Download - Jowett matthew - Innovation in other sectors
MIHealth Forum, Health Management & Clinical Innovation
Barcelona, 24 June 2012
Adding value to health systems
through service delivery reforms
Matthew Jowett Ph.D.
Senior Health Financing Specialist & Acting Head,
WHO Barcelona Office for Health System Strengthening
The challenge
Hospitals: internal coordination
Hospitals: external coordination
Concluding messages
Outline
HEALTH SYSTEMS OPERATING
WITHIN A RAPIDLY CHANGING
ENVIRONMENT
Increasing diabetes
Increasing cancers
Increasing COPDs
Increasing CVDs
Ageing, dementia & growing co-morbidities
Technological advances
Downward pressure on
public finances
6
Ageing, multiple morbidities and dementia
• of 65+ year olds in Australia have three or more chronic conditions 80%
• of general and acute hospital beds in England used by 65+ year olds many with dementia
2/3
• is the projected increase in dementia suffers in Western Europe 2010-2050 93%
The challenge
Hospitals: internal coordination
Hospitals: external coordination
Concluding messages
Role of the hospital under question
Growing quality and patient safety
concerns. Specialists operating in silos.
Rural areas? What is desirable / possible?
Represents a large fixed cost in the health system (inflexibility)
Decentralise where possible, centralise
where deemed necessary
The challenge
Hospitals: internal coordination
Hospitals: external coordination
Concluding messages
Unnecessary admissions - diabetes
Note: Rates are age-sex standardised to 2005 OECD population.
Source: OECD Health Data 2011.
OECD
Unnecessary admissions - asthma
Note: Rates are age-sex standardised to 2005 OECD population.
Source: OECD Health Data 2011.
OECD
Unnecessary admissions - COPD
Note: Rates are age-sex standardised to 2005 OECD population.
Source: OECD Health Data 2011.
OECD
PHC - room for improvement
• Two countries with free and widely accessible primary care (i.e. full coverage)
• Why is there such poor awareness of own blood pressure, low treatment rates, and poor control?
Source: Wolf-Maier, et al. 2004. “Hypertension treatment and control in five European countries, Canada, and the
United States” Hypertension 2004;43;10-17. CREDIT: M. JAKAB
The challenge
Hospitals: internal coordination
Hospitals: external coordination
Concluding messages
CORE RISK FACTORS
UNDERLYING MAJOR CHRONIC
ILLNESSES
Unhealthy diet
Harmful use of
alcohol
Physical inactivity
Tobacco use
FUTURE ACTIONS
Unhealthy diet
Multi-professional
teams
Harmful use of
alcohol
Family doctors as “navigators” throughout
patient pathway
Physical inactivity Align payment
mechanisms & strengthen fiscal
instruments
Tobacco use
Strengthen population-based
interventions
Dietary habits in Finland Population aged 15-64 years (1978-2007)
Butter on bread Vegetables daily Skimmed or 1 %-milk
Women
0
20
40
60
80
Men
0
20
40
60
80 %
Source: National Public Health Institute T (KL)/ Health Behaviour among the Finnish Adult Population (AVTK)
Much spending on inpatient care represents a significant
misallocation of resources
“Persistence of a model of primary care which is fragmented and
often consists of a single doctor with limited support is no longer fit for purpose” (Nigel Edwards, WHO
Europe, April 2012)
Better coordinated and integrated health and
social care
Improvements in health literacy can add significant
value within health systems