Transcript Slide 1

Republic of Serbia
MINISTRY OF HEALTH
Politicians and policy makers –
where are managers in policy creation?
An inclusive approach for Tertiary health care policy in Serbia
Katrava A,
Jekić I.M, Boulton G, Rupert P, Christensen SB, Obrovački M, Novak S, Janković-Vuković T,
Đukić V*, Peško P*, Dmitrović T*, Drašković D** Dujmović F**, Trenkić S***,Pavlović R****
*
**
***
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EAR/EU SOFRECO Technical Assistance-TA Team, Belgrade
Clinical Centre of Serbia, Belgrade
Clinical Centre of Vojvodina, Novi Sad
Clincal Centre of Niš
Clinical Centre of Kragujevac
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Context
Background / Current situation
Methods
Results
Conclusions
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Context
Traditionally, politicians and policy makers dictate to health care
institutions managers national strategy for service delivery.
The EU/EAR Project provided to the Ministry of Health-MoH has
been charged with
1. reforming tertiary care services
2. developing and implementing 4 CC’s business plans and introducing
change management training
3. implementing an EIB loan of EUR 200M (project value EUR 280M )
for reconstruction and reequipping of the 4 beneficiary institutions:
–
Clinical Centres in Belgrade, Novi Sad, Nis and Kragujevac.
All policy decisions made at a political level and in these 4 out of
120 inpatient institutions will have a trickle down effect to the rest
of the system for
•
•
•
patient care
teaching
research
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
CONTEXT
HOSPITAL SYSTEM IN THE RS
Inpatient health institutions in the RS
MoH - Govt’ Agencies - HIF - PHI
122 inpatient institutions*
High
THC
Cost
SHC
4 + 24 = 28
4 CC
4 CHC, 5 Clinics, 15 Institutes
56
(40 General hospitals,16
Special hospitals)
PHC
38
(20 DZ, 18 zavodi)
Low
Primary HC – outpatient care
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Chronic / prolonged / palliative care
Context
4 Clinical Centers of Serbia
•The four Clinical Centres, with
– over 14.000 employees
– approx.
240.000 admissions
– approx.
110.000 surgeries and
– approx.
1.745.000 outpatients visits
– approx.
270.000 emergency visits
– approx.
222.000.000 EUR annual operating budget
represent one-quarter of the activity and budget of the Serbian health care system,
and are leaders for innovative changes in other sectors (primary and secondary
health care).
•Managers of this small number of big institutions are increasingly asked to be
members of policy bodies, along side top opinion leaders in the country - and they
are influencing change at many levels.
•THC policy and renewed services delivery model is to be implemented by
managers in the four Clinical Centres.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Background
•In Europe, HC systems are gradually
shifting from centrally to regionally and
locally regulated and financed HC systems
•Traditionally, in the Serbian health care
system policy and decision-making is
centrally planned, regulated and managed.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Context
Fundamentals that will transform
the health care system
• Economic pressures will mount – annual budget – approx.
EUR 220 mil – increase 2,5 times over last 5 years
• Professional expectations are growing about delivery patterns
to which Serbian health care system should aspire – overall
over 14.000 employees – over 1000 University Professors and
over 2500 MD
• Patient expectations about health service will rise in the years
ahead – over 2.300.000 patients annually – over 110.000
surgeries
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Background
Administration of the Serbian Public Health Care
System
GOVERNMENT
MINISTER OF HEALTH
NATIONAL HEALTH COUNCIL
HEALTH INSURANCE FUND
NATIONAL ETHICS BOARD
DEPUTY MINISTER OF HEALTH
NATIONAL AGENCY FOR
ACCREDITATION OF HEALTH CARE
FACILITIES
ASSISTANT MINISTERS
NATIONAL PUBLIC HEALTH
INSTITUTE
Health Policy
+ Planning
Health Insurance
+ Financing
Sanitary
Inspection +
Public Health
International
Relations + Project
Coordination
Organization of
Health Service
+ for Health
Inspection
PRIMARY HEALTH
CARE CENTERS
REGIONAL +
MUNICIPAL
OFFICES
HOSPITALS
PATIENTS
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
REGIONAL +
MUNICIPAL
OFFICES
CURRENT SITUATION – Legal framework
to address strategic planning /
Reform of the THC services
For tertiary level health care the current Health Law and various decrees suggest that
tertiary level services should :
Occupy approximately 6,000 beds representing 0.8 per 1,000 population
Much of the current law and regulation concentrates on “inputs” (size of facility, staff
numbers, equipment etc.), whereas contemporary THC planning (and indeed primary
and secondary care planning) should focus on:
–
–
–
An overall service perspective (rather than an institutional perspective) covering the whole
range of health care interventions for particular patient groups and the identification of the
respective role of each level of health care in the health care continuum (e.g. the cancer
network);
Outputs, types of output and outcomes (e.g. cardiac surgery – numbers and types of
revascularization procedures) with inputs being inferred from outputs, using a variety of
quantitative and qualitative measures;
Matching service need/demand with viable units of clinical organization from the
perspectives of clinical and economic effectiveness (given that a number of tertiary level
services often require access to high cost infrastructure and technologies), affordability and
clinical governance.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Hospital system in the RS – Facts and figures
Tertiary health care, number of beds per 1000 population
North
Central
South
Catchment area
THC beds per 1000 pop
1.7 M population
1.5 per 1000 pop.
3.2 M population**
2.5 per 1000 pop.
