Departament de Salut Catalan healthcare system Catalan Health System Toni Dedeu, MD, PhD,MSc...

Departament de Salut

Catalan healthcare system

Catalan Health System

Toni Dedeu, MD, PhD,MSc

Director of International Affairs and Cooperation

Barcelona, 10th March 2011

Government of Catalonia Ministry of Health



Government of Catalonia Ministry

of Health

The Globe


Catalan healthcare systemSocio-demographic characteristics of Spain

17 Autonomous Communities

Area: 504,750 km² Population (2008)1: 46,745,807

Life expectancy (2007)2: 81.05 years

Birth rate (2007)3: 10.98

Gross Mortality rate (2007)4: 8.59

Infant mortality (2007)5: 3.7

GDP/Capita(2008)6: 94.4

(1) Municipal Registre 01/01/2009 INE /INS National Instite of Statistis

(2-5) INE / INS National Instite of Statistis

(6) Eurostat UE-15=100




Historical and political context

1. DECENTRALISATION OF THE STATE: 1981

• Transfer of responsibility for regional healthcare to the Catalan Autonomous Government

2. GENERAL HEALTHCARE ACT:1986 • National Healthcare System

• Universal coverage• A Taxation based financing system

Ministry of Health

Government of Catalonia


Catalan healthcare systemDevolution process to Autonomous Communities

1981

1984

1987

1987

19901990

1994

2001

2001

2001

20012001

2001

2001

20012001

2001

Ministry of Health



Catalan healthcare systemThe Spanish National Healthcare System

• Funded by taxes• Decentralized to autonomous communities• Universal coverage• Free access• Very wide range of publicly covered services• Co-payment in pharmaceutical products for outpatient

care• Interterritorial Board




Central Government

- Basic legislation and coordination- Financing- Minimum package funded through NHS- Pharmaceutical policy- International health policy- Educational requirements

AutonomousGovernment

- Subsidiary legislation- Public health - Organizational structure- Accreditation and planning- Purchasing and service provision

Health System Decentralization

Ministry of Health




C A T A L O N I A

Ministry of Health



Catalan healthcare systemC A T A L O N I AAutonomous CommunityArea: 32,106 km2

Population: 7,611,711 inhabitants*Life expectancy: 81.4 yearsBirth rate (2007):11.68/1,000 inhabitants Gross Mortality rate (2007):8.28/1,000 inh.Infant mortality: 2.7 /1,000 live birthsGDP/Capita(2008)1: 110.4

High urban concentrationOwn language and culture

Employment by sectors :• Services 65.42%• Industry 21.43%• Construction 11.40%• Agriculture 1.74%

Tourism(2008): 17,335,800 visitors

Source: IDESCAT•RCA 2009(1) UE-15=100



Catalan healthcare systemCatalan population


2008



Health & Social Trends in Catalonia: Chronic Diseases/Ageing / Caring and Dependency

Catalonia 2050: 45% total population aged 60

yr or morewww.idescat.cat/cat/poblacio/projeccions/




of Health

• Demographic transitionDemographic transition: : ageing population, decreasing ageing population, decreasing total fertility rates, immigrationtotal fertility rates, immigration

• Epidemiological transition – changing diseaseEpidemiological transition – changing disease profiles profiles to chronic diseases to chronic diseases

• Increasing patient expectations and medicalIncreasing patient expectations and medical litigation – litigation – need for evidence-based practiceneed for evidence-based practice

• Decreased information asymmetry andDecreased information asymmetry and increased increased consumer choicesconsumer choices

• Technology changesTechnology changes• Demand for cost-effective healthcare servicesDemand for cost-effective healthcare services

Trends




of Health

• Health Map 1984 .ResourcesHealth Map 1984 .Resources• Health Map 2008 Public Health and Social Health Map 2008 Public Health and Social

