Rt 1 The different dimensions of universal coverage and access to care
-
Upload
health-and-labour -
Category
Health & Medicine
-
view
528 -
download
4
Transcript of Rt 1 The different dimensions of universal coverage and access to care
![Page 1: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/1.jpg)
Prof. Dr. J. De Maeseneer, MD, PhD, FRCGP (Hon)
Department of Family Medicine and PHC- Ghent University, Belgium
General Practitioner (part-time), Community Health Centre ,
Ledeberg-Ghent (Belgium)
Chairman European Forum for Primary Care
Secretary-General The network Towards Unity for Health
Director International Centre for PHC and FM – Ghent University, Belgium
WHO-Collaborating Centre on PHC
Prof. Dr. S. Willems, MA, PhD
The Hague, 30.11.2011
The different dimensions of universal
coverage and access to care
![Page 2: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/2.jpg)
1. The basics
2. Social determinants of Health, universal coverage
and access to care
3. The new challenge: inequity by disease
The different dimensions of universal coverage and
access to care
![Page 3: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/3.jpg)
![Page 4: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/4.jpg)
![Page 5: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/5.jpg)
![Page 6: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/6.jpg)
![Page 7: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/7.jpg)
![Page 8: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/8.jpg)
![Page 9: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/9.jpg)
1. The basics
2. Social determinants of Health, universal coverage
and access to care
3. The new challenge: inequity by disease
The different dimensions of universal coverage and
access to care
![Page 10: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/10.jpg)
![Page 11: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/11.jpg)
http://www.who.int/social_determinants/resources/csdh_media/primary_health_care_2007_en.pdf
![Page 12: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/12.jpg)
Healthy life expectancy in Belgium, 25 years, men
28,1
3842,6
45,9
20
25
30
35
40
45
50
55
basic secundary
school: 1st cycle
secundary
school: 2nd
cycle
university/higher
education
Socio-economic inequalities in health
Healthy life expectancy in Belgium
(Bossuyt, et al. Public Health 2004)
![Page 13: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/13.jpg)
![Page 14: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/14.jpg)
![Page 15: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/15.jpg)
Sara Willems – 14/12/2005
vzw De Keeting,
Mechelen
vzw De Willers, Willebroek
![Page 16: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/16.jpg)
Sara Willems – 14/12/2005
![Page 17: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/17.jpg)
Sara Willems – 14/12/2005
![Page 18: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/18.jpg)
Sara Willems – 14/12/2005
![Page 19: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/19.jpg)
Sara Willems – 14/12/2005
![Page 20: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/20.jpg)
Sara Willems – 14/12/2005
![Page 21: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/21.jpg)
Sara Willems – 14/12/2005
![Page 22: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/22.jpg)
Sara Willems – 14/12/2005
![Page 23: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/23.jpg)
Sara Willems – 14/12/2005
![Page 24: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/24.jpg)
Sara Willems – 14/12/2005
![Page 25: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/25.jpg)
Sara Willems – 14/12/2005
![Page 26: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/26.jpg)
Sara Willems – 14/12/2005
![Page 27: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/27.jpg)
The need for integrated care: health and welfare.
![Page 28: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/28.jpg)
![Page 29: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/29.jpg)
CSO
![Page 30: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/30.jpg)
CSO
![Page 31: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/31.jpg)
![Page 32: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/32.jpg)
COPC-example: dental problems: periodontal
disease
Risk factor for:
• Diabetes
• Coronary Heart Disease
• Preterm birth and low birth weight
• Osteoporosis
![Page 33: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/33.jpg)
Community Health Centre:
- Family Physicians; nurses;
dieticians; health promotors;
dentists; social workers; …
- 6000 patients; 60 nationalities
- Capitation; no co-payment
- COPC-strategy
![Page 34: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/34.jpg)
Identifying health problem:
Family physicians/nurses: problematic oral condition
of todlers, leading to feeding problems, crying, not
sleeping,...
