Health System Reform in Austria

• Enforcement of prevention and health promotion • Shift of hospital utilisation to ambulatory care facilities • Treatment of chronical diseases! • Allocation of ressources (regional, personal, financial dimension)

1 Enforcement of Primary Care –why?

WHO 2008, World Health Report – Primary Health Care –Now more than ever 2 Elements of Primary Care

• First access to health services

• Comprehensive and integrated (adressing any health related problem)

• Coordination of all advice and support needed

• Contionuous: longitutinality over substantial periods of time • Cooperation: doctor is part of a multidisciplinary group

B. Starfield: Primary Care, Balancing Health Needs, sercices and Technology. Oxford Umiverity Press, 1998 Primary Health Care Team

Hebamme Kooperation und Physio‐ FA Kinder‐ Vernetzung mit: therapeut Jugend‐ heilkunde • Apotheken Ergo‐ • Fachärzten/ PV‐Partner PV‐Management therapeut bei Bedarf Fachspezialisten Weitere • Zahnärzten Allgemein‐ Ord. • Bandagisten mediziner Assistenz Logopäde • Beratungshilfen PV‐Kernteam • Kinder‐ /Jugendwohlfahrt DGKS/ DGKP • Pflegeheimen Diätologe Mobile • Krankenhäusern Dienste • Schulen Psycho‐ Sozial‐ • Gemeinden therapeut arbeiter GuK‐ • SV‐Träger Psychologe • etc.

Challenges to develop Prinmary Care

Tamas Szolyak 27/05/2015 Key Trends Shaping the Health Industry Globally

Resources

• Lyfe time cost of individuals is increasing significantly – combined with aging this means a huge financial burden • Health care jobs ae in competition with other opportunities and loosing attractiveness

Technology

• Innovation in health care leads to significant disruption of ordinary service models

Consumer activation is reshaping the industry

• Consumers expectations are changing fast, need for health equality and health data (self-) management requires new approaches of care coordination

2015.07.15. Primary Care – key characteristics

Primary care is the first level of a health care system where people present their health problems and where the majority of the population’s curative health needs, health promotion and preventive health needs are satisfied (Starfield 1994).

Overall health is considered within primary care in a more holistic matter, paying not only attention to medical health needs, but also to other causes of ill health, such as social or employment determinants. This makes primary care more health-centric than disease-centric.

A strong primary care system when primary care is accessible, coordinates care on a continuous basis, provides a broad range of health care services (comprehensiveness), and operates with supportive governance structures, appropriate financial resources and investments in the development of the primary care workforce.

2015.07.15. Major development elements of Primary Care • Key attributes: – The point of first contact for all new needs – Person-focused rather than disease-focused continuous care over time – Comprehensive care provided for all needs that are common in the population – Coordination of care for common needs and also those that are sufficiently uncommon to require special services.

2015.07.15. Definition by EXPH

• Primary care is the provision of universally accessible, person-centered, comprehensive health and community services provided by a team of professionals accountable for addressing a large majority of personal health needs. These services are delivered in a sustained partnership with patients and informal caregivers, in the context of family and community, and play a central role in the overall coordination and continuity of people’s care.

5 Moving from transaction to population based care; focus on individual patient health improvement

SOURCE: Carter, Chalouhi, Richardson – What it takes to make integrated care work (McKinsey2015.07.15. Health International, 2011) Key Pillars to refocus on Primary Care

Prevention and therapy management must be properly addressed, need to shift services to the right competencies

Reinvent care delivery, and refocus services to improve health

Develop the right tools to support a strong primary care (enablers)

2015.07.15. Two major projects focus to achieve the described restructuring and reinforcing of PC

Health co- creation

Clear patient pathways Population demand driven service structure

2015.07.15. Where we are in the development of our system?

• Population demand driven service planning Refocus primary • Inserting support and management functions care on • Initiating integration of competencies • Put patient knowledge and management into the centre of improving health diagnosis, intervention and support

• Care pathway guidelines developed on evidence based Redesign care clinical guidelines • Coordination support and case management pathway and • Patients engagement and patient activity is included in the guidelines coordination • Algorithm to develop individual care plan

• Develop the system step by step Gradually • Spend resources and time to manage patients health change the culture and expectations • Focus on health experience developments to ensure short culture term developments are acknowledged

2015.07.15. Thank you for your attention! Regional Management of Health in Austria

Ines Czasný High Level Meeting of Health Experts of the Visegrad Group and CEE Countries - Bratislava, May 27-28, 2015 Gesundheit Österreich GmbH Austrian Public-Health-Institute

GÖG (Gesundheit Österreich GmbH) was established in its current form by federal law on 1 August 2006 as the National Planning and Research Institute in Health Care System 3 Business units are integrated in GÖG (owner is MoH Austria): ÖBIG (Österreichisches Bundesinstitut für Gesundheitswesen – Austrian Health Institute), a well-known research institute established in 1973 by federal law to plan, regulate and promote the Austrian Health Care System FGÖ (Fond Gesundes Österreich – Fund for a Healthy Austria), established in 1992 with the task to improve health promotion and prevention in Austria BIQG (Bundesinstitut für Qualität im Gesundheitswesen - Federal Institute for Quality Assurance in Health Care), established in July 2007 to guarantee the quality of health services rendered in Austria by for instance maintaining quality registers and reports and performing Health Technology Assessment (HTA) Content

