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The Catalan Health System and the Institutionalization of Health
Promoting Practices
International Hospital Federation Symposium Parallel session
24th April 2014
Anna Riera [email protected]
Contents • A brief explanation about how the Catalan Healthcare
system is organized.
• The chain of incentives that work through the system:
from health policy makers to clinical practice.
• How health promoting practices are incentivised,
guaranteed and evaluated all through the health system
• Some examples
Catalan Health System
HEALTH MINISTRY
PUBLIC
HEALTH
AGENCY
AGENCY
FOR
QUALITY
IN
HEALTH
CARE
CATALAN HEALTH SERVICE (Public insurance: provision)
LOSC
PUBLIC HEALTHCARE SERVICES NETWORK PROVIDERS (Services delivery)
PRIMARY CARE
ACUTE CARE/ ESPECIALIZED
CARE Hospitals
LONG TERM CARE
SERVICES
MENTAL HEALTHCARE
SERVICES
POPULATION 7.553.650
Public Healthcare Providers Network - SISCAT
Primary Care Services
Especialized Care
Services
Mental Healthcare
Services
Social Care and Long term
Care Services
Primary Care Teams (367)
Hospitals
(64)
Hospital day
facilities Home
hospitalization
Ambulatory out-patients and hospital care
(41)
Long and medium term
care (convalescence, palliative care)
(96) Hospital day
facilities Promotion Prevention
Continuing care Promotion Prevention Continuing care
HEALTHCARE SERVICES PORTFOLIO
Management logic (healthcare
organizations)
Public policies logic (Healthcare model and
public services)
HEALTH CARE DELIVERY SERVICES goals
(Healthcare system and healthcare providers
management)
• Resources management
• Efficiency • Sustainability • Results oriented • Contract objectives
Health System goals, Healthcare Model
(demand centred, guaranteed rights and
public resources)
• Public interest • Prioritize • Cost-efficiency
services criteria • Maximize public
benefit • Global Health
results
Professional Logic
(prevention, diagnosis, treatment, care)
CLINICAL GOALS (Clinical results and patients outcome)
• Technology • Clinical knowledge • Efficacy • Clinical outcomes • Patients health • Community practices
CHAIN OF INCENTIVES (different logics)
Health Plan
More health and better quality of life for all
Better quality, accessibility and safety in health interventions
A more solid and sustainable health system, changing practices
3 Main focuses
Health Objectives And programs
Change of the assistencial healthcare
model
Modernization of the organizational
model
1
2
3
Catalan public health system strategy
Health Plan
32 Projects
1. Objectives and health programs
2. Orientation to the chronically ill
3. Increase resolution from the first levels
4. High Quality in specialization
5. Focus on patient and their families
6. New contract and purchasing model (results oriented)
7. Professional knowledge commitment
8. Improving governance and participation
9. Information share and accountability. Evaluation
1
2
3
Health Plan
Catalan public health system strategy
Contract/ Provision
Healthcare
Purchasing Model:
Results-oriented
Evaluation Accountability
of the health system
Tools How?
Public policies What?
Primary Care Services
Especialized Care
Services
Mental Health Services
Social Care and Long term
Care Services
Service delivery Who?
Quality Outcomes
HEALTH MINISTRY CATALAN HEALTH SERVICE
PUBLIC HEALTHCARE SERVICES
NETWORK PROVIDERS
PUBLIC AGENCY FOR QUALITY IN
HEALTH CARE
Contract objectives
CATALAN HEALTH SERVICE
Health Plan
ACCREDITATION STANDARDS Health promotion practices: Primary Care Services are Responsible for health Promotion practices, focus on community, requested standards
HEALTH PLAN Public policy Prioritize of health outcomes and results desired
PUBLIC RESULTS SHARED Healthcare system results: accountability Benchmarking practices
How health promotion practices becomes a commitment
HEALTHCARE PROVIDERS OBJECTIVES Health service portfolio Purchasing incentives related to health policies Contract evaluation
ACCREDITATION (Standards)
HEALTH PLAN (Health system goals)
HEALTH OBJECTIVES (Contract objectives)
PUBLIC RESULTS SHARED (Indicators)
• Estudiar les característiques demogràfiques, epidemiològiques, socioeconòmiqes, culturals, etc., dels seus ciutadans, així com de la comunitat a la qual serveix.
• Disposar d’un diagnòstic de salut comunitari de la població. • Dissenyar les estratègies conforme al diagnòstic de salut comunitari i actuar conforme a l’estratègia definida. • Cobrir les necessitats dels grups d’interès (stakeholders) que l’afecten. • Identificar els factors clau d’èxit per cada grup d’interès i monitorar-ne el grau de compliment.
• D’aquí al 2020 augmentar en un 5% la proporció de l'esperança de vida en bona qualitat. • Reduir la prevalença de tabaquisme per sota del 28%. • Promoure la salut i reduir la freqüència de les malalties cròniques amb la implementació
d’intervencions cost-efectives alineades amb les prioritats de salut i que arribin a un 15% de la població.
• Monitorar anualment la proporció de pacients de 35 a 74 a atesos a l’AP amb xifres de colesterolèmia >200 mg/dl amb valoració de risc cardiovascular.
• Estendre el programa del pacient expert.
• Assolir un determinat percentatge mínim de: − Pacients de 15 a 69 a que realitzin activitats físiques saludables. − Pacients fumadors que hagin adquirit la condició d'ex fumadors al llarg de l’any. − Població entre 6 i 14 a amb avaluació del sobrepès i l’obesitat. − Nens de 5 anys vacunats amb la triple vírica. − Població de 60 anys o més vacunada contra la grip estacional. − Pacients de 15 a o més amb cribratge de consum d’alcohol.
• Taxa i percentatge d’hospitalitzacions evitables totals. • Percentatge de pacients polimedicats. • Taxa d’urgències hospitalàries. • Índex estandarditzat d’hospitalitzacions per MPOC. • Percentatge de pacients consumidors d’antiulcerosos sense justificació farmacològica. • Percentatge de pacients amb diagnòstic de lumbàlgia a qui s’ha realitzat una prova d’imatge lumbar en les primeres 6 setmanes posteriors al
diagnòstic.
EXAMPLES
INDICATORS/OBJECTIVES
SOME CONSIDERATIONS
• There must be alignment of objectives from health policy-
makers to clinical practice.
• We have several tools to do that:
ü Public Health Services portfolio definition.
ü Establish healthcare system goals.
ü Accreditation.
ü Contract objectives, purchasing incentives.
ü Accountability (healthcare system results publicly shared).
• And closing the circle: improve practices adjusting again and
again our activity to reach those goals.
