25/06/14 - Strengthening primary health care and prevention programmes would help stem the growing tide of diabetes and other chronic health conditions in the Czech Republic, according to a new OECD report.
The OECD Health Care Quality Review of Czech Republic says the country is the only one in the OECD in which reported smoking rates are rising. Daily adult tobacco consumption increased by 5% between 2000 and 2011, compared to an OECD average reduction of 21% in that period.
The prevalence of diabetes is about 8% in the Czech Republic, higher than the OECD average of 6.9%. Rates of adult obesity rose from 14% in 2000 to 21% in 2011, and are higher than the OECD average of 17.2%. A troubling picture also emerges for self-reported overweight or obesity among Czech 15-year-olds, which increased from 9% to 15%.
The Czech Republic also has some of the worst mortality figures for heart disease (IHD) and stroke (cerebrovascular accident or CVA). Death rates from heart disease are 260.4 per 100,000 population – more than double the OECD average of 115.2. For stroke, the rate is 106.4 per 100,000 population, compared to an OECD average of 69.1.
There has also been some good progress. The Czech Republic has more than halved its rate of case fatality after a heart attack, from 15.7% in 2001 to 6.8% in 2011. This is one of the steepest declines in the OECD. The prevalence of chronic heart disease among type 2 diabetes patients has fallen, from 40% in 2001 to below 30% in 2008. The country also has lower hospital admission rates for asthma and chronic obstructive pulmonary disease than the OECD average.
Acting Head of the OECD Health Division, Francesca Colombo, said the extent of chronic disease was a worrying trend. “The fact that obesity rates are higher than the OECD average and growing is very alarming,” she said. “The Czech Republic needs to renew its focus on programmes that prevent disease. More attention also needs to be directed to early detection, so that people can receive treatment early. These measures not only make people healthier, they can save lives and avoid high cost trajectories.”
Ms Colombo said one strategy could include giving GPs incentives to play a leading role in managing complex diabetes patients.
The Czech Republic also needs to engage more people in cancer screening. Just over half of women aged 20-69 participate in cervical screening, compared to the OECD average of 59.6%. The incidence of cervical cancer has been stable at 1,000 new cancers per year, suggesting a need to improve screening participation.
The Czech Republic has initiated screening of blood pressure, cholesterol and other cardiovascular risk factors. But the cost-effectiveness of this programme needs to be evaluated.
The report also says that the current system of one-time mandatory hospital accreditation places the quality and safety of the health system at risk. The Czech Republic should continuously monitor hospitals to give them incentives to meet high standards. All health services should participate in a national reporting system for adverse events, but only 20% of hospitals currently do.
A barrier to improving quality is the nation’s weak data collection system. A more sophisticated method of data collection would enable the health system to be measured more transparently, and help policy-makers identify system shortcomings to improve quality of care.
The OECD report also recommends:
Establishing a national patient register for type 2 diabetes, and continuing to strengthen existing type 1 and gestational diabetes registers;
Encouraging the routine use of electronic health records in both primary and hospital settings;
Clarifying the roles and responsibilities of the Ministry of Health, regional governments, health insurance funds and other stakeholders;
Ensuring patient organisations have an independent voice and contribute to health service reform and quality monitoring.
OECD Reviews of Health Care Quality examine what works and what doesn’t in countries, benchmarking their efforts and providing advice on reforms to improve quality of health care. The country reviews will be followed by a final summary report on the lessons and good practices relevant to all governments.