New regional models to ensure the sustainability of healthcare

1
New regional models to ensure the sustainability
of healthcare

• Regions working for Sustainable Health Systems a
  shift towards preventive care

Brussels, 7 October 2008
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The Spanish National Healthcare System

• Funded by taxes
• Decentralized to regional autonomies
• Universal coverage
• Free access
• Very wide range of publicly funded services
• Copayment for pharmaceutical products
• Services provided mainly in public facilities
• Sustainability and funding system under discussion

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Health system decentralization
Central Government
Basic legislation and coordination Financing Minim
um package funded through the NHS Pharmaceutical
policy International health policy Educational
requirements
Autonomous Government
Subsidiary legislation Public health Systems
organizational structure Accreditation and
planning Purchasing and service provision
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Socio-demographic characteristics
Autonomous Community Area 32.106,5
km2 Population (2008) 7,503,118 inhabitants
Life expectancy (2005) 80.6 years Birth rate
(2006) 11.7 births per 1,000 inhabitants Gross
mortality rate (2005) 8.9 deaths per 1,000
inhabitants Infant mortality (2005)
2.87 GDP/Capita (PPP 2006) US 34,645

Tourism (2006) 29,830,000 visitors

• Employment by sectors
• Services 59.4
• Industry 28.8
• Construction 8.3
• Agriculture 3.5

High urban concentration Own language and culture
Source IDESCAT
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The Public Health Reform (PHR)
Public health (including occupational health,
environmental health, and food safety)
A priority (Tinell Agreement)
Promotion, prevention and protection, through
surveillance, monitoring and research
Individual and collective policies and
contributions
Public Health Agency of Catalonia one-stop
service (finestreta única)
A new executive organization focused on
territory
With town councils and other local entities With
citizens With professionals
Related to HLG Community health Change
management
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Rationale I

• Public health a main topic for the healthcare
  system
• International context (globalization, European
  framework, alerts and crisis, etc.).
• New concepts (the new PH, social and
  environmental factors of health and equity the
  community-based approach).
• Social demand for confidence and security
  (administrations, citizens, enterprises, and the
  media).
• Individual and collective policies and benefits
• Ley de Cohesión y Calidad del SNS (Law on
  Cohesion and Quality of the NHS) (article 11 PH
  benefits).
• Definition of the benefits catalogue for PH (to
  be developed by Autonomous Communities)
• Service portfolio
• Laws on health protection and food safety

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Rationale II

• Organizational reform executive capacity,
  continuity and proximity
• Separation of regulatory function from planning
  function (MH-DGPH) of services provision (ASPCAT)
• Agency model (based on health protection and food
  safety agencies), with its own legal personality
• Deconcentration and decentralization
• Relation to health territorial governments
• Participation of local administrations
  (government and provision)
• Cooperation and coordination of public resources
  (Government of Catalonia, town councils, regional
  governments) one-stop service (finestreta única)
• Participation of trusted external suppliers
• Promotion of transversality and ongoing medical
  care (especially primary health care)
• Quality-oriented
• Renewal and transformation of managerial and
  technical human resources
• Key role information and communication
  technologies
• Relation to research and innovation

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The present model
The reformed model
Catalunya antecedents i situació actual (2)

• Anticipatory
• Resolutive
• Based on the best scientific evidence (or on the
  precautionary principle)
• Law enforcement
• Close to citizens and to territory
• Transparent in communication
• Generating
  
  confidence and
• safety!

• Fragmented and scattered
• Loss of leadership and initiative
• Conceptual and organizational inertia
• Bureaucratized provision of services and variable
  efficiency
• Little continuity / integration with the rest of
  the health system
• Territorial inequities in provision
• Low renewal, cohesion and technical coordination
• User frustration (territory local and regional
  entities)

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Why a public health agency?
Improvement in resolution capacity
Political / technical division
Defined product
AGENCY
Quantifiable Evaluable
Management autonomy
Quality increase
The PH Service Reform
Some of the essential functions of PH
Territorial equity
Health surveillance
Support for PH competences
Protection (health authority)
Promotion prevention
Relation to the MH - DGPH and the HLG
Rapid and efficient intervention capacity in risk
situations
Integration resources
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Health territorial governments
Sharing competence government between the
Government of Catalonia and Municipalities

• Objective To create a stable collaboration body
  between the Regional Government and
  Municipalities
• Legal status consortium
• Specific objectives

• Equity education of disparities
• Transversality of interventions
• Integration of care (from public to healthcare)
• Sustainability
• Response to demographic challenges
• Participation
• Transparency
• Increase subsidization

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Health territorial governments and public health
teams

• A decentralized agency
• Relation to health territorial governments and
  local suppliers

Sectorial team of PH () (multidisciplinary and
polyvalent)
HLG The Government Provision
Government of Catalonia
Regional Director PH
Local entities
() in collaboration with municipal technicians
Hospitals Mental h. Social AP
health services
PHT
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New regional models to ensure the sustainability
of healthcare

• Regions working for Sustainable Health Systems a
  shift towards preventive care

Brussels, 7 October 2008