COPC-project : from individual care
to community health care
![Page 35: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/35.jpg)
A dentist?
I cannot afford that.
I don’t know where
to find a dentist
Focus Group sessions –
involving the community
I’m doing Fristi in his
bottle to stop him cry
My child is to afraid of
the dentist and to be
honest, me too
COPC-project : DENTAL FITNESS
![Page 36: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/36.jpg)
Working together with…
COPC-project : DENTAL FITNESS
![Page 37: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/37.jpg)
Results research children 30 months
old:
• 18,5 % early symptoms of childhood
caries (7,4 % – 29,6 %)
• 100% need for treatment!
Correlation with
• deprivation
• nationality (Eastern-Europe)
• no previous dentist consultations
COPC-project : DENTAL FITNESS
![Page 38: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/38.jpg)
Childhood caries:
• Information and Sensibilisation
• Involving providers, social
workers, parents, schools…
Strategies:
Community oriented,
intersectoral, participation.
Educational platform for
students in dentistry
COPC-project : DENTAL FITNESS
![Page 39: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/39.jpg)
Accessible primary dental care
Centre for Primary Oral Health Care
Botermarkt Ledeberg (CEMOB)
Started 01/09/2006
Towards accessible oral
health care !
Ghent University
COPC-project : DENTAL FITNESS
![Page 40: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/40.jpg)
Integration of personal and community health care
The Lancet 2008;372:871-2
![Page 41: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/41.jpg)
“Towards Unity for Health”
www.the-networktufh.org
![Page 42: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/42.jpg)
Intersectoral action for health: the community
Ledeberg (8.700 inh.)
• Platform of stakeholders
• Implementing COPC-strategy, taking different
sectors on board
• Accessible, comprehensive, quality local health care
facility: a multidisciplinary Primary Health Care
Centre
![Page 43: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/43.jpg)
Platform of stakeholders:
• 40 to 50 people
• 3 monthly
• Exchange of information
• “Community diagnosis”
Intra-family violence
![Page 44: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/44.jpg)
![Page 45: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/45.jpg)
![Page 46: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/46.jpg)
1. The basics
2. Social determinants of Health, universal coverage
and access to care
3. The new challenge: inequity by disease
The different dimensions of universal coverage and
access to care
![Page 47: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/47.jpg)
Multimorbidity becomes the rule, not the
exception
• More than half of the patients with COPD have either
cardiovascular problems, or diabetes
• Patients with COPD have a 3- to 6-fold risk to have all
these problems
• 50 % of 65+ have at least 3 chronic conditions
• 20 % of 65+ have at least 5 chronic conditions
(Eur Respir J 2008;32:962-69)
(Anderson 2003)
![Page 48: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/48.jpg)
The challenge: vertical disease- oriented
programs and multimorbidity
• Create duplication
• Lead to inefficient facility utilization
• May lead to gaps in patients with multiple co-
morbidities
• Lead to inequity between patients
![Page 49: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/49.jpg)
• In many countries, specific access to services is
conditioned by the diagnosis of the patient. This may
lead to a new kind of "inequity", the "inequity by
disease".
• It is worthwhile studying what is the actual presentation
of this phenomenon, and what could be done to handle
it appropriately. How will market forces and
commercialisation play a role in this development?
The need for a shift in chronic care: from "Chronic
Disease Management" to "Participatory Patient
Management".
![Page 50: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/50.jpg)
“Inequity by disease” becomes an
increasing problem both in developed
and developing countries
[ see www.15by2015.org ]
![Page 51: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/51.jpg)
![Page 52: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/52.jpg)
![Page 54: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/54.jpg)
The Future of Primary Health
Care in Europe IV Welcome to Gothenburg, Sweden
September 3-4, 2012
![Page 55: Rt 1 The different dimensions of universal coverage and access to care](https://reader033.fdocuments.us/reader033/viewer/2022051709/587c31761a28aba0118b69bd/html5/thumbnails/55.jpg)