2.6 M population
1.1 per 1000 pop.
7.5 M population
Target: 0.8 per 1000 pop.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
CURRENT SITUATION – Inefficiencies and Drawbacks created by the
current situation
Lack of strategic planning of network and health services over the
past 15 years.
Weakness of refferal system.
Hospital and health sector standards (set by IPH) are rigid,
historical, normative, and largely input – based are not related
to new organisational models and modernisation.
Hospital reimbursement systems are not linked to efficiency,
effectivness, output and performance (outcome). The change
alone would have a profound impact on the size and nature of the
hospital network.
Data systems at hospital level are extensive, yet information for
operational and performance management of a large modern
health care and hospital system is inadequate and under developed.
The application of inconsistent data definitions, the quality assurance of
data and variable methods of dealing with data, hampers reliable inter
regional and inter hospital comparison.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
CURRENT SITUATION
Limitations of current legislation underpinning services
planning
Services planning is occurring in context of significant
organizational change
Legislation has its part to play in facilitating or hindering such
change
However, there is recognition of the complexity of health
care environment and stakeholders within it
In an attempt to introduce services planning as strategic
planning involving key stakeholders/managers
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Methods
•The EU/EAR Project inclusive approach that links
–organizational change in institutions and
–policy change at a national level
•is endorsed by the MoH, and for the first time provides the
opportunity for mangers to be involved in both.
•For the first time, planning at a national level
–is service/patient group rather than institution based
–involves practitioners
•managers in Tertiary Health Care - THC institutions - providers
•Institute for Public Health-IPH - planners
•Health Insurance Fund-HIF – purchasers
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Methods
Health sector reform – strategic shifts in future role and
organisation of the hospital sector
Improve accessibility to tertiary level care for patients.
Move from input – based planning (eg.size of facility,
number of staff, equipment etc.) to focus more on
outputs (eg. cardiac surgery – number and types of
revascularization procedures) and outcomes (eg.
improved health status of population)
Role of standards, accreditations and clinical
guidelines.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
The Goal
MoH aim is, to produce a modern tertiary health care policy for
Serbia and to establish distinct policy development, business
planning, commissioning and financing and performance
management processes and capacities for tertiary level health
care.
Appropriate CARE, in the appropriate SETTING, at the
appropriate TIME
Major issues :
•
Access to Care
•
Quality of Care
•
Cost of Care
The extent of the health system contribution of the 4 CCs means that
any change in their organization and financing aimed to
enchance efficiency and quality will have a further “trickle down”
positive impact on the entire health care system.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Methods – to achieve the goal
•The official EAR/TA mechanisms include:
–Project Steering Committee
–THC Expert Group and Task Forces (mandated by
the Ministerial Decree)
–the Clinical Centres Senior Managment
–Clinical Directors
–Business Planning Work Groups
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
EIB
EAR/TA
MoH/
THC Expert group
Tertiary
Healthcare
Strategy/ Policy
in Serbia
(National level)
National
level THC Task
Forces
(by specialty)
Institute’s
Management
CC BP
Work
Groups
Business
Plans for
each CC
CC Senior
Management
Design
Master Plan
for each CC
MoH/PIU
EIB
EAR/TA
EIB
EAR /TA
Design &
Supervision
Consultants
Results
•Areas the MoH is seeking advice on include:
– THC service provision models
– Organizational structure of institutions
– Redefinition of capacity plans and capital investments
(facilities and equipment) for THC institutions and redefined
THC services
– HR planning
– Models for financing of and contracting with THC
institutions
– Health technology assessment (HTA)
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Results
•Since establishment in June 2006
–THC Expert Group has developed, completed and
presented most general parts of the THC policy
–now needs to address the more detailed issues to
convert THC policy into strategy.
•Additionally, THC service-specific Task Forces
have been formed by Ministerial Decree to advise
on practical issues of
– THC policy, strategy and implementation
– for Serbia’s three population catchment areas (North,
Center and South) until end 2008.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Results - Implementation Possibilities
THC Services
Policy and Strategy Implementation
MoH THC Expert Group with EAR/TA Tertiary Care Project:
Definition for THC in the RS
Criteria for identifying tertiary level care services
Categorisation and Classification of Tertiary level care
(national level provision, regional level provision and
complex case - mix)
Task Forces (specialty/patient group - specific) to be
established in January 2008 for tertiary level service
planning and organisation of care delivery across the
network
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Results
•Hospital Managers of 4 big university
institutions and their teams are increasingly
involved in THC policy development through
all mentioned bodies and mechanisms.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Conclusions
3 steps towards a healthy and viable future
Build bridges / network partnerships across the 3 levels of care
– Pivotal role of physicians/managers
– Relationship building
• Leadership and trust
• Incremental and “ big – bang ” approach
– Alligned incentives
Enhance efficiency and quality
– Invest in modern management tools
• Build HR talent and core competencies
• Capable managers need access to appropriate information to enhance decision - making
• Need standard coding system (activity and financial data, diagnostic procedures)
– Measure outcomes
• Data performance tools (activity and financial data – ABC)
Patient empowerment
– Informed patients – access to information
– Active participation in process / well - being
– Manage expectations
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
THANK YOU
Annette Katrava
Deputy Team Leader & Hospital Manager
EAR/EU Project
Capacity Building of the Ministry of Health for
Tertiary Care Services
Technical Assistance – TA Sofreco Project Office
11000 Belgrade, Serbia
Pasterova st. 1/III
[email protected]
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction