Health Systems and the Challenge of Chronic Disease— Through the Lens of Breast Cancer

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    Ebnacak Okrab LgkunHkrvkrf Mni`kn Bquaty AgataktavbHkrvkrf Obfackn SchiinMni`kn Vksl Eircb ig Bxpkgfbf Kccbss ti Ckgcbr Ckrb kgf CigtrinObxackg Hbknth Eiugfktaig

    Voktbni k TbchiRgaig eir Agtbrgktaigkn Ckgcbr Cigtrin

    Okrch 01, 04;6

    Hbknth Systbos kgf thbChknnbgmb ie Chrigac Fasbksb

    Vhriumh thb Nbgs ie @rbkst Ckgcbr

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    Erio kgbcfitb

    ti bvafbgcb

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    Jkgukry, 0448

    Jugb, 044=

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    ti bvafbgcb

    Erio kgbcfitb

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    MVE.CCC ?

    mni`kn hbknth +

    ckgcbr ckrb

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    Chknnbgmb kgf fasprivb thboyths k`iut ckgcbr

    O;. Rggbcbsskry

    O0. Rgkeeirfk`nb O3. AgkppripraktbO6: Aopissa`nb

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    Ckgcbr as k fasbksb ie `ith rach kgf piir< ybt at asagcrbksagmny thb piir whi sueebr:

    ;. Bxpisurb ti rasl ekctirs 0. Trbvbgtk`nb ckgcbrs (agebctaig)

    3. Fbkth kgf fask`anaty erio trbktk`nbckgcbr

    6. Stamok kgf fascraoagktaig

    2. Kviafk`nb pkag kgf sueebragm

    Vhb Ckgcbr Favafb: Kg Bquaty Aopbrktavb

    E k c b t s

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    Nbulkboak

    Knn ckgcbrs

    Siurcb: Lgkun, Krrbink, Obgfbz. bstaoktbs `ksbf ig AKPC, Mni`ickg, 04;4.

    ;44%

    @rbkst

    Cbrvax

    Vbstas

    Tristktb

    Gig-hiflags

    Hiflags

    Vyriaf

    Chagk

    ;44%

    Chagk

    Obxaci

    Ckgkfk

    Obxaci

    Ckgkfk

    Vhb Ippirtugaty ti Survavb (O/A) ShiunfGit @b Fbeagbf `y Agciob

    Chanfrbg

    Siurcb: Lgkun, Krrbink, Obgfbz. bstaoktbs `ksbf ig AKPC, Mni`ickg, 04;4.

    NI]

    AGCIO

    HAMH

    AGCIOB

    NI]

    AGCIO

    HAMH

    AGCIOB

    Ag Ckgkfk, knoist 14% ie chanfrbg wath nbulboak survavb.Ag thb piirbst ciugtrabs igny ;4% survavb.

    14% ;4%

    hb `k k f fb

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    Nktag Kobrack

    Kerack

    Chagk :;,0=5

    Vhb Mni`kn Tkag favafb

    Obxaci :0,344

    0=0,444 om

    05=,444 om3=,444 om

    Gig-obthkfigb, Oirphagb Bquavknbgt ipaiafcigsuoptaig pbr fbkth erio HAU ir ckgcbr agpkag

    :Tiirbst ;4% ;4% : 26 om

    Pachbst ;4% ;4% : 1=,644 omRS/Ckgkfk : 0=4,444 om

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    Vhb i i k i k b h b

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    Vhb cists i ag kct ig krb humb:Si wb oust Agvbst A G kctaig

    Vi`kcci as k humb bcigioac rasl: 3.5% niwbr MFT3.5

    Vitkn bcigioac cist ie ckgcbr, 04;4: 0-6% ie mni`kn MFT0 6 MFT

    Trbvbgtaig kgf trbktobgt ieebr pitbgtakn wirnf skvagms ie$ RS ;34-164 `annaig

    ;344 1644

    kviafk`nb ckgcbr fbkths: ;/3-;/0, 0.6-3.= oannaig< 84% NAOCs;/3-;/0 064

    3=4 84%

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    Vhb cists ti cnisb thb ckgcbr favafboky `b nbss thkg okgy ebkr:

    Tkag obfacktaig as chbkp

    Tracbs frip: Hbp@ kgf HTU vkccagbs Fbnavbry & eagkgcagm pnkteiros & aggivktaigs krbugfbrutanazbf kgf ugfbvbnipbf

    Turchksagm as erkmobgtbf, pricurbobgt as ugstk`nb

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    Chknnbgmb kgf fasprivb thboyths k`iut ckgcbr

    O;. Rggbcbsskry

    O0. Rgkeeirfk`nbO3. Agkppripraktb

    O6: Aopissa`nb

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    ]iobg kgf oithbrs ag NOACsekcb okgy rasls thriumh thb naeb cycnb

    ]iobg ;2-21, kggukn fbkths ;2-21

    Fak`btbs

    ;04,881

    @rbkstckgcbr

    ;55,2==

    Siurcb: Bstaoktbs ksbf ig fktk erio ]HI: Mni`kn Hbknth I`sbrvktiry, 0448 kgf Ourrky bt kn Nkgcbt 04;;.

    Cbrvacknckgcbr

    ;60,=66

    Oirtknatyag

    chanf`arth

    360,144

    -32% ag34 ybkr

    34

    32%

    ? 634, 0;4 fbkths

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    Eknsb fachitioabs chknnbgmb Rgavbrskn HbknthCivbrkmb (RHC)

    Cioougack`nb ir agebctaigkssicaktbf

    GCF

    Chrigac

    HAU/KAFs (LS) @rbkst ckgcbr

    Kcutb

    Fakrrhbks

    Pbsparktiry agebctaig

    KOA

    Agekgt Nbulkboak

    Fasbksb: y chr igacaty kgf agebctaig

    Cbrvackn Ckgcbr H TU) N igm tbro fask`anaty pist age bctaig (pina i)

    Chr igac w kcutb bpasifbs: Ksthok, obgtkn

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    Hbknth SystboEugctaigs

    Stkmb ie Chrigac Fasbksb Naeb Cycnb /ciopigbgts CCC

    TraokryTrbvbgtaig

    Sbcigfkryprbvbgtaig

    Fakmgisas

    Vrbktobgt

    Survavirshap/Pbhk`anatktaig

    /

    Tknnaktaig/Bgf-ie-naeb ckrb

    /

    Stbwkrfshap

    Eagkgcagm

    Fbnavbry

    PbsiurcbMbgbrktaig

    Pbspigfagm ti thb chknnbgmb ie chrigacaty:Hbknth systbo eugctaigs `y ckrb cigtaguuo

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    K rbspigsb ti chrigac anngbss rbquarbs kg kpprikchthkt agtbmrktbs agtbrvbgtaigs knigm thb cigtaguuo ie

    fasbksb kgf naeb cycnb

    ;. Traokry prbvbgtaig

    0. Sbcigfkry prbvbgcag (bkrny fbtbctaig) ( )

    3. Fakmgisas 6. Vrbktobgt

    2. Survavirshap

    5. Tknnaktavb ckrb

    BRHC ?Beebctavb Civbrkmb + Beebctavb Eagkgcakn Tritbctaig

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    Fakmigknazagm Ckgcbr Ckrb:Eagkgcagm & Fbnavbry

    & ;. Eagkgcagm: Agtbmrktb ckgcbr ckrb agti gktaigkn

    agsurkgcb kgf sicakn sbcuraty primrkos

    Obxaci , Chagk , Agfak 0. Fbnavbry: Hkrgbss pnkteiros `y agtbmrktagm

    `rbkst kgf cbrvackn ckgcbr prbvbgtaig, scrbbgagm

    kgf survavirshap ckrb agti OCH, SPH,HAU/KAFS, sicakn wbnekrb kgf kgta-pivbrty primrkos.

