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 - ÖSG) and for the regional level (Regional Health Care Structure Plans - RSG) » 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 Institute for Quality Assurance in Health Care - business unit of GÖG) » 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 framework for “Regional Healthcare Structure Plans “(RSGs) of the 9 provinces (Agreement under Art. 15a of Austria’s Constitutional Act, on the Organization and Funding of Health Care) 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