Date post: | 27-Dec-2015 |
Category: |
Documents |
Upload: | claude-fletcher |
View: | 215 times |
Download: | 2 times |
Integrated Health Service Delivery Networks(IHSDNs)
Dr Malhi ChoAdvisor HSS
Venezuela, Aruba, Curazao, Sint Maarten and Netherland Caribbean
Islands
June 3rd 2015
Overview• Two visions of Health Systems
• The crisis of the current Health Care System
• IHSDNs (The response) o Integrated People Centered Care o Building an IHSDNs
• Systems Thinking for Health Systems Strengthening
Health System Bio-Medical Model PHC – Based System
VALUESHealth as a privilege, a commodity or act of compassion
Health as a Human RightEquitySolidarity
FOCUS Patients/sick individuals People, Families, Communities
GOVERNANCE Doctor - PatientMultiple involvementNHA/MoH leadership
FINANCINGPayment to providers (fee-for-service)Profit oriented
Affordable Universal Access to health and Universal Health CoverageSocial Protection in Health
PROVISION OF SERVICES
Acute, Episodic, Curative careComprehensive integrated and continues Health care and Social Services
DEVELOPMENT OF RESOURCES
Physicians, Nurses and other professions akin to curative careTechnology as a business tool
Wide range of professions and competenciesRational use of technology
SYSTEMS’ APPROACH
Linear Adaptive System
Fragmentation of Healthcare Delivery Services
PRIMER NIVEL
SEGUNDO NIVEL
TERCERNIVEL
Social Security
Private Practice(High Technology)
Other
Providers
Private Non-profit(NGOs)
Local Govs
Universities
HIV
-AID
S
Mala
ria &
Oth
ers
Mate
rnal-
Ch
ild
Healt
h
Ministryof Health
Traditional Medicine
Fragmentation of Healthcare Delivery Services
The Current Health System• Centered on acute, episodic care
• Supply driven and organized by levels that fragment care
• Hospital-based and dependent on costly technologies and specialist care
• Provision of curative services through fragmented process of care
• Lack of continuity, poor quality and safety
• Inefficient referral systems
• Generator of exclusion and dissatisfaction
The patient “vanishes”
The patient “shows up”
The patient is “treated”
The patient is discharged
The current health system and the radar phenomenon
Are we prepared for give responses to the need
of people?
“People with chronic conditions attempt to
obtain continuous care in a systems where
healthcare services and financial mechanisms are oriented to the delivery of
episodic care”.Jesús María FernándezDep. de Sanidad y ConsumoBasque Country, Spain.
Gerard Anderson, Analysis of the Medical Expenditure Panel Survey, 2004.
The lack of or poor coordination in healthcare delivery increases the number of unnecessary hospital
admissions
Source:Medicare Standard Analytic File,2004
Integrated Health Service Delivery Networks (IHSDNs)
Integrated Health Services Delivery NetworksMandates, Context and Justification
Resolution CD49.R22 (September, 2009)
• “Recognizing that integrated health services delivery networks are one of the principal operational expressions of the PHC approach in health service delivery, helping to make several of its essential elements a reality, namely universal coverage and access; the first contact; comprehensive care; appropriate health care; optimal organization and management; and intersectoral action… “
• “…integrated health services delivery networks increase access to the system, reduce inappropriate care and the fragmentation of care, prevent the duplication of infrastructure and services, lower production costs, and better meet the needs and expectations of individuals, families, and communities…”
Systems Benefits of IHSDNs• Improved accessibility; reduced fragmented care;
improved overall efficiency; less duplication of services and infrastructure; more effective response to people’s needs and expectations; reduced production cost and increased cost-effectiveness; decrease in unnecessary hospital admissions; reductions in excessive utilization of diagnostic test; improvement in economy of scales; improved balance between specialist and generalist; better performance of total operating margins, cash flows and net income.
• Dowling, W.L. (1999). Hospitals and health systems. In: Introduction to health services. Williams, S.J.; Torrens, P.R., Editors. 5th ed. Delmar Publishers, An International Thomson Publishing Company.
• 43 Wan, T.T.H.; Lin, B.Y.; Ma, A. (2002). Integration mechanisms and hospital efficiency in integrated health care delivery systems. Journal of Medical Systems, 26: 127-143.
• 44 Lee, S.D.; Alexander, J.A.; Bazzoli, J. (2003). Whom do they serve? Community responsiveness among hospitals affiliated with systems and networks. Medical Care, 41: 165-174.
• 45 Aletras, V.; Jones, A.; Sheldon, T.A. (1997). Economies of scale and scope. In: Ferguson, B.; Sheldon, T.A; Posnett, J. Concentration and choice in health care. London: Financial Times Healthcare.
• 46 Soler, J.L.P (2003). Estrategia de gestion y organizacion de una red de laboratorios de diferentes hospitales publicos. Bogota, Primer Forum Internacional de Redes de Servicios y Ordenamiento Territorial en Salud. Secretaria de Salud de Bogota/Organizacion Panamericana de la Salud.
• 47 Dowling, W.L. (1999). Hospitals and health systems. In: Introduction to health services. Williams, S.J.; Torrens, P.R., Editors. 5th ed. Delmar Publishers, An International Thomson Publishing Company.
• 48 Shortell, S.M.; Gillies, R.R.; Anderson, D.A. (1994). The new world of managed care: creating organized delivery systems. Health Affairs, Vol. 13, Issue 5: 46-64.
