Assessment of the data infrastructure ....................................................... 75 2.4. Recommendations to improve the Czech data infrastructure ................... 80 2.5. Conclusion................................................................................................ 85 Bibliography .................................................................................................... 87 Annex 2.A1. Health care data in the Czech Republic .................................... 89 OECD REVIEWS OF HEALTH CARE QUALITY: CZECH REPUBLIC © OECD 2014 6 – TABLE OF CONTENTS Chapter 3. Screening and prevention programmes in the Czech Republic .... 97 3.1. Introduction .............................................................................................. 98 3.2. Configuration of screening and prevention programmes in the Czech Republic ............................................................................................... 99 3.3. Current outcomes associated with screening and prevention programmes in the Czech Republic .............................................................. 102 3.4. Governance challenges faced by screening and prevention programmes in the Czech Republic .............................................................. 112 3.5. Securing a greater quality dividend from screening and prevention programmes in the Czech Republic .............................................................. 116 3.6. Conclusion.............................................................................................. 124 Notes ............................................................................................................. 126 Bibliography .................................................................................................. 127 Chapter 4. Diabetes care in the Czech Republic ........................................... 131 4.1. Introduction ............................................................................................ 132 4.2. The prevalence of diabetes and metabolic syndrome are a cause for concern .................................................................................................... 134 4.3. Scaling-up primary and secondary prevention for diabetes ................... 137 4.4. Despite some improvement, there are still shortcomings in the outcomes of diabetes ..................................................................................... 142 4.5. The Czech Republic should step up efforts to provide good quality care for diabetes, and to manage complications ............................................ 146 4.6. Conclusion.............................................................................................. 154 Bibliography .................................................................................................. 156 Figures Figure 1.1. Life expectancy at birth, 1970 and 2011 (or nearest year) ............ 44 Figure 1.2. Annual average growth rate in per capita health expenditure, real terms, 2000-11 (or nearest year)............................................................... 45 Figure 1.3. Cancer five-year relative survival, 2006-11 (or nearest period) ...... 46 Figure 1.4. Acute myocardial infarction – case fatality in 30 days after admission in adults aged 45 years and over (left) and ischemic stroke (right) in hospital case fatality rates ................................................................ 47 Figure 2.1. Balancing individual data privacy concerns and benefits to patient safety and system performance ....................................................... 77 Figure 3.1. Cervical cancer screening rates ................................................... 103 Figure 3.2. Socioeconomic differences in cervical cancer screening ............ 104 Figure 3.3. Breast cancer screening rates ...................................................... 106 Figure 3.4. Socioeconomic differences in breast cancer screening ............... 107 Figure 3.5. Socioeconomic differences in colorectal cancer screening ......... 108 Figure 3.6. Smoking and drunkenness amongst 15-year-olds ....................... 110 OECD REVIEWS OF HEALTH CARE QUALITY: CZECH REPUBLIC © OECD 2014 7 TABLE OF CONTENTS – Figure 3.7. Diabetes hospital admission in adults, 2006 and 2011 (or nearest year) ............................................................................................. 112 Figure 3.8. Structure of the Quality Indicators in Community Healthcare (QICH) programme, Israel ............................................................................ 120 Figure 3.9. DAMD output allowing GPs to compare the quality of their practice with peers ............................................................................ 121 Figure 4.1. The prevalence of diabetes in the Czech Republic is rising ........ 135 Figure 4.2. Obesity rates amongst adults in OECD countries, 2011 (or nearest year) ............................................................................................. 136 Figure 4.3. Mortality rate from diabetes, 2003-12 ........................................ 142 Figure 4.4. Care pathway for patient with type 2 diabetes ............................ 148 Tables Table 1.1. A typology of health care policies that influence health care quality ................................................................................................ 42 Table 2.A1.1. An overview of Czech health care data ............................. 90 Table 4.1. Quality indicators in community health indicators for diabetes in Israel, 2009 ...................................................................... 145 Table 4.2. Managing the progression of diabetes helps reduce treatment needs and control costs ........................................................... 146 OECD REVIEWS OF HEALTH CARE QUALITY: CZECH REPUBLIC © OECD 2014