» Regional Structure of Austria

» Austrian Health Care System - Overview

» Health Reform 2005 - ÖSG & RSG

» Health Reform 2012 - Governance by objectives Austria Federal republic with 9 provinces (“Bundesländer”), 32 health care regions and 95 districts

Area: 83,879 km2 Population: 8.5 million Source: Statistik Austria The Austrian Health Care System - Overview

» Health care system is based on a compulsory social insurance; access to services is regulated by law (General Social Insurance Act)

» Comprehensive social health insurance coverage is a major feature of the Austrian health care system  99.9 % of the population is protected.

» High density of easily accessible health care facilities (278 hospitals with 64,825 beds; 46,000 physicians); free access to all parts of the out-patient sector  no gate-keeping

» Health care system is characterized by the cooperation of a large number of actors. Competences are regulated by law.

»The Federal Government plays a central role (eg. legislation); many competences are delegated to the 9 provinces and to the 22 social security institutions (principle of self-governance).

» Joint responsibility for structural policies and planning (agreements under Art. 15a of Austria’s Constitutional Act) The Austrian Health Care System - Funding

» Equal access to health care services is guaranteed by the solidarity-based funding principle.

» Mainly public financed system (social insurance and taxes)  76 % of the health expenditures are public financed

2012 » € 34.1 billion total expenditure on health » 11.1 % of GDP

» € 25.9 bn. public, € 8.2 bn. private

» 34 % In-patient care 23 % Out-patient care 16 % Medical goods 14 % Long-term care Structure of the Austrian Health Care System Health Reform 2005

» Strengthen integrated health care – measures to overcome the strict separation of health care sectors and improvement of coordination of planning, financing and governance » Reform of Institutions on federal and regional level (Federal Health Care Agency, Regional Health Care Funds) » Integrated Health Care Structure Plans for the federal level (Austrian Health Care Structure Plan - ) and for the regional level (Regional Health Care Structure Plans - ) » Improve quality of health care – measures to built up a uniform nationwide system of quality measurement and quality management as well as quality assurance (Act on Health Care Quality, Federal InstituteÖSG for Quality Assurance in Health Care - business unit of GÖG) RSG » Ensure economic stability –sustainable financial security of the health care system Legal Implementation of Integrated Health Care Planning

“Austrian Health Care Structure Plan” (ÖSG) builds the mandatory Act, on the Organization and Funding of Health Care framework for “Regional Healthcare Structure Plans “(RSGs) of the 9 provinces (Agreement under Art. 15a of Austria’s Constitutional )

hospitalsKrankenanstaltenincl. rehabilita- inkl. resolutionBeschluss of resolutionAbstimmung of tioncentersselbstständige and Ambulatorien independent Federalder Bundes- Regionalin Landes- outpatientund Rehabilitationszentren departments commissiongesundheits- commissionsgesundheits- kommission plattformen on health on health official system system Bescheiddecision governance governance regionalLandes- kranken-hospital integrated anstalten- framework-plan plan by law planning plan Verordnungregulation ÖSG RSG total contracts

Agreement Gesamtvertrag

Vereinbarung detailled-plan establish-Stellen- mentplan plan Einzel-single contract ••stationärerIn-patient Bereich sector vertrag ••ambulanterOut-patient Bereich sector ••RehabilitationsbereichRehabilitation ••SchnittstelleBiomedical zum equipment Pflegebereich sectorniedergelassener of resident Bereich health • interface to long-term care professionalsinkl. Gruppenpraxen Health Reform 2005

» Strengthen integrated health care – measures to overcome the strict separation of health care sectors and improvement of coordination of planning, financing and governance » Reform of Institutions on federal and regional level (Federal Health Care Agency, Regional Health Care Funds) » Integrated Health Care Structure Plans for the federal level (Austrian Health Care Structure Plan - ) and for the regional level (Regional Health Care Structure Plans - ) » Improve quality of health care – measures to built up a uniform nationwide system of quality measurement and quality management as well as quality assurance (Act on Health Care Quality, Federal InstituteÖSG for Quality Assurance in Health Care - business unit of GÖG) RSG » Ensure economic stability –sustainable financial security of the health care system Health Expenditure in Austria Rate of (Acute Care) Hospital Discharges in Austria Physician focussed health system in Austria Health Reform 2012

»Is a deepening concretization of the health reform 2005  sustainable financial security of the health care system » Gradually reducing growth of public health expenditure in relation to projected growth of GDP  definition of health expenditure targets » Governance by objectives, via targets in the areas of »healthoutcome » health care processes Deriving targets for each actor, » health care structures measures and instruments » financial development » Equal partnership between federal authority, 9 regional authorities (provinces) and public health insurances under the condition of unchanged responsibilities » Federal and 9 regional 4-year contracts (2013-2016) and yearly working programs » Bi-annual monitoring of health care reform progress in the 9 provinces Health Reform 2012 Governance by Objectives – „Federal 4 Year Contracts“ Governance Range Governance Range Outcome-Orientation Health Care Structures

Measures Measures Operational Objectives Operational Objectives Strategic Objectives Strategic Objectives

Common objectives of the partnership in the sense of vision, mission & action-oriented Governance Range Governance Range principals (values) Health Care Processes Financial Objectives

Measures Measures Operational Objectives Operational Objectives Strategic Objectives Strategic Objectives

 regional implementation in

9 „Regional 4 Year Contracts“ Contact

Many thanks for your attention!

