building the foundations for better health

Building the Foundations for Better Health

Health Services Organization

Policy Options for the Integration of Health Systems and Services

VII REGIONAL FORUMStrengthening of Health Systems Based on

Primary Health Care (PHC)Quito, Ecuador

29-31 October 2007

Health Systems Based on Primary Health Care

Right to Health

Equity

Solidarity

Capacity torespond to

health needsFocus on

quality

Res

pons

ibili

ty

and

acco

unta

bilit

y

Social

justice

Sustainability

Participation

Inte

rsec

tora

l

appr

oach

FirstcontactComprehensive,

Integrated, and

continuous care

Fam

ily and

comm

unity

orientation

Em

phasis onprom

otion andprevention

Appro

pria

teca

re

Mechanisms

for active

participationAcceptable

legal, policy, andinstitutional framework

Pro-equity policies

and programs

Optim

al

organization

and managem

ent

Ad

eq

ua

te

hu

ma

nre

sou

rce

s

Res

ourc

esad

apte

d t

o ne

eds

Inte

rsec

tora

l

actio

n

Universal

coverage

Health Services

The greatest challenge in terms of the organization and delivery of health services is fragmentation.

Policy Options for the Integration of Health

Systems and Services

Starting Point … Segmentation of health systems and

fragmentation of health services Pressures on health systems Shortcomings of care and organizational

models Progress worldwide and in countries of

the Region

Fragmentation Problems

Quality of Care and Results

Lack of continuity in care

Lack of coordination between the first level and specialized

levels of care

Many practices and interventions are not evidence-based

Wide variety of clinical practices

No incentives for health promotion

Costs Inefficient management of resources - Duplication (services,

procedures, diagnostic tests, etc.)

Lack of incentives for quality. Disparity between levels of care



The Tower of Babel? : Networks:

“Not all networks are integrated networks”

Coordination – Integration Segmentation and Fragmentation Primary health care (PHC) vs. primary

care or first-level of care Public health and public health services

What does the project aim to contribute?



Key questions: 1. What is the most appropriate

response to the fragmentation of health services and the problems that it creates?

2. What defines an Integrated Health Services Network?

3. How can we measure the extent of health services integration?

4. How can we address the organization of integrated networks?



Integrated Delivery Systems (IDS): “An integrated system is a network of

organizations that provides, or is organized to provide, ongoing and coordinated services to a particular population, and that takes responsibility for the clinical and financial results and the health outcomes of the population it serves. These systems, widely participatory and vertically integrated, offer a wide range of outpatient and in-patient services, care for acute and chronic illness, and home care.” (Shortell et al.)

Definitions:

Additional elements:

Based on the Primary Health Care Strategy and coordinated from the first level of care

With geographic responsibility Integrated vertically and coordinated

horizontally Also integrates public health services


Systems and Services 1. An expanded definition: Integrated Systems of Health Services:

“A network of organizations that provides, or is organized to provide,

ongoing services based on primary health care and coordinated

from the first level to a particular population in a particular

territory, and that is accountable for the clinical and financial results

and the health status of the population it serves. These systems,

widely participatory, vertically integrated, and horizontally

coordinated, offer a wide range of services to address the ongoing

needs of their users, from promotion and prevention to outpatient

and in-patient services, care for acute and chronic illnesses, home

care, rehabilitation, palliative care, and public health services.”



2. Attributes of integrated networks: Reference population is in a defined area Support systems are organized Health needs and priorities Scope of services Distribution of roles Integrated and coordinated care model Measurement of the impact of services



3. Strategic and operational attributes for measuring integration: Governance Financial mechanisms Management of the network Computer support systems Integration mechanisms Identification of health needs Care model Intersectoral action Monitoring and evaluation model

62 Operational Attributes

Evaluation of the Health Services Network

Strategic Attributes

Operational Attributes Degree of Compliance

Governance

Is there a single government structure?

Does it have a Mission and Vision Statement geared to network integration and management?

Does it have clearly established structures that differentiate between management of the network and the coordination of care?

Is there user representation with at least an advisory role in the governance structure?

Financial Mechanisms

Sufficient and available financing

Multiple contracts for the purchase of services, single or integrated financing of insurance

Financing mechanisms: Capitation, annual budget

Does it have a defined financial management system?

Existence of financial incentives and an organizational structure that aligns government, management, medical entities, and other providers in order to achieve the objectives.

Availability of information on costs, quality, results, and satisfaction for the different segments—users, employees, funders, and society

Existence of incentives to keep people healthy that reward promotion and prevention activities?



4. Policy options for integration: Options for governance:

Legal security for organization in an integrated network

Legal structure and framework for governance

Financing, payment mechanisms, incentives, financial protection for the population

Options for financing:

Capitation

New payment mechanisms for providers

Incentives



Insurance policies and protection of the population

Policies for the procurement of services Public providers Private providers

Public-private participation (legal framework)

Policies for the organization of services Care model Vertical integration and horizontal

coordination



Policies for the generation and use of resources:

Human resources policies

Education Training

Substitution

Continuing education

Evaluation and introduction of technologies



5. Phases in the configuration of integrated health services systems1. Situation analysis of health care and population-based health networks

2. Definition of the care model

3. Delimitation of health areas and levels of care

4. Design of services network

5. Configuration of the first level of care

6. Configuration of the second and third levels of care

7. Configuration of support services and logistical systems

8. Vertical integration of the services network

9. Configuration of the governance model

10. Design of monitoring and evaluation systems.

Success Factors

1. Align the delivery network with community needs

2. Strengthen primary health care and the first level of care

3. Strengthen and integrate the information system

4. Provide relevant information on costs, quality, and clinical results

5. Adopt a culture of shared risk 6. Align suppliers, managers, and government

structures.

Health Systems Based on PHC

Right to Health

Equity

Solidarity

Capacity torespond to

health needsFocus on

quality

Res

pons

ibili

tyan

d ac

coun

tabi

lity

Social

justice

Sustainability

Participation

Inte

rsec

tora

l

appr

oach

FirstcontactComprehensive,

integrated, and

continuous care

Fam

ily and

comm

unity

orientation

Em

phasis onprom

otion andprevention

Appro

pria

teca

re

Mechanisms

for active

participationAcceptable

legal, policy, and institutional

framework

Pro-equitypolicies andPrograms

Optim

al

organization

and managem

ent

Ad

eq

ua

te

hu

ma

nre

sou

rce

s

Res

ourc

esad

apte

d t

o ne

eds

Inte

rsec

tora

l

actio

n

Universal

coverage

Health Services OrganizationIntegrated Hospitals and Health Services Systems

Building the Foundation for Better Health

Dr. Reynaldo Holder Regional [email protected]

building the foundations for better health

Documents

integration of health

delivery of health services

health outcomes

level of care public

primary health care

primary health care

primary health careright

public health serviceswhat