Clinical Benefits of IHSDNs• Continuity of care is associated with improvements in
clinical effectiveness, responsiveness, acceptability and efficiency; increased perception of effectiveness (healthcare managers and providers); improve timely access to First Level of Care and other levels when required; less unnecessary repetition of history-taking, diagnostic procedures, and bureaucracy; improved shared decision-making processes between provider and patient and facilitate the implementation of self-care strategies and chronic disease monitoring.
• Christakis, D.A.; Mell, L.; Koepsell, T.D.; Zummerman, F.J.; Connel, F.A. (2001). Association of lower continuity of care with greater risk of emergency department use and hospitalization in children. Pediatrics 2001;107(3):524-29.
• 50 Hjordahl, P.; Laerum, E. (1992). Continuity of care in general practice: effect on patient satisfaction. BMJ 1992;304(6837):1287-90. • 51 Parchman, M.L.; Pugh, J.A.; Noel, P.H.; Larme, A.C. (1992). Continuity of care, self-management behaviors, and glucose control in patients with
type 2 diabetes. Med Care 2002;40(2):137-44. • 52 Ham, Ch (2007). Clinically Integrated Systems: The next step in English health reform? Briefing Paper. The Nuffield Trust. • 53 WHO European Office for Integrated Health Care Services (2001). Workshop on Integrated Care. Barcelona, WHO Integrated Care Meeting. • Lloyd, J.; Wait, S. Integrated Care: A guide for policy makers. London: Alliance for Health and the Future. • 55 Gillies, R.R.; Shortell, S.M.; Anderson, D.A.; Mitchell, J.B.; Morgan, K.L. (1993). Conceptualizing and measuring integration: findings from the health
systems integration study. Hospital & Health Services Administration 1993; 38(4):467-89. • 56 Hartz, Z.M.A.; Contandriopoulos, A.P. Integralidade da atencao e integracao de servicos de saude: desafios para avaliar a implantacao de um
“sistema sem muros”. Cadernos de Saude Publica 2004;20 Sup 2:S331-S336. • 57 Gillies, R.R.; Shortell, S.M.; Anderson, D.A.; Mitchell, J.B.; Morgan, K.L. (1993). Conceptualizing and measuring integration: findings from the health
systems integration study. Hospital & Health Services Administration 1993;38(4):467-89.
Integrated Health Service Delivery Networks (IHSDNs)
Integrated Health Service Delivery Networks (IHSDNs)
Progress in Country Implementation• Countries with on-going reforms based on PAHO’s IHSDNs
framework:o Brazil
• Ordinance 4.279 (2010) on organization of IHSDNs in the SUS• Ordinance 7.508 (2011) on integration and coordination of care between states
(Federal Regulation)• National consultation on a new policy for Hospital Care (2012)• The experience of Minas Gerais
o Chile• The experiences in Ñuble and the Western Metropolitan Regions
o Colombia• New legislation (Act 1438 of January 19, 2011)
o El Salvador• National Health Policy (“Building Hope”)
o New Model of Care (People Centred integrated care)o Strengthening of the First Level of Care (ECOS)
• Intersectorial Health Commissiono Others:
• Panamá, Perú, Paraguay, Uruguay, Trinidad and Tobagoo Regional Level:
• PHC Collaborative Network• Guidelines for implementation of IHSDNs• Development of a Regional Agenda for Hospitals in IHSDNs
Global Trends in Health Systems
and Healthcare Delivery
Título de la presentación
ORGANIZATION
• Strong resurgence of Primary Health Care (PHC) values and principles
• The demand for health services to provide integrated, coordinated and continuous care
• The First Level of Care (Primary Care) “in the drivers seat”
FINANCING• To provide more with the same or less resources• Financial allocation linked to performance• Increased accountability• New ways of paying providers• Push toward Universal Access of Health and
Universal Coverage of Health and Social Protection
QUALITY• People at the center of care• Evidence based medicine• Patient and Provider Safety
MANAGEMENT• Professionalization• More accountability• Assignment /contracting based on competencies• Results Based Management
INNOVATIONS• New modalities of delivery• The technological revolution and the impact on
healthcare cost• New approaches to old problems…and new
problems require creative approaches
Integrated People Centered Care
“the management and delivery of health services such that people receive a continuum
of health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative care services,
through the different levels and sites of care within the health systems, and according to
their needs throughout the life course” PAHO, 2010
Right to the highestattainable level of
health
Equity
Solidarity
Responsiveness topeoples’ health
needs
Quality-oriented
Go
vernm
ent
accou
ntab
ility
Social justic
eSustainability
Particip
ation
Inte
rsec
toria
lity
First Contact Comprehensive,
integrated and
continuing care Family and
comm
unity
based
Em
ph
asis on
p
rom
otio
n an
dp
reventio
nA
ppropriatecare
Active
participation
mechanismsSound policy,
legal & institutionalframework
Pro-equitypolicies
& programs
Optim
al
organization
& m
anagement
Ap
pro
priate
hu
man
reso
urces
Ade
quat
e an
dS
usta
inab
lere
sour
ces
Inte
rsec
toria
l
actio
ns
Universal
coverage
and access
Systems Thinking in BuildingPHC-Based Systems
HEALTH SYSTEM
Governance
Fina
ncin
g
Development
of Resources
Provisio
n
of Serv
ice
Thank you.