Ines Czasný

Stubenring 6 1010 Vienna, Austria T: +43 1 515 61- 0 F: +43 1 513 84 72 E: [email protected] www.goeg.at Regional management of health in the Moravian Silesian Region

Oldřich Pospíšil MD FRCS FDSRCS, Martin Doležal

High level meeting of health experts of the Visegrad group, Bratislava, 27. - 28. 5. 2015 Sharing experience discussion

1 Sole objective: Integrated health care management in all facilities owned by the Regional Government (i.e. in 6 hospitals)

2 What has been achieved: • Complex information system for operation rooms and centalized sterilization lines • Provision of uniform file keeping and evaluation of qualitative economic parameters of hospital management  aiming to provide uniform cost-related statistical data • System of data exchange – within the network of regional facilities (implementation)

3 Planned projects: • e-request for external applicants • e–booking – booking and planning system, online booking of doctor appointments • Enforcing better process management in the care for chronicly diseased • unified software support of electornic nursing documentation

4 Thank you for your attention

Oldřich Pospíšil MD FRCS FDSRCS [email protected] Ing. Martin Doležal [email protected] Bc. Alžběta Víchová [email protected] Mgr. Leona Šrubařová [email protected]

Bratislava, 27. 5. 2015

5 Regional management of healthcare in Hungary

Balázs Babarczy 27th May 2015 Objectives

• Restructuring the system of (specialist) healthcare provision • Improving access, by adjusting capacities to patient flows • Improving quality, by regrouping highly specialist tertialry care in dedicated centres Actions

• Nationalisation of providers formerly managed by local and county governments • Creation of an administrative body (GYEMSZIÁEEK), with regional offices • Dividing the country into 8 health regions, based on patient flows • Defining different levels of care progressivity • Assigning catchment areas to provider units • Provider restructuring Resources

• Merger of 5 background institutions into one methodological support unit

National Institute of Pharmacy

Institute for Basic National Centre and Continuing for Healthcare Education of Audit and Health Workers Inspection

Institute for National Institute GYEMSZI Healthcare Quality for Strategic Improvement and Health Research / ÁEEK Hospital Engineering Motives

• Insufficient coordination of activities and resources in the locally managed system • No, or only marginal, structural adjustment through case-based payment • Need of streamlining through evidence- based design Expected outcomes

• Increased level of quality and transaprency • More efficient care provision • Better resource allocation • The right case treated at the right level • In practice, a lot of work still to be done (managing data, monitoring quality, countering local interests, etc.). Thank you for your attention! Strengthening delivery of prevention of disease Salt reduction initiative in Croatia

PhD Vedran Poljak, MD Croatian Institute of Public Health WHO

Global status report on NCDs, 2014 •NCDs currently cause more deaths than all other causes combined •NCD deaths are projected to increase to 52 million by 2030 •Four major NCDs responsible for 82% of NCD deaths Global NCD targets Strategic Plan for the Reduction of excessive salt intake in the Republic of Croatia 2015 ‐2019 Croatia

• According to the EU plan, salt intake should be also cut down, and salt content should be labelled on all food articles.

• In 2006, at the Croatian Congress on Hypertension Declaration of salt reducing programme in Croatia was announced, and in 2007 at the Croatian Congress on Atherosclerosis, Croatian action on salt and health (CRASH), and national programme for reducing salt intake were launched.

• From that time data on salt intake and awareness of harmfulness of salt intake in Croatia were obtained. The goal

• The goal of the Strategic Plan for the Reduction of excessive salt intake in Croatia is to gradually reduce salt intake in the general population of the Republic of Croatian for an average of 4% a year, from the current 11.6 grams per day to 9.3 grams in 2019.

• It would ultimately contribute to the realization of the plan of the WHO and the UN on the reduction of salt intake by 30% by 2025, adopted within the European framework for national initiatives to reduce salt intake through food (ESAN). Expected results

• salt intake by 20% until 2020

• blood pressure by 2 mmHg

• hypertension –stroke – heart attacks

• healthcare expenditures Millimeters are important

SBP for 1‐3 mmHg = risk of stroke for 20‐30%

• High blood pressure accounts for 35‐50% of stroke risks • Hypertension is the single most important modifiable risk factor for ischemic stroke • Stroke is the second leading cause of death in Croatia Projected effect of salt reduction on future cardiovascular disease

3 g NaCl (1.2 g Na) day reduction results in: • Reduction of hypertensive women by 16‐24% • Reduction of hypertensive men by 22‐34%