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    O;. Rggbcbsskry

    O0. Rgkeeirfk`nbO3. Agkppripraktb

    O6: Aopissa`nb

    Chknnbgmb kgf fasprivb thboyths k`iut ckgcbr

    0443 Ob i Pb i

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    0443 Obxaci PbeiroLby Eagkgcagm Bnbobgts:

    ;. Kccbss ti pu`nacny-eugfbf, hbkvany su`safazbf, primrbssavb

    hbknth agsurkgcb Sbmuri Tipunkr - eir knn ekoanabs bxcnufbferio Sicakn Sbcuraty

    -

    0. Sbpkrktb `ufmbtagm kgf eugfs eir pu`nac hbknth miifs wathugavbrskn civbrkmb

    3. Tkclkmb ie pbrsigkn hbknth sbrvacbs `ksbf ig cist-

    beebctavbgbss kgf `urfbg ie fasbksb bxpkgfs ivbr taob

    6. Eugf eir cktkstriphac anngbss civbragm spbcaeac agtbrvbgtaigseir spbcaeac fasbksbs bxpkgfs ivbr taob

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    Obxaci 0443 Hbknth rbeiro crbktbf Sbmur i Tipunkr 0443

    Hirazigtkn Civbrkmb:

    @bgbeacakrabs

    U b r t a c k

    n C i v b r k m b

    F a s b k s b s k g

    f A g t b r v b g

    t a i g s :

    @ b g b

    e a t s T k c

    l k m b

    Keeanaktaig : 0446: 5.2 o 524 04;0: 26.5 o 2654

    @bgbeat pkclkmb:

    0446: ;;3

    04;0: 086+2=

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    Kccbnbrktbf, ugavbrskn, vbrtackn civbrkmb `y fasbksbwath kg beebctavb pkclkmb ie agtbrvbgtaigs

    0446/5: HAU/KAFS, cbrvackn ckgcbr, KNN agchanfrbg

    044=: Knn pbfaktrac ckgcbrs< @rbkst ckgcbr 04;;: Vbstacunkr kgf Tristktb ckgcbr kgf GHN

    04;0: Ivkrakg (cinirbctkn) ckgcbr

    Obxaci Sbmuri Tipunkr : fakmigkn, eagkgcakn pritbctaig eir cktkstriphac anngbss

    Sb i Ti k kgf kg b

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    Sbmuri Tipunkr kgf ckgcbr:Bvafbgcb ie aopkct

    @rbkst ckgcbr kfhbrbgcb ti trbktobgt :

    0442: 044/54404;4: ;4/144

    Sagcb thb agcirpirktaig ie chanfhiifckgcbrs agti thb Sbmuri Tipunkr

    34-oigth survavkn: 34% ti knoist =4% 3434% =4%kfhbrbgcb ti trbktobgt: =4% ti 12%.

    =4% 12%

    Vhb huokg ekcbs ie Sbmuri

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    Vhb huokg ekcbs ie SbmuriTipunkr: Muannbroagk Kvank

    &

    K`ash Piobi

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    % fakmgisbf ag Stkmb 6 `y stktb6 # 0 lannbr ie wiobg

    34-2634-26 0

    2-;4% fbtbctbf agStkmb 4-;

    2-;4% 4-;

    Tiir ougacapknatbs:

    24% Stkmb 6< 2x thbrktb eir rach 24%

    6

    @rbkst Ckgcbr: Fbnavbry ekanurb

    Tiir

    Pach

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    Beebctavb Rgavbrskn Hbknth Civbrkmb (BRHC )

    @bgbeacakrabs : @bmaggagm wath Uungbrk`nb mriups

    @bgbeats -thb pkclkmb : Bxpnacat: agtbrvbgtaigs, fasbksbs, hbknth cigfataigs

    Ciopnbtb: Cioougaty, pu`nac, pbrsigkn kgf cktkstriphac

    Cist-beebctavb: agcrbksagm ut git bxhukstavb Trikctavb: ti prioitb bquaty kgf ramhts Hamh quknaty

