Transcript Slide 1

AIGARS MIEZITIS
4 September 2012
eu.baltic.net
Part-financed by the European Union
(European Regional Development Fund and European
Neighbourhood and Partnership Instrument)
Dynamics of Health Care Budget Expenditures
Mill/LVL
600.00
576.59
500.00
518.09
503.73
496.05
486.54
400.00
432.78
414.21
414.46
300.00
296.82
200.00
245.17
100.00
0.00
2004 gads
2005 gads
2006 gads
2007 gads
2008 gads
2009.gads
noslēgums
2010.gads
budžets
2010.gads
budžets ar MK
un FM rīk.
(uz 20.12.10)
Sagatavots Veselības ministrijā
2011 gada
apstiprinātais
budžets
17/07/2015
2012 gads
akceptēts MK
20.11.2010
2
Health Care Reform
Limited Access
More Access
Limited
Funding
COLLAPSE
Limited
Funding
COLLAPSE
Basic
Care
for all
More
Access
(bread & H2O)
Basic Care for all
More care for some; same care for
(bread
& H2O)
Robust
Funding
Back to the 90s
Utopia
Robust
Funding
Back to the 90s
Utopia
Limited Access
most (moving on)
More care for some; same
care for most (moving on)
Clyde Yancy, MD Baylor Heart and Vascular Center
Purchaser
Provider
Cover the costs
Fairly and predictable
Transparent
Long term conditions
Incentives
Control of the costs
Allocate resources
Transparent
Pay for performance
Good quality
Increased production
Flexible
Cost efficient
• The payments are not based on quality
• A large number of people who are exempt from
paying patient fees
• The proportion of the public health care budget
resources allocated for inpatient care is too
high
• Insufficient availability of PHC
• Insufficient number of nurses in proportion to
the numbers of doctors and patients
• Insufficient use of e-health solutions in health
care resource planning
1%
3%
21%
36%
1%
11%
2%
4%
10%
11%
Capitation
Premium for quality based on monthly indicators
Payment based on manipulations
Allowance for practice
Compensation of patient copayment
Other allowances
Payment for short-term registered and unregistered patients
Extra for nurse and GP assistant
Payment for Secondary Ambulatory services
Premium for quality based on yearly indicators

Objective is to increase
Value = outcomes relative to costs
Costs
Clinical
processes
Outcomes
7
Redistribution of financial flow inside health
care system
2009
2011
Outpatient care
24.0
30.0
Inpatient care
40.7
30.0
Reimbursement of pharmaceuticals
12.4
12.0
Emergency Health Care
4.0
5.0
Health promotion
1.3
2.6
Other (education, capital investments,
international obligations, administrative costs)
17.6
20.4
8






To strength organization of PHC practice
To increase accessibility of GP
To promote the GP active involvement in disease
prevention
To ensure more effective management of patients
with chronic diseases
To tackle the spread of infectious diseases
To motivate GP-s to provide broad range of health
services to patients




Quality and Outcomes Framework was introduced
in Egland in 2004.
It incentivises family doctors (FD) to improve
their services to patients, including improved
clinical care and better outcomes.
It is a way how to reward family doctor practices
(NOT individual FD) for meeting higher standards
in quality of care.
QOF operates through a system of points which
are awarded for levels of achievement against set
criteria and for which FD receive financial reward.



1.
2.
3.
Quality Bonus System which is paid once a year
retrospectively;
The aim of the QBS is to promote active
involvement of family doctors in disease
prevention, tackle the spread of infectious
diseases, ensure more effective chronic disease
management in the community and to provide a
broad range of health services.
There are three main indicator domains:
Prevention
Chronic disease management
Additional skills from family doctor
1.
2.
Capitation
Quality Bonus System (QBS), open to
family doctors on a voluntary basis
Prevention
eg check-up, vaccination, screening
II.
Chronic conditions
OUTCOMES
I.
eg diabetes, hypertension
Increase Minor surgery, pregnancy care,
Reduce referrals, hospitalization rate
IV.
COSTS
III. Increase of cost efficiency of Health
Care system
Organization
Support of use IT solutions
13








Voluntary scheme with status as a ‘measure of
excellence’
Criteria for entry into scheme
A single scheme applying only to family doctors
Indicators within control or influence of the family
doctor
Audit trail
Targets have to be ‘absolute’ not comparative
Target ranges based on evidence
No ‘exception reporting’
14
The National Health Service Latvia
31 k-3 Cesu Street
Riga, Latvia, LV-1012
Aigars Miezitis
ImPrim Project
[email protected]
SFAM.Q - Diabetes
Criteria
What’s important for a good Quality of Care?
1. A healthy life-style
Normal weight
Physical activity
Smokefree
2. B-glucose control
3. BP control
4. Hyperlipidemi therapy
5. Regular fundus control
6. Regular check up of feet
7. Regular control of microalbuminuria
8. Patients self-management and knowledge about their
disease (co-production).
SFAM.Q - Diabetes
Indicators
How do we measure quality of care??
1. Proportions of patients with data on
BMI, Physical activity and Smoking habits
2. Proportion of pat.s with data on
a) HbA1C and Proportion of pat.s w HbA1C <6,5
3. Proportion of pat.s w BP ≤130/80
4. Proportion f pat.s w T-Chol check last 2 ys
And proportion of those with <5,0
5-7. Proportion of patients having made a check up
of fundus,
feet,
Microalbuminuria
and
8. Is there an individual plan for this patient?
SFAM.Q - Diabetes
Standards
What goals do we have??
1. Proportions of patients with data on
BMI (90%), Physical activity (70%) and Smoking habits (90%) and
<20% smokers
2. Proportion of pat.s with data on
a) HbA1C (90%) and Proportion of pat.s w HbA1C <6,5 (70%)
3. Proportion of pat.s w BP ≤130/80 (50%)
4. Proportion f pat.s w T-Chol check last 2 ys (65%)
And proportion of those with <5,0 (30%)
5-7. Proportion of patients having made a check up
of fundus, (100%)
feet, (100%)
Microalbuminuria (70%)
and
8. Is there an individual plan for this patient? (50%)
SFAM.Q - Diabetes
Standards
How do we measure this??
Check up 10-20 records for patients with diabetes per doctor
and make your notes
If you want to make it more easy start with
HbA1C, T-Chol, fundus controls, control of feet, proportion of patients w BP
<130/80 and the use of an individual treatment programme
Quality work from GPs’ perspective
The APO audit method
The APO audit method
• Diabetes audit in Sothern Sweden:
• Physicians and nurses in PHC and Secondary
Care
• Patients, 3 groups:
– Children. Adults - Type 1 and Type 2
• Barbara Starfield, ACG Case Mix:
– Case Mix Audit. Physicians and patients