Potential savings for Croatia: • €6.14 millions ‐ €21.49 millions in treating hypertension • 3100 to 6200 less new cardiovascular disease cases per year • 2300 to 4700 less deaths per year WHO Tool kit • Thank you for your attention [email protected]

Croatian Institute of Public Health Strentgthening delivery of preventive care and promotion of well-being of population

Health 2020 - a key strategic document for the period 2016-2020

Oldřich Pospíšil MD FRCS FDSRCS, Martin Doležal

High level meeting of health experts of the Visegrad group, Bratislava, 27. - 28. 5. 2015 Sharing experience discussion

1 1 / Promoting Physical Activity 1.1 / PA support in pre-school education 1.2 / Active Mobility 1.3 / Supporting sport for all and active use of the leisure time 1.4 / Promoting Physical Activity in Health and Social Services 1.5 / Promoting physical activity among employers 1.6 / Physical activity and environment 1.7 / Promoting Physical Activity in the media 1.8 / Research and evaluation of program supporting physical activity

2 2 / Proper/correct nutrition and eating habits 2.1 / Creating an environment with good food 2.2 / Supporting the production and acquiring proper nutrition and healthy lifestyles throughout life, especially among the most vulnerable population 2.3 / Strengthening health system in promoting good nutrition and healthy lifestyle 2.4 / Promotion of surveillance, monitoring, evaluation and research in to proper nutrition and nutritional status of the population of the Czech Republic and its subgroups 2.5 / Creating communities and alliances 3 3 / Limiting risk behavior 3a / Alcohol Use 3a1 / increase awareness of the extent and nature of the health, social and economic problems caused by harmful use of alcohol and ensuring the availability of effective measures 3a2 / increase the availability of effective therapeutic interventions to reduce and prevent damage caused by alcohol abuse 3a3 / reduction of the damages caused by alcohol use with its negative impact on physical and mental health of the population, with the impact on the threat to public order and safety, including traffic accidents, with a negative impact on work performance and also the reduction and prevention of harmful alcohol use in so called risk groups 3a4 / limiting the availability of alcoholic beverages, especially for children and teenagers and a favorable adjustment of environmental factors 4 3b / Usage of addictive substances and gambling addiction 3b1 / Reduce the degree of experimental and occasional use of drugs, particularly among young people, reduce the degree of gambling, 3b2 / Reduce the degree of problematic and intensive addictive substance abuse and problem gambling 3b3 / reduce the potential risks associated with drug abuse and problem gambling for individuals and society 3b4 / reduce the availability of drugs, especially for young people, enhance the legislative regulation of gambling 5 Strategic priorities of program “Health 2020” Priority Area 1: Making lifelong investment in health and disease prevention, strengthen the role of citizens and create conditions for growth and fulfillment their potential health

Priority Area 2: Challenge the serious health problems in the area of non-infectious and infectious diseases, and regularly/continuously monitor the health status of the population 6 Strategic priorities of program “Health 2020” Priority Area 3: Strengthening health systems focused on people, to ensure the usability and accessibility of health services in user’s terms, focus on the protection and promotion of health and prevention of disease, develop the capacity of public health, ensure readiness in crisis situations, continuously monitor the health situation and make appropriate responses in extraordinary situations

Priority Area 4: Participate in the creation of conditions for the development of resistant social groups, i. e. the communities living in an environment that is favorable to their health 7 Selected Strategic aims/goals Health 2020

1. Improve health of the population and reduce health inequalities

2. Strengthen the role of public authorities in health sector and invite to the management and decision- making all sections of society, social groups and individuals

8 Thank you for your attention

Oldřich Pospíšil MD FRCS FDSRCS [email protected] Ing. Martin Doležal [email protected] Bc. Alžběta Víchová [email protected]

Bratislava, 27. 5. 2015

9 Strengthening delivery of preventive services

Tamas Szolyak 27/05/2015 Key Projects in place

Health Promotion Officies

• Developed based on the local community needs • Primary and secondary prevention in focus

Heath advisor roles

• Coach nurses, develop ways of communication fits to different cultural, socioeconomical background

New roles in Primary Care focusing on prevention • Enhance the capabilities of PC to act in the field of primary prevention, find and support individuals having health risk

2015.07.15. Actions to utilize activities focusing on health promotion • Utilizing EU funds and other available funds to increase the level of conscious development in health improvement • Primary CARE methodological institute and Health improvement institute had been combined into one „think tank” institute

2015.07.15. Reasons to move in this direction

• Evidences prove the impact of health centric, person focused integrated approaches – Death avoided – Years spent in health – Need for hospitalization and acute treatment • Health is investment into the future – not widely accepted, so proof is required, and HC has to deliver it

4 Expected outcomes

Prevention and integration will positively impact the health experience of the society

PREM and PROM has proven impact on hard outcomes measuring these factors will provide positive trends

Positive results can be well communicated, therefore the implemented activities will enhance the speed of change

2015.07.15. Thank you for your attention! Cooperation and development in R&D in biomedicine and biotechnologies CONNECTION OF NEW FOOD TRENDS AND HEALTH

