Transcript Diapositivo 1 - Institut for Statskundskab

Critical Governance
in Health in Portugal
Presented by:
Clara Michele Bruheim – [email protected]
Authors:
Maria Vitória Mourão – [email protected]
Clara Michele Bruheim – [email protected]
Patrícia Campaniço – [email protected]
5th International Conference
The financial crisis, welfare state challenges and new
forms of risk management
Store Restrup Herregaard
March 2th – 4th 2011
Overview
• Background
• Objectives
▫ General Objectives
▫ Specific Objectives
• Methodology
• Results
• Conclusion
Background (1)
•Economic and
Financial Crisis:
Enhance of
growth of the national
population's
Growth of
needs in using
Investment in
Health services
Health Care
increased life
Responsibility to
Investment of
expectancy and more
provide efficient
9.8% of GDP
deficit and
unemployment
•Ageing population,
chronic patients
Health care
(Barros and Simões, 2007: XV)
•Technological
innovations
Background (2)
• Optimization of invested
resources in Health
• Organization and
Coordination
Improvement of the
National Health System
Aim of the Study
Objectives (1)
• General Objectives
1)Clarify the planning and response mechanisms to take the most of
investment and increase the effectiveness of the National Health
Service, as well as the satisfaction of individuals needs and
expectations;
2)Reveal the relationship between the public debate on costs and
quality of Health in Portugal and the formulation of new ways of
governance;
3)Assess the risk of different levels of health care for those who are
only users of the National Health Service and to holders of agreements
with sub-health systems or private insurance beneficiaries.
Objectives (2)
• Specific Objectives
1)Identify priority areas of health governance, given the current
backdrop of economic and financial crisis;
2)Build a framework of responses to major points of vulnerability of
Health Governance, namely: the financing of the National Health
System; the negotiations with suppliers of the Ministry of Health; the
management of human resources in Health, the role of the Citizen in
strengthening the social contract in Health Access to health care; the
waiting lists for surgeries and consultations; and the public-private
partnerships.
Methodology
•
Qualitative methodology
•
Literature review and document analysis of secondary
statistical sources
•
In-depth interviews to 9 privileged stakeholders in health,
chosen by snowball - 3 health professionals, 3 policy makers
and 3 experts in the field- using an interview guide, in the
months of January and February 2011
•
Content analysis
Results (1) - Financing of the National Health
Service in a crisis context
 Current health expenditure in Portugal is not excessive compared in absolute
terms with other OECD countries
To optimize investment and improve the efficiency of the system
 Increase tax revenue from the profits of large economic and financial groups;
 Reduce waste and inefficiencies;
 Strengthen the network of primary and preventive care
 Optimize technological resources
 Electronic prescription of medicines and diagnostic methods, electronic health
record
 Prescription by International Denomination of substances
 Increase the use of generics
 Long-term negotiations with the suppliers of the Ministry of Health
Results (2) - Human Resources Management
Strategic management of human resources
 Definition of the ratio of professionals per inhabitant
 Require full-time schedules and an exclusive dedication of
professionals
 Give more stability to professionals and dignify careers
 Assign roles to nurses to release doctors
 Have an effective top governance, independent of political interests,
which articulate the action of the various organisms
 Recruitment to positions according to skills and professional profiles
and a good monitoring of professionals’ activities.
Results (3) - The reinforcement of the Health
social contract: the role of the citizen
Health
System
Civil Society
Active
participation of
Information and
the Citizen
Communication
Citizen
Technologies
Health Literacy
Promotion of
Prevention and
Education on Health
Results (4) - Access to health care: the right to
health as a fundamental right
• Barriers to access health care
• Access to health care
▫ Portuguese Constitution - the right of access to health care, through the National Health
Service
▫ The private sector (profit and nonprofit) - a complementary role in health care
▫ The non-profit sector or third sector - important role in access to healthcare for vulnerable
populations - importance to define and regulate the role of the social sector
• Waiting Lists
▫ Improved response to waiting lists
▫ Promotion of publication of the waiting times
▫ Diagnosis and evaluation of waiting lists
▫ Redefining the roles of health professionals
▫ Better management and human resources planning
▫ Strengthening Primary health care
Results (5) - Public-private partnerships with
the Profitable sector
• Adverse opinions are based:
▫ in the absence of public interest of these partnerships
▫ In confusion between public and private money
▫ In the need to have an evaluation and technical assessment to
those partnerships that don't exist
• The risk of arising of two levels of performance, one to the users of
the National Health Service and other to holders of agreements with
sub-health systems or private insurance beneficiaries
Conclusions (1)
Crisis situation and the risks
the need for decisions
To transform the unforeseen consequences of decisions
additional mechanisms introduction of cost containment
• The Funding of National Health Service: public debate of the state budget and the reduction of
waste and inefficiencies;
• The medicine policies: negotiations with suppliers over the long term; ready-payment of goods;
prescription taking into account the user’s clinical and financial situation; and promoting generics
use;
• The Health’s human resources: human resources planning and management and training;
dignity of medical careers; status of exclusivity and increased availability, and people’s nomination
to positions based on principles of competency and job profiles ;
Conclusions (2)
• The Health social contract: strengthening the contract, and the citizen’s role;
• The access to health care: the social sector’s role and strengthening primary care;
• The Waiting lists for consultations and surgeries: publishing of the maximum terms
for consultations and surgery; diagnosis, monitoring and evaluation of waiting lists; and
strengthening primary care;
• And the public-private partnerships with the profitable sector: partnerships with a
clear public interest; and regulation, inspection and evaluation of partnerships.
The debate about costs and quality of health in Portugal generates new forms
of governance
Risk as a social construction that legitimizes certain governmental practices
Thank you for your attention
For more information,
Please Contact:
Michele Bruheim
Research Fellow
Centre for Public Admnistration and Public Policies and Public Policy
(CAPP)
Institute of Social and Political Sciences (ISCSP)
Technical University of Lisbon (UTL)
Rua Almerindo Lessa 1300-663 Lisboa
Tel: [+351] 21 361 94 30 Ext.3223
Fax:[+351] 21 361 94 42
Mob.: [+351] 91 825 85 54
E-mail:[email protected]
Patrícia Campaniço
Research Fellow
Centre for Public Admnistration and Public Policies and Public Policy
(CAPP)
Institute of Social and Political Sciences (ISCSP)
Technical University of Lisbon (UTL)
Rua Almerindo Lessa 1300-663 Lisboa
Tel: [+351] 21 361 94 30 Ext.3224
Fax:[+351] 21 361 94 42
Mob.: [+351] 96 44 24 86
Skype: patricia.campanico
E-mail:[email protected]