Ingen diastitel

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INTERFACES IN HEALTH CARE PORTUGAL
Bom dia!!!
Good morning!!!
HOPE 2004 Presentation at Innsbrück, Austria
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Bom dia! Portugal
Contents

• A snapshot of Portugal
• A snapshot of history
• Primary Interfaces
• Interface management
• The management of challenges Creating new
  interfaces?

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Bom dia! Portugal
A snapshot of Portugal
AREA 92.389 Km2 POPULATION10,6
millions (including Azores and the Madeira
Islands)
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Bom dia! Portugal
A snapshot of history

• 1974 The Carnation Revolution
• 1979 Parliament approved for the establishment
  of a National Health System integrating existing
  facilities, (mainly) tax financed, aimed to
  provide universal and comprehensive care, free
  (or almost free) of charge
• 1986 Member of The European Union
• 1993 Reform of the health service into 5
  Regions and 18 Subregions
• 1990s to present day Reforms focusing on
  patient service, efficiency, management, quality
  assessment and the role of the private sector

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Bom dia! Portugal
A snapshot of history
1979
2004
1960
25 years!!!
NHS
Years of life expectancy (females)
66,8
75,2
80,3
Years of life expectancy (males)
61,2
67,7
73,5
Infant mortality (per 1000)
77,5
24,3
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Primary interfaces
Bom dia! Portugal
PRIVATE HEALTHCARE
MINISTERY OF HEALTH
5 Regional Health Administrations
Health Units
HC
HOSPITAL
HC
HC

353 Health Centers 1922
Extensions
82 NHS hospitals - 15 central - 10
specialized - 36 district - 21 community
primary interfaces
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Bom dia! Portugal
Interface management State/regions vs. Health
Units
STATE / REGIONS
HOSPITALS
HEALTHCARE CENTERS
Since 1990 part DRG, part historical budget
- Immunization (0-14 years) haemodialysis -
Capitation (adjustment according to sex, etc.)
Expenditure, of GDP
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Bom dia! Portugal
Interface management State/regions vs. Health
Units
STATE / REGIONS
?
HOSPITALS
HEALTHCARE CENTERS
Since 1990 part DRG, part historical budget
- Immunization (0-14 years) haemodialysis -
Capitation (adjustment according to sex, etc.)
Trough contracting attempt to raise level of
production, quality, etc.
Expenditure, of GDP
RAPID GROWTH
RELATIVELY LARGE PRIVATE SECTOR
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Bom dia! Portugal
Interface management State/regions vs. hospitals
Objectives of the DRG resource allocation model

• Provide a more rational distribution of
  resources
• Provide capability to benchmark hospitals
• Provide hospitals with incentives to operate
  efficiently
• Provide management tools for hospitals
• Provide the central government/regions with
  information

Difficulties in the interface management

• Chronic underfinancing of public hospitals
• Different funding philosophy between the
  inpatient and the ambulatory systems
• Limited DRG costing capabilities and limited
  implementation of hospital level information
  systems

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Bom dia! Portugal
Interface management Charateristics and examples
.... in
out ....

HOSPITAL


A lot of projects going on
Large investment in new hospitals
GP are organized in teams Large investment
-
-
-
?
?
Crowded ERs Shortage of staff (nurses)
Afternoon doctors
Few socials institutions for outpatients
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Bom dia! Portugal
The management of challenges Creating new
interfaces?

• Management of existing interfaces
• - Launch of accreditationprocess (6 hospitals)
  (interfaces within hospitals)
• Greater managerial autonomy in primary care
  (interfaces between hospitals and health centers)
• Central planning of specialist functions
  (interfaces between hospitals)
• - Other initiatives, eg. generic prescriptions
• Creating new interfaces?
• Payer / provider separation Creation of 31
  hospitals as public enterprises
• Lauch of several Public Private Partnerships
  (PPPs) 10 new hospitals to be built

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Bom dia! Portugal
In conclusion......... we will all be able to
learn from the successes and failures of the
portuguese health system of tomorrow...... It
represents a specific response to the challenges
of interfaces and interface management It will be
interesting to follow!!
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We would like to thank our coordinators and
HOPE!!!
Obrigado / obrigada !!!
Thank you!!!
Trine, José, Carmen, Martha, Julia, Jan Isabel