PhD Vedran Poljak, MD Croatian Institute of Public Health GLOBAL TRENDS

Source: IADSA Source: EUROMONITOR FUNCTIONAL FOOD AND FOOD SUPPLEMENTS CONSUMPTION IN CROATIA

Source: CASI GLOBAL TRENDS problems, categorization, legislation LEGISLATION PROBLEM? CATEGORIZATION PROBLEM? FUNCTIONAL FOOD AND POSITIVE HEALTH IMPACT CURRENT SITUATION ON SALT REDUCTION

Bakery products are main (>35%) source of NaCl in diet REFORMULATING PRODUCTS ACCORDING „SALT REDUCTION” DEMANDS IN CROATIA

1,53 % NaCL

(0 %, 1 %, 2%, 3 % NaCl) Thank you for your attention

• [email protected] • [email protected]

CROATIAN INSTITUTE OF PUBLIC HEALTH Cooperation and development in research and innovation in health technologies

Bence Haidekker

28. 05. 2015 Actions

Social Renewal Operational Programme (supported by EU and Hungarian Government): • R & D strategy - capacity survey • Preparation of project proposals • Focus: • Maximizing the benefits, minimize risks and minimize the costs of contributing to the clinical pharmacy; • Clinical pharmaceutical value chain - the whole supply system - covering the whole of innovative logistics; • Pediatric medicine and pharmacy; • The quality of cardiovascular care innovation processes. Actions Interreg CENTRAL EUROPE - INNOHealth project: • Central European Programme for Complex Improvement of Innovative Spirit, Competences, Skills and Capacities and Mental Wellbeing at Competitive and Responsible SMEs • Partners: Slovenia, Slovakia, Poland, Germany, Austria, Czech Republic, Italy Actions

EIT Health: • The consortium of more than 50 core partners and 90 associate partners from leading businesses, research centres and universities from across 14 EU countries. • The goal of EIT Health is to contribute to increasing the competitiveness of European industry, improve the quality of life of Europe’s citizens and the sustainability of healthcare system.

(EIT: European Institute of Innovation and Technology - A body of the European Union) EIT Health in Europe & the World

EIT Health is leveraging the expertise of more than 140 leading organizations spanning key areas of healthcare such as Pharma, MedTech, Payers, Research Institutions and Universities. EIT Health Flagships Opportunities

• Clinical trials • enhance the competitiveness of pharmaceutical research and development • in 2012-2013 clinical trials generated revenues for the national economy 0.25 % of the GDP • Cooperation, information sharing, knowledge sharing in the area of rare diseases • Biotechnology development • Harmonisation of basic research Thank you for your attention! Health Data Management

Ines Czasný High Level Meeting of Health Experts of the Visegrad Group and CEE Countries - Bratislava, May 27-28, 2015 Gesundheit Österreich GmbH Austrian Public-Health-Institute

Area: 83,879 km2 Population: 8.5 million Source: Statistik Austria Content

» Legal Framework & History

» Actual Data Availability & Next Steps

» Austrian Health Information System

» Web-Services

» E-Card & ELGA Structure of the Austrian Health Care System

Out-patient Legal Framework & History of Documentation

» 1997 implementation of the „Austrian (P)DRG-System“, which is a procedure-oriented hospital financing system on the basis of diagnosis-related groups » standardised medical documentation (diagnosis and procedures) as a prerequisite  1996 adoption of the Health Documentation Act focussed on the in-patient sector » Start to develop a catalogue of procedures for the out-patient sector » Health Reform Act 2005: Strengthen integrated health care  develop guidelines for a nationwide standardised documentation including all sectors of the Austrian health care system » Since 2010 pilot projects to test the integrated catalogue of procedures » Health Reform Act 2013: including a revision of the Health Documentation Act » Mandatory standardised documentation also of out-patient procedures (starting with 2014) »incl. patient pseudonyms (out-patient 2014; in-patient 2015) Actual Data Availability

In-patient sector Morbidity-Iceberg supply and utilisation of “ ” capacities, procedures and diagnosis (ICD 10)

Rehabilitation centres supply and utilisation of capacities, procedures and diagnosis (9 Indication Groups)

Out-patient sector supply of capacities (not all health professions) utilisation and procedures (since 2014) no diagnosis Next Steps

» Check and improve the data-quality in the out-patient sector »Further development of data-bases and routine data-analysis,  support the ongoing health reform » Pilot projects to implement a nationwide standardized documentation of diagnosis in the out-patient sector Austrian Health Information System „ÖGIS/QGIS“ Austrian Health Information System „ÖGIS/QGIS“

ad-hoc-queries: simple und quick

automatically generated preparation of demography ÖGIS/QGIS Information in tables, graphics und maps

epidemiology D A social-economics Integration of Geo-informations T in statistical methods health care system A geography analysis on different regional levels (from 2.354 municipalities to Austria in total)

analysis possibilities in connection with accessibility and catchment areas of health care suppliers “ÖGIS” - Regional Analysis/HAR, catchment areas „ÖGIS“ – Time Series Analysis / Life Expectancy Austrian Healthcare Structure Plan (ÖSG 2012) Web-Services: REGIS

