Transcript Diapositivo 1

Hospital planning in Portugal
Jorge Simões
Chair of the Portuguese Health Regulation Authority
Lisbon, 22nd March 2011
Outline
1. The Portuguese Health System
2. The hospital sector in Portugal
3. The case of hospital networks
4. The Portuguese National Health Plan
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Outline
1. The Portuguese Health System
2. The hospital sector in Portugal
3. The case of hospital networks
4. The Portuguese National Health Plan
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The Portuguese Health System
 Based on a National Health Service (NHS), that is:
 Universal – for all citizens
 General – all services for all citizens
 (almost) Free of charge (at the point of service) – only
minor fees to avoid overconsumption
 But with private and public mix in terms of:
 Funding of services
 Delivery of services
…however this mix had important changes over time
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The Portuguese Health System
 Private and public mix in delivery
Proportion of total consultations in private providers, Portugal 2005
Specialty
% private consultations
Dental Care
92,1%
Gynecology
67,6%
Ophthalmology
66,9%
Cardiology
54,2%
Orthopedics
45,5%
Pediatrics
31,1%
Primary care
17,1%
Source: Simões, Barros and Pereira, 2008
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The Portuguese Health System
 Private and public mix in funding (2006)
Public funding
- National Health Service
- Public subsystems
- Other (fiscal deductions)
Private funding
- Private subsistems
- Voluntary health insurance
- Out-of-pocket payments
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71.2%
57.5%
7.1%
5.7%
28.8%
1.9%
2.4%
23.9%
The Portuguese Health System
 Effective solutions to rationalize resource utilization in the
NHS appeared first in the late 90’s:
 1995-2002: NHS reform with emphasis in public and private
sector complementarities
 2002-2004:
• Corporatization of NHS hospitals
• Public-Private Partnerships
• Annual contracting between the Ministry of Health and
each NHS hospital
• Creation of the Portuguese Health Regulatory Authority
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The Portuguese Health System
 2005-2010:
• Creation of hospital centers (integration of hospitals)
• Creation of the national network of integrated long term
care
• Reform of primary care reform
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Outline
1. The Portuguese Health System
2. The hospital sector in Portugal
3. The case of hospital networks
4. The Portuguese National Health Plan
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The hospital sector in Portugal
 Definition of “hospital”
 NHS hospitals: in legislation and contracts - common
characteristics:
• Inpatient care
• Outpatient care (emergency or consultations)
• Diagnostic and therapeutic modalities
 For private: no legal definition of hospital
• We use inpatient care as main characteristic
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The hospital sector in Portugal
 Network of hospitals
Ownership
Number
NHS (public) hospitals
105
Private (for-profit + not-for-profit)
213
Official hospitals (military + paramilitary + prison)
Total
11
329
Sources: ACSS, ERS
 Geographical distribution
 Biased in favor of urban areas
 Concentration is higher for private hospitals
 Correlation of nº. hospitals and population (unit=district): 0,96
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The hospital sector in Portugal
District
No. Public Hospitals
District
No. Private Hospitals
Lisboa
22
Lisboa
64
Porto
16
Porto
51
Coimbra
12
Braga
17
Aveiro
9
Coimbra
15
Leiria
6
Aveiro
11
Setúbal
6
Leiria
10
Braga
5
Faro
7
Santarém
4
Évora
7
Bragança
3
Setúbal
6
Castelo Branco
3
Viseu
5
Faro
3
Viana do Castelo
5
Guarda
3
Castelo Branco
4
Vila Real
3
Santarém
3
Viseu
3
Vila Real
3
Beja
2
Bragança
2
Portalegre
2
Guarda
2
Viana do Castelo
2
Portalegre
1
Évora
1
Beja
0
Portugal mainland
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105
Portugal mainland
12
213
Sources: ACSS, ERS
The hospital sector in Portugal
Public hospitals in districts
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Private hospitals in districts
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Sources: ACSS, ERS
The hospital sector in Portugal
The NHS public hospital sector
 Scale of planning
 National level
 Typology of hospitals
 Reflects the degree of technical differentiation of each hospital
and area of geographical influence:
• Central: higher differentiation + larger area
• District: medium differentiation + medium area
• Level-1: lower differentiation + smaller area
 University hospitals: also provide clinical education and
training to doctors, nurses and other health professionals
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The hospital sector in Portugal
The NHS public hospital sector
Type of hospital
Central hospitals
- General
- Specialized
District hospitals
Level-1 hospitals
Total
Source: ACSS
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Number
41
18
23
45
19
105
The hospital sector in Portugal
The NHS public hospital sector
 Type of management: corporatization of NHS hospitals
 SPA hospitals: under the direct administration of the
Government
 EPE hospitals: corporatized hospitals; remain public property
but differ from SPA hospitals in terms of management
instruments at its disposal (administrative and financial
autonomy)
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The hospital sector in Portugal
The NHS public hospital sector
 Public-Private Partnerships (PPP):
 Service provided jointly by private and public parties, sharing
financial, technical and operational risk;
 Three alternatives in Portugal:
• Only for management of hospital
• Only for construction of hospital
• For management and construction of hospital
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The hospital sector in Portugal
The NHS public hospital sector
Type of management
SPA hospitals
EPE (corporatized) hospitals
