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Comparing health outcomes and pharma pricing around the world: A PISA for healthcare is a health minister's worst nightmare…
Last week here in Paris, the OECD unveiled several ambitious healthcare policy initiatives at its Policy Forum and Health Ministerial meetings, and Secretary-General Angel Gurria notably kicked things off by outlining what he called a new "PISA for Healthcare" programme. The Patient Reported Indicators Survey (PaRIS) was formally launched with the ambition of becoming the pre-eminent standard to measure quality, access and value for money of health policies within the OECD countries.
The OECD runs a comparable survey in assessing education standards around the world - the much publicised PISA survey - which is among the OECD's most high-profile and highest-impact endeavours. Such is the influence of the PISA survey that many governments nervously await its publication every three years as a key measure of the success - or not - of their education policies. Indeed, Sweden's dramatic fall down the PISA survey was a key contributing factor to the downfall of the eight-year centre-right government in the 2014 elections.
Undoubtedly, this kind of survey holds a lot of power, and potentially even more so in an area as politically sensitive as healthcare. Comparing healthcare systems is a notoriously volatile area, and the OECD's approach has raised even more eyebrows by focusing on patient-reported outcome measures (PROMs). This means that a patient's own experience of the healthcare system of any given country will be the key determining factor in how it will fare against the system in other countries - in effect, the patient becomes the judge, jury and executioner of their own healthcare system…something which could become the bane of the life of health ministers around the world.
So not only is the OECD entering into very delicate territory - but it will also be using pretty ground-breaking methodology in doing so. Historically, the OECD has been known for its "Health at a Glance" reports that highlight top-line healthcare indicators on expenditure trends and other key areas - but this is an entirely new approach, with numerous methodological question marks immediately raised. And this is very much recognised in the initial recommendations that accompany the launch (available here). Healthcare is a far too complex subject to be distilled into one comparable number across the board - the health forecasts and pharmaceutical risk ratings at IHS Markit are only the starting point for a far more in-depth journey of trends and assessments of healthcare systems. But with PaRIS, clearly what media reports will inevitably focus on - and governments potentially fear - will be the ultimate ranking trends of each country, irrespective of any methodological issues of the report and other nuances that accompany any country's healthcare system.
At the same time, the OECD also last week presented a separate report that focuses on another, equally thorny subject: pharmaceutical pricing policy. Here, the OECD warned over escalating healthcare costs and the pricing negotiating power of pharmaceutical companies, and recommended stronger HTA controls, joint procurement and risk-sharing across its member countries. With this, the OECD is joining several initiatives from international organisations on pharmaceutical pricing, including the WHO's pricing transparency programme as well as various HTA and pricing cooperation initiatives among regional economic blocs around the world.
Clearly, the OECD's PaRIS initiative is a positive, radical step, and we very much look forward to the journey that it is embarking on. Together with the report on pharmaceutical pricing, the OECD is ramping up its influence and impact on healthcare policy, with significant repercussions for patients, policymakers, pharma companies and healthcare services around the world.
Gustav Ando is the Director of the Life Science practice at IHS Markit
Posted 24 January 2017
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