» Regional Health Information System http://regis.oebig.at »permits regional comparisons in the context of health- related evaluations » Covers the fields »demography, » life-expectancy, » mortality, » morbidity, » accidents, » determinants of health Web-Services: HEALTH PORTAL

Public health portal where reliable health information of assured quality is provided and where the services of Austria’s health care system are described in detail. Web-Services: Compasses

» These information services »provide orientation for patients who need information on Austria’s health care services with regard to hospital care, rehabilitation, nonphysician health care professions and addiction-related services » help to find specific types of institutions or centres in a certain region and provide detailed information, e.g., on available medical services, equipment, complementary services and important contacts »give statistical data, e.g., on treatments carried out and on diagnoses

»“Hospital-Compass”: www.spitalskompass.at

»“Rehabilitation-Compass”: rehakompass.goeg.at Informationen about all Acute-Care-Hospitals in Ö

17 Informationen about all Rehabilitation Centres in Ö

18 E-Card

» 2005 introduction of an electronic health insurance card (e-card) for all persons insured with a social health insurance fund » Chip-Card, including » name of the person insured » social insurance number » information about the status of insurance giving » free access to health care facilities (with contract) » also in other European countries

»is a prerequisite for ELGA, the electronic health file  the legal basis (ELGA Act) was adopted at 2012 » Primary objective: improving the flow of information in the health care sector ELGA - Electronic Health File

www.elga.gv.at

Benefit for the patients Hospital discharge reports » more information laboratory and radiology results » better quality of care medication » more comfort and security » every insured person is included  possibility to opt-out Timeline » Since 2014: ELGA-Portal » End of 2015: public hospitals (stepwise) » Middle of 2016: panel doctors and pharmacies » 2017: private hospitals » 2022: dentist Contact

Many thanks for your attention!

Ines Czasný

Stubenring 6 1010 Vienna, Austria T: +43 1 515 61- 0 F: +43 1 513 84 72 E: [email protected] www.goeg.at Public Health Data Management Platform in Croatia (NJZIS‐central public health registry)

Vedran Poljak PhD, MD Ivan Pristaš PhD, MD, AS IS . Around 20 national health registries in CIPH and 20 more in other health agencies (if widen the definition, two times more) . Every registry its own IT solution supporting only internal processes (data entry, upload, validations, database administration, reporting) . High redundancy in public health reporting data sets (e.g. a hospital has 15 forms for CIPH only) . Still many paper forms (~50%) . Low penetration of data standards (except ICD10) . No central data governance and synchronization . Low analytical flexibility and responsiveness . High burden of administrative work on data

Still the most reliable source of health information in the country!

2 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO TO BE . All registries on one platform (central public health registry ‐ NJZIS) . Business processes shared among stakeholders . county health institutes . MoH . HIF . national health agencies . professional chambers . Single point of metadata administration (codebooks, standards, users) . Consolidated reporting (joint procedures) . Data redundancies eliminated . Improved validations, data quality and analytics . Improved data exchange (paper ‐> .txt ‐> xml ‐> CDA) 3 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO General business case of NJZIS

Persons Public Health NGO, Public and health Other services systems NPO workers users providers

Manage data and Use services, Provide, use, Use services, system, use participate, integrate participate services follow, support, public services advocate Integrated Manage management integrated system Use services, system, use provide, align services and integrate General collection of NJZIS health services services: manage, act, share, Connect through cooperate, connect, integrate, projects, standardize, virtualize, support integrate, Deliver, rationalize Other support, projects & cooperate, use services programs Follow, develop, Provide cross‐ Align, improve, use Manage border services conduct services expenditures, and reporting use services decisions Platform NJZIS

Science and MS EC 4 EconomyHRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO Finances education EU Main goals . One way data collection  multi stakeholder business process . Health statistics  health assessment . Surveillance  health outcomes (quality, efficiency &safety of procedures, products and equipment) . Data quality management . accuracy . reliability . timeliness . completeness etc. . Advanced analytical services . Various information sources combining (e.g. comorbidity research) . Decision making based on information

5 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO General use case

User (person)

Use and provide Platform NJZIS services; Unify and personalize services

Check and Accept, check, record, forward confirm identity message

User Enable preview and Contract and Accept and check (system) deliver service, integrate request on registry, conduct process external services answer

6 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO National registries in scope • Health resources registries (workforce, organisations, equipment) • Infectious diseases registries (general, TB, HIV/AIDS, legionelle) • Chronic conditions registries (cancer, psychoses, disabilities, ) • Health services registries (discharges, births, abortions, immunizations) • Deaths (causes of death, suicides, perinatal deaths)

7 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO Case example –Health workforce registry . 2014: Paper communication between MoH, CIPH, HIF, professional chambers, health providers and health care personnel

. 2015: Interoperability in using shared services ‐ (interoperability agreement, legal alignment ‐ health information law draft, new common process, semantical consolidation – common codebooks, technical integration ‐ platform)

. 2016: New services –Nacional registry of health providers, health worker’s license status check, planning of health resources, hospital organizational structure monitoring, contracting based on registry info

