catalan health system toni dedeu, md, ph d, msc director of international affairs and cooperation
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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
Departament de Salut
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
Government of Catalonia Ministry of Health
Departament de Salut
Catalan healthcare system
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
Departament de Salut
Catalan healthcare systemDevolution process to Autonomous Communities
1981
1984
1987
1987
19901990
1994
2001
2001
2001
20012001
2001
2001
20012001
2001
Ministry of Health
Government of Catalonia
Departament de Salut
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
Government of Catalonia Ministry of Health
Departament de Salut
Catalan healthcare system
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
Government of Catalonia
Departament de Salut
Catalan healthcare system
C A T A L O N I A
Ministry of Health
Government of Catalonia
Departament de Salut
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
Government of Catalonia Ministry of Health
Departament de Salut
Catalan healthcare systemCatalan population
Government of Catalonia Ministry of Health
2008
Departament de Salut
Catalan healthcare system
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/
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
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
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
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
Departament de Salut
Catalan healthcare system
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
Departament de Salut
Catalan healthcare systemCatalan Government Budget 2010 (39,699 B €)
Ministry of Health
Government of Catalonia
Departament de Salut
Catalan healthcare system
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%
Government of Catalonia Ministry
of Health
Departament de Salut
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
Government of Catalonia
Departament de Salut
Catalan healthcare system
Catalan Healthcare SystemCitizen’s Pathways. Gatekeeping based
CITIZENS
HOSPITALSH1 H2 H3
Social & Healthcare
Services
Mental Health Care
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
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
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
of Health
Chronic Care Expanded Model
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
of Health
Chronic Care Expanded Model
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
of Health
Chronic Care Expanded Model
Departament de Salut
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
Government of Catalonia
• Building healthy public policyBuilding healthy public policy• Creating supportive environments Creating supportive environments • Strengthening community action
Departament de Salut
Catalan healthcare system
Catalan Healthcare System Primary Healthcare Team & Primary Healthcare
Ministry of Health
Government of Catalonia
Departament de Salut
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
Government of Catalonia
Departament de Salut
Catalan healthcare system
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)
Departament de Salut
Catalan healthcare systemPrimary Health Care Centres
PHC PHC
Ministry of Health
Government of Catalonia
Departament de Salut
Catalan healthcare systemPrimary Health Care Centres
PHC SortPHC in Barcelona city
Ministry of Health
Government of Catalonia
Departament de Salut
Catalan healthcare system
The Catalan HealthcareNew perspectives
Government of Catalonia Ministry of Health
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
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
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
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
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
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
Departament de Salut
Catalan healthcare system
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
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
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
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
of Health
Sustainability
• Universal coverage• Public financing of the services• Purchaser-Provider split• Citizen’s participation• Patient choice• Continuity of care• Integration and coordination
Departament de Salut
Catalan healthcare system
Government of Catalonia Ministry
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
Departament de Salut
Catalan healthcare systemHealth & Social Trends in Catalonia: High Tech / Genomics / Telemedicine
Ministry of Health
Government of Catalonia
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