ServicesServices• Health Plan Health Plan • Master Plans Master Plans • Purchasing System. ContractsPurchasing System. Contracts• Central Results WarehouseCentral Results Warehouse• Quality Assurance AgencyQuality Assurance Agency• Innovation Plan for Primary Health and Innovation Plan for Primary Health and

Community CareCommunity Care• Public Health ActPublic Health Act

Getting ready



Providers

Catalan Healthcare System Primary Healthcare Providers

Catalan Public Health InsuranceCatSalut

Catalan Government

Ministry of Health

Financing

CatalanParliament

Planning

Commissioning and Buying

CATALAN HEALTH INSTITUTE - ICSHospitals Primary

CareMental Health Other

PC 1 PC2

Social-Health Care

Hospital Consortium 1

Hospital Consortium 2

Hospital Consortium

3

Mental Health 1

Mental Health 1

Ambulance Trust 1

Ambulance Trust 2

€€

14Other


Catalan healthcare systemCatalan Government Budget 2010 (39,699 B €)

Ministry of Health




Healthcare Budget by service range CatSalut/ICS 2010 9,779.81 € billion euros

Inpatient medication supplied out of

hospital6,32%

Rehabilitatin0,47%

Mental health care4,55%

Long term care4,85%

Hospital care 56,93%

Renal failure attention1,26%

Health care transportation and

emergencies4,14%

Oxygen therapy0,42%

Other specialized Attention0,40%

Primary Care20,66%


of Health


Catalan healthcare systemGeneral diagram of the Catalan Healthcare System

USER

USER

CATALAN HEALTH SERVICECatSalut

(CATALAN PUBLIC HEALTH

INSURANCE)100%

CATALAN HEALTH SERVICECatSalut

(CATALAN PUBLIC HEALTH

INSURANCE)100%

SUPLEMENTARYPRIVATE INSURERS

20%

SUPLEMENTARYPRIVATE INSURERS

20%

CATALAN HEALTH INSTITUTE

(ICS)20%

CATALAN HEALTH INSTITUTE

(ICS)20%

PRIVATE CENTRES10%

PRIVATE CENTRES10%

PublicServiceNetwork

PublicServiceNetwork

CONTRACTED PROVIDERS

70%

CONTRACTED PROVIDERS

70%

Insurance Services

Ministry of Health




Catalan Healthcare SystemCitizen’s Pathways. Gatekeeping based

CITIZENS

HOSPITALSH1 H2 H3

Social & Healthcare

Services

Mental Health Care




of Health

Chronic Care Expanded Model

Victoria Barr, Sylvia Robinson, Brenda Martin-Link, Lisa Underhill, Anita Drotts & Darlene Ravensdale (2002)Adapted from Glasgow, R., Orleans, C., Wagner E., Curry S., Solberg, L (2002) and the WHO -Ottawa Charter of Health Promotion (1986)

• Integration of health promotion into the prevention and management of chronic disease• Demonstrates clear associations between the health system and the community




of Health

Chronic Care Expanded Model


Catalan healthcare systemReform process evolutionReform process evolution

Process Starting point

“80”

Intermediate

Stage ”90”

Current

Stage “00”Base line Possibilism Structure and organization Capacity to assume new

demands

Knowledge level Data collect: Health map Acting globally on health:

General Health Care act

Acting on the territory

Action focus on Supply Supply Demand

Objectives To rationalize Quality assurance : Accreditation

Promote prevention

Care levels Primary Care reform Consolidation levels of care Continuity of care in an integrated health system

Services provision Introduction professional management

Coordination with providers Alliances among providers.

Management based on territory

Payment system Payment by length of stay

Global budget

Payment by procedures Payment by health objectives

Ministry of Health


• Building healthy public policyBuilding healthy public policy• Creating supportive environments Creating supportive environments • Strengthening community action



Catalan Healthcare System Primary Healthcare Team & Primary Healthcare

Ministry of Health



Catalan healthcare systemPrimary HealthcareResources / Population

• Resources of PHC per population:Resources of PHC per population:

1 family doctor per 1600-2000 inhab. >14 1 family doctor per 1600-2000 inhab. >14 yearsyears

1 pediatrician per 1500 children < 14 years1 pediatrician per 1500 children < 14 years 1 dentist per 11000 inhab.1 dentist per 11000 inhab. 1 nurse per MD1 nurse per MD 1 social worker1 social worker 1 support officer / 5000 inhab1 support officer / 5000 inhab.