8 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO Use case: Health workforce registry

Health care MoH Zdr.Zdr.providers org. org. jed. jed. HIF CIPH

Communicate Manage Manage changes finances resources, supervise Manage public CIPH registries Professional health data KomoreKomore u u zdravstvuchambers zdravstvu Synchronize Health workforce registry license, provide services to Receive, members check and Receive or HCP registry reply send data High cost equipment registry Users … Personnel Find information, control personal Exchange data, Report data communicate graduated Citizens changes, report persons Platform NJZIS …

Fundamental population registries ISVU EU and MS registries: EUROSTAT, ECDC, IARC, INSPIRE, OIB, DGU, Matice, RegZap, 9 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO PARENT… CEZIH, ZOROH (insured persons, equipment, procedures) Health workforce registry at MoH

Users (eCitizens)

Professional Health care Personnel Komore u Komore u Zdr. org. jed. chamberszdravstvu providersZdr. org. jed. CIPH MoH zdravstvu citizens

Workforce administration department Plans and approvals Synchronize Find information, Report passed Report (employments and license control personal exam changes specializations) data, communicate changes, report Exams (national, specialist) Manage Report public health validation data Acknowledgments (nurses, validations)

Receive, check Provide results, and reply preview, reply Receive or send data Health Health care units workforce administration department registry Hospitals Send decisions, Manage Check permissions and education financial Exchange data cessations resources and license Companies Platform NJZIS

Private practice HIF CEZIH

10 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO OIB, DGU, Matice, RegZap, Trgovački sud, ISVU Case example – Infectious diseases registry . Replacing paper‐based reporting („yellow form”or print‐out from EHR) . Reporting through CEZIH (PHC), HIS (hospitals) or directly (non‐ contracted HCP) . web service or web form . around 120 HE teams and county institutes in a single virtual environment . Coordination at CIPH . Report status communication, outbreaks and epidemics . Automatized reporting to ECDC (Tessy) . Ad‐hoc analyses and BI . Local solutions obsolete . New services for county institutes

11 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO Use case – Infectious diseases registry

CIPH MoH HIF

Coordinate HCP Manage resources, Zdr.Zdr. org. org. jed. jed. counties, manage public health data supervise, plan Manage financial Early detect and resources report disease CIPH registries ŽupanijskiCounty IPH ZJZ Županijski ZJZ Coordinate HE teams, manage Receive, check and report statuses Receive or Infectious diseases reg. reply send data Health workforce reg. HEHE teams Early detect and HE report disease ispostaveispostave intervene, record Find information, control personal Exchange data, data Users communicate changes, report Personnel Platform NJZIS Citizens

… ECDC (TESSY) OIB, DGU, ZOROH, CEZIH

12 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO Invested resources . Multi‐stakeholder strategic planning

. 5 years strategic development program 2012‐2016

. Outsourced consultancy and implementation projects ~ 800,000 €

. Internal CIPH resources ‐ yearly around 8 person‐years (eHealth and public health experts, registry administrators, supporting legal and logistic administration)

13 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO Main optimizations in all registries . Address data coded uniquely according to national geo‐codes (DGU RPJ) . Citizen’s ID (OIB) and ensured person’s ID (MBO) together with accompanying demographic data updated uniquely through web service . Health care providers uniquely coded . Common codebooks . Cause of death synchronized . Shared services, access and roles by organisation and county level permissions . Multi‐stakeholder platform

14 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO Thank you for your attention . [email protected] . [email protected]

CROATIAN INSTITUTE OF PUBLIC HEALTH

15 HRVATSKI ZAVOD ZA JAVNO ZDRAVSTVO Health data management

Implementation of population health indicators in the Czech Republic

Oldřich Pospíšil MD FRCS FDSRCS, Martin Doležal

High level meeting of health experts of the Visegrad group, Bratislava, 27. - 28. 5. 2015 Sharing experience discussion

1 Legislative and project-based reasoning of health indicators (i)

Current EU regulations in force • Regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work, and following implementing regulations: • No 328/2011 of 5 April 2011, as regards statistics on causes of death • No 349/2011 of 11 April 2011, as regards statistics on accidents at work • No 141/2013 of 19 February 2013, as regards statistics based on the European Health Interview Survey (EHIS) • No 359/2015 of 4 March 2015, as regards statistics on healthcare expenditure and financing

OECD/Eurostat/WHO-Europe Joint Questionnaires • Non-Monetary Health Care Statistics • Health Accounts Legislative and project-based reasoning of health indicators (ii)

Other international data collections • World Health Organisation • European Health for All database (HFA-DB) • Organisation for Economic Co-operation and Development (OECD) • Health Care Quality Indicators • OECD Health Data

Ongoing pilot project for implementation of new indicators • Health Expenditure by Diseases and Conditions • Inventory on Morbidity Statistics in The Czech Republic European Core Health Indicators

• The European Community Health Indicators initiative started in 1998 as a project responding to the European Commission’s call to establish a set of public health indicators for the EU.