    Eagkgcakn pritbctaig

    A gtbmrktbf kccriss thb naeb cycnb

    B b t b gkg k i b k b i k

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    Beebctavb eagkgcakn civbrkmb ie kchrigac fasbksb: `rbkst ckgcbr

    Obxaci: Nkrmb kgf bxbopnkry agvbstobgt ag eagkgcakn pritbctaigeir ckgcbr prbvbgtaig kgf trbktobgt eir wiobg, ybt k niw survavknrktb. Ippirtugatabs ti aoprivb fbnavbry

    Ckgcbr Cigtrin-Ckrb cigtaguuo -

    TraokryTrbvbgtaig

    BkrnyFbtbctaig

    Fakmgisas

    Vrbktobgt

    Survavirshap

    Tknnaktaig

    Fbnavbry kgf eagkgcakn pritbctaig chknnbgmbs:

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    @ b g b e a

    t s : c i v b r b

    f a g t b r v b g

    t a i g s

    Fbnavbry kgf eagkgcakn pritbctaig chknnbgmbs:

    Sbmuri Tipunkr ag Obxaci

    KCCBNBPKVBF UBPVACKN CIUBPKMB eir Cktkstriphac Anngbssbsagcnufbf ag thb Eugf : `rbkst ckgcbr, KAFS

    Cioougaty kgf Tu`nac Hbknth Sbrvacbs

    Tiir Pach

    CHANFPBG: Hbknth agsurkgcb eir k Gbw Mbgbrktaig

    Tkclkmb ie bssbgtakn pbrsigknsbrvacbs

    @bgbeacakrabs

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    Jukgatk:Kfvkgcbf obtkstktac `rbkst ckgcbr fub

    ti oassbf ippirtugatabs

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    Agcnufagm cbrvackn kgf `rbkst ckgcbr kwkrbgbss eirbkrny fbtbctaig ag Ipirtugafkfbs

    Ipirtugafkfbs

    Muk fb irabgtkcag yckpkcatkcag k tatunkrbs`bgbeacakrais fbn primrkokIpirtugafkfbs agcnufbsageiroktaig ig `rbkst ckgcbr ks ie0441/;4 0441 ;4

    ;.2 oannaig cipabs ti prioitbr

    ;24 Pbkchbs 2.8 oannaig ekoanabs ?

    oirb thkg 14% ie piir hiusbhinfs28414%

    Fakmigknazagm Fbnavbry:

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    Fakmigknazagm Fbnavbry:

    Vrkagagm praokry ckrb privafbrs ag bkrny fbtbctaig kgf

    okgmbobgt ie `rbkst ckgcbr Trioitbrs (+6444), Gursbs & OFs

    (+;644), obfackn stufbgts (+=24) Gubvi Nbig, Jknasci, Oirbnis, Tub`nkSamgaeackgt agcrbksb ag lgiwnbfmb, bspbcaknny ag C@B

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    @rbkst Ckgcbr Agataktavb:Bxpniragm k fakmigkn kpprikch ag Chagk

    Hkrvkrf Schiin ie Tu`nac Hbknth kgf Hkrvkrf Mni`kn BquatyAgataktavb krb cinnk`irktagm wath thb Knn-Chagk ]iobgs Ebfbrktaig kgf Gktaigkn Cbgtbr eir ]iobgs kgfChanfrbgs Hbknth ti cigfuct panit prijbcts kcriss saxciugtabs ag Chagk, bxpniragm kg bvafbgcb-`ksbf, fakmigknoifbn eir `rbkst ckgcbr bfucktaig kgf kwkrbgbss kt thbpraokry nbvbn ie ckrb kfkptagm kgf bxtbgfagm thb Obxacioifbn

    5

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    @b kgiptaoastiptaoknast