Ministry of Health




Catalan Health System Primary Care: Scope of Services

Free choice of Practice and GP, Paediatrician and Nurse

Acute medicine (GP/P, N, Dentist)

Acute homecare (GP/P/N/SW/D)

Chronic Care (All the Team + Call Center + Nurse Liaison + Chronic Care (All the Team + Call Center + Nurse Liaison + Coordination + …Coordination + …

Promotion and Prevention of care (GP/P, N, D)

Homecare (SW, GP/P, N,D)

Minor surgery (GP)

Other techniques: anticoagulant control and treatment, spirometry, ultrasound, etc. (GP, N)

Vocational Training (GP, N)

Continuous Medical Education (All the Team)

Research (All the Team)

Community Care (All the Team + Community agents /Community Plans)


Catalan healthcare systemPrimary Health Care Centres

PHC PHC

Ministry of Health



Catalan healthcare systemPrimary Health Care Centres

PHC SortPHC in Barcelona city

Ministry of Health




The Catalan HealthcareNew perspectives





of Health

• Practice performance variation gap is shrinkingPractice performance variation gap is shrinking

Facts &Trends

FIGURA 10

Homecare programme

Primary Healthcare Teams in Barcelona area - 2008




of Health

Tools

• Quality Indicators / Performance Indicators Quality Indicators / Performance Indicators introduced in the payment system /Accountabilityintroduced in the payment system /Accountability

• 100% Electronic Record at Primary Healthcare100% Electronic Record at Primary Healthcare

• Shared Clinical Record HC3Shared Clinical Record HC3

• Clinical guidelinesClinical guidelines

• Multidisciplinary TeamsMultidisciplinary Teams• Nurses rolesNurses roles• Public Health ActPublic Health Act• Innovation Plan for Primary healthcare and Innovation Plan for Primary healthcare and

community carecommunity care




of Health

The Health Care in Catalonia

PC HPhysicianPatient

Encounter

DiagnosticTherapeuticProcedures

ComputerizedClinical guideline

PCISCCG

NursePatient

Encounter

DiagnosticTherapeuticProceduresCare plan

ComputerizedClinical pathway

PCISHomecare: PDA

Nurse Patient

Telephoniccommunication

MonitoringTherapeuticCare plan

ComputerizedMonitoring

PCISTelephone CC

Physician(Nurse)Patient

Encounter

DiagnosticTherapeuticProcedures

ComputerizedClinical guideline

HISCCG



35

INTEROPERABILITY

Catalan Shared Medical Record

TelemedicineMedical Image

Digitization Plan

Personal Health Folder

Electronic Prescribing

RESOURCES SHARINGNETWORKING MODEL

COLLABORATION MODELCO-RESPONSIBILITY

Key ICT Projects – Governing characteristics




of Health

Provision of Services: Challenges

FromFrom ToTo

Reactive Proactive

Disease-oriented Prevention-oriented

Acute interventions Chronic care interventions

Individual Multidisciplinary

Fragmented health services Continuum of care




of Health

Sustainability

• Universal coverage• Public financing of the services• Purchaser-Provider split• Citizen’s participation• Patient choice• Continuity of care• Integration and coordination




of Health

Equity

• Access • 68 hospital centers• Primary Healthcare centers• Socio-healthcare centers• Mental Health centers• Telemedicine• Call Center• Health Direct• Patient’s Folder• Internet


Catalan healthcare systemHealth & Social Trends in Catalonia: High Tech / Genomics / Telemedicine

Ministry of Health




GràciesThank you

Spacibo bolchoi

[email protected]


www.gencat.cat/salut/

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