• European Core Health Indicators (ECHI) indicators are currently considered as a monitoring tool in upcoming implementation of National strategy Health 2020 in the Czech Republic

• ECHI shortlist include following areas for health indicators (88 indicators in total): • Demography and socio-economic situation e.g.: Population, birth rate, total unemployment rate • Health Status e.g.: Life expectancy, HIV/AIDS morbidity, cancer incidence • Determinants of health e.g.: Body mass index, number of regular smokers, total alcohol consumption • Health interventions: health services e.g.: vaccination coverage in children, breast cancer screening coverage, survival rates of cancer patients, average hospital length of stay • Health interventions: health promotion e.g. Policies on environmental tobacco smoke exposure Data sources available for production of health indicators

• National Health Information System (NHIS) • Program of statistical investigations of Ministry of Health • National health registers • Czech National Cancer Registry • National register of hospitalization • National register of reproduction health • National register of cardiovascular surgery and intervention •etc. • National register of providers • National register of health care professionals •etc.

• planned extension of the NHIS • national registry of care reimbursed from public health insurance • data of health insurance companies • crucial in future production of health indicators regarding health services and health interventions, disease morbidity, etc. Thank you for your attention

Oldřich Pospíšil MD FRCS FDSRCS [email protected] Doc. RNDr. Ladislav Dušek, Ph.D. [email protected] Ing. Martin Doležal [email protected] Bc. Alžběta Víchová [email protected]

Bratislava, 27. 5. 2015

6 Health data management in Hungary

Balázs Babarczy 28th May 2015 Objectives

• Facilitating data streams between healthcare providers – Digital patient records – E-Prescriptions – E-Referrals • Providing information for evidence-informed decision making – Linking sectoral databeses together – Creating analytical tools on the provider/sector level – Institutionalising Health System Performance Assessment Actions

• A project for the creation of common coding tables, and a data transmission system in the healthcare sector • A project for the electronic trasmission of patient records • A project for IT infractructure development • A project for developing data analytics and reports • A managerial information system pilot for public hospitals • HSPA in a legal framework Resources

• Patient-level databases of the National Health Insurance Fund • Patient registries • Infrastructure and financial data for state- owned providers • Software, hardware and infrastructural development Motives

• Utilisation of extensive data resources • Streamlining and manageing patient pathways • Designing the optimal system of care provision • Better managing and evaluating care providers • Supporting strategic decision-making Expected outcomes • Up-to-date IT infrasctructure available throughout the healthcare system • Enhanced capacity of using IT services in coding and management at the provider level • More extensive data sources, e.g. on human resources • A more transparent and accountable health system Thank you for your attention! Healthcare Infrastuctural Developments in Hungary

Bence Haidekker 28.05.2015. Financial sources 2007‐2013 • TIOP: Social Infrastructure Operational Programme inpatient and outpatient infrastructural developments, e‐health developments • ROPs, KMOP: regional operational programmes with special remark on Central Hungary OP outpatient and primary care infrastructural developments • KEOP: Environmental protection, energetic modernization • International funds: Swiss, Norwegian and other cross‐border c& transnational cooperation Main targets

• Reduce territorial inequalities between health services •Improve access to health services •Improve effectiveness of health services, promotion of structural reforms Horizontal dimensions: • Territorial cohesion • Sustainable development • Equal opportunity TIOP health developments 2007-2013

Inpatient health service Outpatient health service 286,5 Mrd Ft 28 Mrd Ft Information technology (e‐Health) 10,5 Mrd Ft Expected impacts

• Improvement of an integrated, comprehensive regionally balanced and qualitative healthcare system •increase of healthy years of the population, • reduction of sick leave days Major health investments

• TIOP‐2.3.1, TIOP 2.3.2, TIOP 2.3.3 National e‐health network developments – 10,5 Mrd Ft • TIOP‐ 2.2.3 – Blood supply network development ‐ 3 Mrd Ft • TIOP 2.2. 2 ‐ Development of emergency care services – 12.6 Mrd Ft •TIOP 2.2.5, 2.2.6, Development of oncological centres and network ‐15,7 Mrd Ft • TIOP 2.2. 4– Infrastructural investments of outpatient care services supporting structural reorganization – 105 Mrd Ft •TIOP 2.2.6 Infrastructural investments of out and inpatient care services supporting structural reorganization – 49 Mrd Ft • TIOP2.2 Hospital investments: Kecskemét, Nyíregyháza, Zalaegerszeg, Gyula, Szentes, Győr, Debrecen, Eger, Szeged, Szekszárd, Várpalota, Veszprém, Budapest 2014‐2020

Human Resource Development Operational Programme 2014‐2020. • integrated programme including social developments, social integration, educational, cultural and health developments with a focus on increased level of employment • significantly fewer financial resources for health developments than in 2007‐2013 • pre‐defined thematic objectives given by the EU Focus areas in 2014-2020

Human Resource Development Operational Programme health focus: • Public health programmes, development of health consciousness of the population • Primary care developments focusing on improvement of services in prevention and rehabilitation • Improvement of health services, continuation of structural reform in healthcare • Improvement of mobility of health professionals Thank you for your attention!