Corespondent:  Sonĵ Hall

The latest figures released by the Australian Institute of Health and Welfare show that record numbers of Australians did not have to pay anything out of pocket when visiting their doctor last year. In 2017–18, 86 percent of patients were bulk-billed, meaning that Australia’s universal health coverage, Medicare, paid the bill in full. The remaining 14 percent faced out-of-pocket costs as their doctors charged rates that were higher than the Medicare bulk-billing rate. The bulk-billing coverage rate rose in all states and territories, with 133 million primary care visits fully covered, 5.6 percent higher than in 2016–17.

• Medicare Bulk Billing Rate Hits Historic 86.1 Per Cent

Country Correspondent: Sonĵ Hall

The start of 2019 marks a turning point for Australian hospitals in delivering better and more appropriate care for Indigenous Australians, who have a 10-year-lower life expectancy compared with non-Indigenous Australians. Developed in collaboration with Indigenous leaders, the newly launched National Safety and Quality Health Service Standards User Guide for Aboriginal and Torres Strait Islander Health provides advice and case studies to assist health services in meeting the new standards required to maintain accreditation starting January 1, 2019. The guide identifies six essential actions to close the gap, including Indigenous representation in governance structures and improved cultural competency in the workforce.

• Launch of National Safety and Quality Health Service Standards User Guide for Aboriginal and Torres Strait Islander Health at COAG Meeting

Correspondent: Danielle Rodin

British Columbia is the first among Canadian provinces to hold more than 40 pharmaceutical companies accountable for their role in the opioid crisis that is crippling the province. A lawsuit filed by Attorney General David Eby alleges that companies were negligent in pushing opioids to physicians while downplaying the risk of addiction. The province is now seeking retribution for costs incurred by the public health care system. Pharmaceutical companies have pushed back, claiming that the complexity of legal and illegally produced opioids is the cause of the spike in overdoses, and that the companies operate within Canadian and international laws. Some critics of the lawsuit say resources should instead be directed at responding to the urgent crisis of illegal opioids and providing clean drugs at injection sites, since a lawsuit could take up to decades to resolve. Other provinces are carefully watching the suit unfold before launching their own legal charges against Big Pharma.

• B.C. Sues Opioid Makers for ‘Negligence and Corruption’ About Addiction Risks
• Alberta Will Look at B.C. Suit Against Pharmaceutical Companies over Opioid Addictions

Health technology assessment (HTA) is the process of evaluating the added value of new medicines and technologies relative to existing therapies. Now, the European Commission is strengthening cross-border cooperation and making it possible for EU countries to use common HTA methodologies and procedures. The goal is to ensure quicker access to innovative health technologies, increase the transparency of value assessments, avoid duplication of work for national HTA bodies, and improve business predictability for manufacturers. In July, more than 300 stakeholders met in Brussels to discuss future HTA cooperation, including the importance of engaging patients and clinicians early and the potential of the EU’s Digital Single Market to enable sharing of disease registry and real-world data across country borders.

• Stakeholders Confirm Support for Strengthened EU Cooperation on HTA
• Conference Invitation: “The Way Forward for HTA Cooperation — The Views of Stakeholders”

Country Correspondent: Paul Dourgnon

To date, a number of reports have pointed to problems in access to medical care in rural and semiurban areas of France. To improve access, the public health insurance agency (L’assurance maladie) announced that telemedicine visits will be reimbursed starting in September 2018. In addition, “tele-expertise” — seeking advice from other medical professionals using telemedicine technology — also will be reimbursed. The move is expected to improve access in particular for older adults who often face physical difficulties accessing medical facilities.

• Téléconsultation : la médecine se généralise enfin

Country Correspondent: Michael Laxy

Mortality from heart disease in Germany increased in 2015 for the first time after more than 20 years of steady decline. With more than one-third (38%) of all deaths now attributable to heart disease, it remains one of the leading causes of death. Experts see this as a sign that new technologies for prevention and treatment of heart disease have reached a saturation point. While the increasing prevalence of heart disease might be partially explained by increased life expectancy, clinicians have called for strengthened prevention measures addressing risk factors such as smoking, physical inactivity, hypertension, obesity, and alcohol use.

• Zahl der Herzkrankheiten nimmt wieder zu

Country Corespondent: Marthe Haverkamp

In August, the Dutch National Information Center on Poisoning published its annual report, which included recent statistics for opioid overdoses in 2017. The number of people using oxycodone in the Netherlands has risen fivefold, from 75,000 in 2007 to 372,000 in 2016, and opioid overdoses rose nearly sevenfold — from 43 in 2008 to 280 in 2017. In the first half of 2018 alone, 215 overdoses were recorded. Fentanyl use, although on the rise, does not play an important role in the Dutch drug scene. The growing problem has not yet resulted in an orchestrated response from the Ministry of Health.

• Netherlands Country Drug Report 2018
• NVIC Jaaroverzicht 2017: Toename van Vergiftigingen met Pijnstillers
• Stijgend gebruik oxycodon leidt tot meer vergiftigingen

The Dutch health insurance company Menzis, one of the four largest insurance companies operating in the Netherlands, has decided to move away from fee-for-service for selected behavioral health conditions. Starting in 2019, it will no longer pay providers for depression and anxiety lasting less than one year, based on the number of treatment sessions. Instead, remuneration will depend on the level of improvement in symptoms and quality of life of the patient as indicated by patient questionnaires and other data sources. The Dutch Association of Psychiatrists disagreed with the move, arguing that the recovery path for behavioral health is highly unpredictable and not necessarily linked to treatment.

• Menzis vergoedt depressiebehandeling op basis van resultaat
• Menzis: ‘Vergoeding depressies resultaatgericht’

Correspondent: Marianne Storm

The Patient Rights Act of 2001 states that patients have a right to receive information about their own health condition and the health services that are provided. If patients experience a serious adverse event, they must be informed of the event, their right to seek compensation from the Norwegian System of Patient Injury Compensation, and their right to contact the Patient and User Ombudsman to request a legal inquiry. Since July 2018, Norwegian health and care providers are legally mandated to offer a meeting with patients or their relatives after a serious adverse event has caused injury or complications. The meeting must take place within 10 days of the incident. The primary goal is to ensure transparency and offer the patient or relative an opportunity to ask questions and hold the provider accountable.

• Plikter å møte pasienter, brukere og pårørende etter svært alvorlige hendelser

Correspondent: Marianne Storm

An intensive treatment protocol for treating psychiatric disorders, developed in Norway, has increased in popularity among therapists in the United States. Professors from Bergen developed an intensive four-day treatment protocol for obsessive-compulsive disorder, panic disorder, and social anxiety disorder. The protocol involves patients actively approaching fearful situations with their therapist and avoiding behavior that would alleviate their anxiety. In Norway, more than 700 patients have been treated with the protocol, with 90 percent of participants experiencing significant recovery. What’s more, the majority of patients remain symptom-free for up to four years. Last year, the researchers received a NOK 20 million (USD 2.3 million) research grant to study the application of the four-day protocol to other types of anxiety disorders.

• Norsk ekspressbehandling mot angst inspirerer i USA
• With Short, Intense Sessions, Some Patients Finish Therapy in Just Weeks

Correspondent: Jennifer Moore

A new initiative by the New Zealand Health Quality and Safety Commission, “Connecting Care,” aims to improve transitions between health and social care for patients with behavioral health conditions. In August, teams of providers from New Zealand’s 20 district health boards, nongovernmental organizations (NGOs), and primary care providers began partnering with patients and their families to identify pathways that would improve transitions. The project focuses on transitions from specialist services to community teams, from specialist care to primary care or NGO services, and from youth to adult services. The initiative is the second national project introduced under a five-year mental health and addiction quality improvement program.

• Pito kōrero me ngā pānui Mental Health & Addiction Quality Improvement

Correspondent: Jennifer Moore

A new report summarizing findings from the 2006 to 2016 New Zealand Health, Work and Retirement Longitudinal Study was released in August. The report showed that in 2016, two-thirds of adults age 55 and older enjoyed good physical, mental, and social health. Approximately one in five were caregivers, and these individuals were more likely to be in poorer health. The study also indicated that older adults who rent their home are at greater risk of mental health deterioration than older adults who are homeowners, and the gap in mental health outcomes between these two groups has increased over time. The study was carried out using six biennial surveys and was led by the Health and Ageing Research Team at Massey University.

• Most NZers Enjoy Good Health as They Age: Report

Country Correspondent: Ulrika Winblad

Dental services are only partly subsidized by the Swedish state and are often very expensive to access. To address this, the Swedish government recently commissioned the Dental and Pharmaceutical Benefits Agency (TLV) to develop a comparative website for dental care prices. TLV is working with several national agencies, as well as private and public organizations, as part of the project. The website aims to be an objective, nondiscriminatory, noncommercial, and competition-neutral platform that will allow individuals to compare prices among different dental providers. Participation is mandatory for any dental care provider that receives public funding. The website will, according to the government, contribute to increased competition among providers.

• Snart kan du jämföra priset för att gå till tandläkaren

Correspondent:  Ulrika Winblad

Provider compliance with the so-called coordination law adopted by the Swedish Parliament in 2018 has so far been inconsistent. The law stipulates that a “coordinating care plan” must be arranged for patients with health and social care needs. The Swedish government has now put in place financial incentives to encourage adherence to the law. SEK 10 million (USD 1.1 million) has been awarded to the Swedish Association of Local Authorities and Regions to facilitate implementation among providers. The additional funding will be used to develop a quality registry on care coordination for the elderly and to disseminate information on how to design coordinating care plans.

• Insatser för äldre med demenssjukdom och multisjuka äldre

Country Correspondent:  Lars Hemkens

The Electronic Patient Dossier (EPD) is a personal health record that collates treatment-related documents, including information on prescriptions, vaccinations, and hospital discharge reports. In August, the University Hospital in Basel was the first in the German-speaking part of the country to open its first EPD. Starting in 2020, all hospitals in Switzerland will be required to offer EPDs to their patients. Information on patient visits and treatments can be registered in the EPD only by approved health care providers and patients themselves. Patients must grant each provider access to their EPD, at one of three access levels.

• Basel-Stadt startet mit den ersten elektronischen Patientendossiers in der Deutschschweiz
• Basel eröffnet erste elektronische Patientendossiers der Deutschschweiz

The Swiss Federal Council aims to adapt current regulations on cannabis use to better address opportunities and risks. The council aims to facilitate access to medicinal cannabis for patients in need — for example, in palliative care situations — and intends to reduce barriers to further research on recreational use.

• Erleichterter Zugang zu Medizinalcannabis und Studien zum Freizeitkonsum

Matt Hancock has replaced Jeremy Hunt as Secretary of Health and Social Care. The previous culture secretary took on the role following Hunt’s move to the Foreign Office. Hancock has pledged to accelerate digital transformation within the National Health Service (NHS). Acknowledging his passion for technology, Hancock believes that more strategic and prolific use of health technology will enable the NHS to deliver more timely care that is better tailored to patients’ needs.

• Tech an Early Priority for Health Secretary

Launched in 2004, the National Health Service (NHS) Quality and Outcomes Framework (QOF) is one of the world’s longest-running and most extensive pay-for-performance reimbursement mechanisms. As part of the 2017–18 contract negotiations with the General Practitioners Committee of the British Medical Association, a review was agreed upon and included in a report titled Next Steps on the NHS Five Year Forward View. The report states that while the QOF’s impact on patient outcomes has been limited, there have been many gains in the organization of long-term care management and the development of the data infrastructure across primary care. The review identifies ways in which the QOF program needs to evolve to provide more holistic patient-centered care to meet the needs of increasingly complex patients and primary care physicians going forward.

• Report of the Review of the Quality and Outcomes Framework in England

Editorial Team

Roosa Tikkanen, Editor

Aisha Gomez, Project Manager

Molly FitzGerald, Coeditor

Country Correspondents

Australia — Sonĵ Hall

Canada — Danielle Rodin

France — Paul Dourgnon

Germany — Michael Laxy

Netherlands — Marthe Haverkamp

New Zealand — Jennifer Moore

Norway — Marianne Storm

Sweden — Ulrika Winblad

Switzerland — Lars Hemkens

United Kingdom — Partha Das

Editor: Roosa Tikkanen

Co-editor: Molly Fitzgerald

Project manager: Aisha Gomez

Country Correspondents: Sonĵ Hall (Australia), Danielle Rodin (Canada), Paul Dourgnon (France), Michael Laxy (Germany), Marthe Haverkamp (Netherlands), Marianne Storm (Norway), Lars Hemkens (Switzerland), Jennifer Schulz Moore (New Zealand), Partha Das (United Kingdom), Roosa Tikkanen (Europe/International