Using health outcomes data to inform decision-making: healthcare payer perspective.

Healthcare payers are charged with the responsibility of achieving maximum profits or output within their limited budget. As the demands are always greater than the budget, there is growing interest in tools that can inform decisions on the allocation of limited resources. Healthcare payers are using health outcomes data to assist the decision-making process, although the way in which such information is being used may differ between payers. From the perspective of the French sickness fund, there is a need for real-world information to supplement the results of clinical trials and inform negotiations on pricing. In the US, the large databases of healthcare insurers are being examined in order to carry out retrospective cohort studies that go some way towards providing such real-world information on outcomes with alternative treatments. Another approach to health outcomes information has been taken by an Israeli healthcare organisation, Maccabi Healthcare Services, which introduced a disease management programme in order to improve outcomes of asthma management. Clearly, healthcare payers are using health outcomes information in a variety of ways to inform decision-making. The extensive databases available to payers may be used to good effect, to obtain real-life information that supplements clinical trial data and economic models of outcomes and costs, and to enable the targeting of interventions.

Rationing health care in France.

Since the Plan Juppé (1995), many facets of the French health care system have been the target of new legislative measures. This paper discusses the main features of the financing and provision of health care services, and focuses on issues related to priority setting and rationing. For more than 20 years, successive but systematic changes have been implemented. Most changes and measures affected the demand and supply of health care services, as well as their prices. Attempts to control demand focused mainly on the increase of user charges (ambulatory care as well as the hospital sector). Control over the volume of supply consisted, for the most part, in limiting the number of health professionals and restricting hospital beds. As far as payment is concerned, the French public authorities had set a general system of administrative prices (negotiated fees for private practice physicians, pharmaceuticals and other medical goods) and implemented global budgets for public hospitals. Among the new features designed in 1996, which target both cost-containment and quality of care, we emphasise the Parliament's involvement in setting national expenditure targets for sickness funds, the experimentation with a gatekeeper-like system (médecin référent), the development of practice guidelines and quality controls through the accreditation of hospitals. As the 1998 Eurobarometer Survey clearly shows, none of these reforms is easy to implement; they will take time to be accepted and will need physicians' support to succeed.