PPP hospitals
Total
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Number
38
64
3
105
The hospital sector in Portugal
The NHS public hospital sector
 Integration arrangements
 Hospital Centers: groups of hospitals in the same geographical
area that have centralized management (in the largest hospital
of the group) and share administrative services and have
coordinated services
• 26 (65 hospitals)
 Local Health Units: group of NHS health care providers that
integrates hospitals and primary care centers of the same
geographical area, that have centralized management (in the
largest hospital) and have coordinated services
• 6 (11 hospitals and 54 primary care centers)
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Outline
1. The Portuguese Health System
2. The hospital sector in Portugal
3. The case of hospital networks
4. The Portuguese National Health Plan
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The case of hospital networks
 Hospital network definition
 Integrated and hierarchical system that regulates
complementarity relations and technical support among
all hospital institutions in a region
 Objectives
 Granting access to relevant and timely health care for all
patients
 Optimizing resource utilization
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The case of hospital networks
 The anatomy of a hospital network
 Points of provision
•
•
•
•
Number
Location
Type of services
Human and physical resources
 Geographical area of influence
 Patient and information pathways
 Rules for patient referencing
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The case of hospital networks
 Design and implementation of a hospital network
 Assess health care needs of populations
 Make better use of already installed capacity
 Adapt services to regional and local specificities
 Integrate inpatient and outpatient care
 Integrate in a national wide planning strategy
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The case of hospital networks
 Options of hospital networks
 Option 1: patient referencing rules constitute access
norms for legal enforcement
 Option 2: hospital networks merely with
programmatic/indicative nature
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The case of hospital networks
 Hospital networks in Portugal
 9 enforced by law
Area
Ministerial decision
Gastroenterology
16/06/2008
Cardiac intervention
08/10/1999 e 18/07/2001
Immunoallergology
01/03/2002
Rehabilitation medicine
26/03/2002
Neurology
18/07/2001
Nephrology
26/03/2002
Oncology / Paediatric Oncology
17/01/2002
Rheumatology
07/04/2000 e 26/03/2002
Urgency and Emergency
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14/11/2001
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The case of hospital networks
 Hospital networks in Portugal
 12 without legal definition
Anatomic Pathology
Intensive Care
Vascular Surgery
Endocrinology
Medical Genetics
Infectology
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Mother and child health
Ophthalmology
Mental health
Transplantation
Urology
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The case of hospital networks
 Some facts (difficulties) about hospital networks in
Portugal
 Definition of rules and strategies that cannot be put in
practice due to resource restrictions
 Referencing rules are merely programmatic and
indicative, and cannot be legally enforced
 Incompatible with other planning instruments of the
Portuguese NHS (e.g., contacts between hospitals and
the Government)
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Outline
1. The Portuguese Health System
2. The hospital sector in Portugal
3. The case of hospital networks
4. The Portuguese National Health Plan
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The Portuguese National Health Plan
 What is a National Health Plan (NHP)
 It’s a strategic instrument that allows for coherent health
policy alignment, with the scope of maximizing health
gains for the general population.
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The Portuguese National Health Plan
 The 2004-2010 Portuguese NHP
 Core strategic goals
• Achieving health gains
• Defining instruments for implementation
 Starting point
• Potential for illness absence
• The Portuguese Health System
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The Portuguese National Health Plan
 WHO evaluation of the Portuguese 2004-2010 NHP
Good:
 The NHP was well received and promoted a broad
consensus over health priorities
 Portugal achieved many health targets
 Most indicators showed improvements, with gaps to
European averages declining
 The NHP provided a comprehensive benchmark for
organizing health system activities
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The Portuguese National Health Plan
 WHO evaluation of the Portuguese 2004-2010 NHP
Not so good:
 Poor link with governing instruments (contracting,
regulation, performance indicators)
 Future performance may be compromised by unhealthy
life styles, unsustainable health system and large health
inequities
 This requires that the next NHP must be strongly oriented
to the strengthening of the health system and to the
achievement of sustainable health gains
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The Portuguese National Health Plan
 The 2011-2016 Portuguese NHP: Conceptual Framework
 Maximizing health gains for the population through the
alignment and integration of sustainable efforts from all
sectors
 Focus on access, quality and citizenship.
More
Health
Mais
valor
emValue
saúde
Cidadania
CITIZENSHIP
Políticas
saudáveis
HEATLH POLICIES
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The Portuguese National Health Plan
 The 2011-2016 Portuguese NHP: critical aspects
 To constitute a reference for the health system
 To embody a vision of health gains
 To develop a model of health planning
 To capitalize and improve the performance of all involved
 To define mechanisms of monitoring and assessment
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