Association for Public Policy Analysis & Management

Deloitte UK’s Centre for Health Solutions is regularly asked to explain the differences
in health systems across Europe, and to suggest which country provides the best care.
A simple enough question perhaps, but there is no simple answer.

Health systems have complex multiple goals and vary considerably in performance.
Comparative performance measurements, benchmarking (including performance
rankings) and research studies by national and international research organisations
often present very different results. Our proposition is that there is no such thing
as the perfect health system. Although a few countries feature consistently as top
performers, there are examples of good performance in most countries that can
provide lessons for all health systems.

The financial crisis at the end of the last decade, the subsequent sustained pressure on public funding and ever increasing demand for services, mean governments throughout Europe are seeking to restrict the rise in healthcare costs and simultaneously improve the quality of care provided – a difficult challenge. Health systems have traditionally been slow to adopt evidence-based innovation, but this is now changing at an accelerated pace, driven by the need to respond to financial and operational challenges and in recognition of the benefits of adopting scientific and technological advancements.

Key drivers of change include the need for effective integration of health and social care services across care settings. This is increasingly becoming a shared vision of European payers, evidenced by new models of care delivery and an emphasis on value-based payment models. There is also a renewed emphasis on improving prevention and well-being, while optimising treatment and paying only for those treatments that work. These new models aim to shift the focus from the number of services and health interventions provided to the value they provide. The problem is in agreeing the definition of ‘value’ and ‘good outcomes’, and in determining what evidence on performance is
required. Consistently achieving good performance at an acceptable cost requires efforts to increase standardisation, reduce variation and eliminate waste.

We have designed this report to provide a framework for improving a country’s health system. We concentrate on a cohort of six European countries with relatively mature health systems (Denmark, France, Germany, the Netherlands, Spain and the UK). We draw on an extensive body of published literature and data from international benchmarking reports to explore performance through the lens of seven ‘Vital Signs’. For each vital sign we identify why its important and what good performance might look like. We support our assessment with key performance metrics, good practice case examples and patient stories from our cohort countries.

Our intention is to provide an insight into current performance and identify levers to help countries, and all healthcare stakeholders within those countries, to deliver better health for the population, better experience and outcomes for patients, and better value for money from
healthcare spending.

We hope this report enables you to have a rich discussion and debate and to take action to deliver better healthcare.