Transcript Former US Surgeon General,

Healthcare Systems in Small
Caribbean Communities
Health Care Conference Aruba:
Better Together
Oranjestad, Aruba
June 1, 2015
M. Joycelyn Elders, MD
Health Care Resources - Aruba
• Population – 103,000
• Health care is single payer and universal
coverage - AZV
• Healthcare expenditures 8.4% of GDP
• 21rst century primary, secondary, tertiary and
emergency services available for all
• Medical Schools – 0 (2 private foreign schools)
• Full service hospital – 1 (290 beds)
• Department of Health
• Eldercare (SABA)
Health Policies
• Informed by health guidelines and standards of
The Netherlands as well as International Health
Regulations and World Health Organization
• Health System stewardship guided by the
Ministry of Health
Vision for the 21rst Century
• Healthy People in Healthy Communities
• Healthcare system that is available, affordable,
accessible and crisis responsive
• Patient-centered, prevention-focused, purposedriven, solution-oriented
• Fosters individual responsibility, human dignity;
improves health status & enhances quality of life
• Healthcare system that is transparent, patientcentered, equitable
• Design & develop a consumer responsive
healthcare system for diverse communities.
If we do not change our
direction,
we are likely
to end up
where we are
headed.
Ancient Chinese Proverb
We must transform our present Sickcare
System into a Healthcare System
Sickcare
System
Transformational
Leaders
Health
Care
System
Engineering a Better Health Care System A
Report From the US President’s Council of
Advisors on Science and Technology
JAMA August 27, 2014 Vol: 312, No. 8, p 787
• Transformation of healthcare delivery is
essential to the linked goals of
affordability, quality of care and healthy
communities.
• Leveraging scientific knowledge to
transform healthcare delivery
US President’s Council of Advisors on Science and
Technology (PCAST) Recommendations
• Better alignment of payment systems with outcomes
• Increase access to relevant health data and analytics.
• Technical assistance in systems engineering
approaches
• Involve communities in improving healthcare delivery.
• Shared lessons from successful efforts
• Train healthcare professionals in new skills and
approaches – systems engineering
Health Goals of the USA – 2020
A Society in which all people live long healthy lives
• Overarching Goals:
–Attain high quality, longer lives free of
preventable disease, disability, injury, and
premature death.
–Achieve health equity, eliminate disparities, and
improve the health of all groups.
–Create social and physical environments that
promote good health for all.
–Promote quality of life, healthy development
and healthy behaviors across all life stages.
IOM Report on Core Metrics for
Health and Healthcare
• Core metrics for better health at lower cost.
–Life expectancy
–Well being (self-reported health status}
–Overweight and obesity
–Addictive behavior
–Unintended pregnancy
–Healthy communities
–Preventive services
IOM Report, continued
–Access to care (Care needed in timely
fashion)
–Evidence-based care
–Care matched with patient goals
–Personal spending burden
–Population spending burden
–Individual engagement
–Community engagement
–Patient safety (www.iom.edu/coremetrics)
Major Problems of Healthcare Systems
• Access
• Provider, Financial, Cultural, Transportation
• Cost
– Costs too much, delivers too little
– Lack of resources, low premiums, high
cost of meds, cost of services abroad
• Quality
– Gross lapses in quality of care
– Major health disparities
– Lack of transparency
Reasons for Increased Cost
of Health Care
•
•
•
•
•
•
•
Increasing number of elderly – living longer
Greater burden of chronic disease
More medications used
Improved technology
Higher rates of hospitalizations
Increased use of nursing facilities
ADL need for 40% for >age 85
Factors Affecting Our Health
• Poverty
– What are the effects of poverty?
• Lack of Health Care, Education, Housing, Food
• Crime, Stress in children & adults, Poor environment
• Lack of education
– How do we reach people for education?
• Home, TV, Books, Online, Schools and Colleges, Churches
• Risky behaviors
– How you live life more critical to longevity than genetics
• Tobacco use, Alcohol & drug abuse, Car crashes, Obesity
• Access to health care
– Provider, Financial, Cultural, Transportation, Time
Major Determinants of Health
Social and behavioral factors
50%
Environment
20%
Genetics
20%
Access to care
10%
The Social Determinants Framework
Health Care
Depressed
immune system
& Chronic
Neuroendocrine
activation
Overall
Health
& WellBeing
Education
Stress
Housing
Social
Physical
Genetic
Policy
Environment
Work
Local
Environment
Health
Community
Outcomes
Income
And
Individual
Transportation
Racism
Criminal
Poor
Justice
Health
Individual
Social
Behaviors
Economic Concerns
Material
Policy
Deprivation
Criteria for Selecting
Rural Health Priorities
•
•
•
•
•
•
•
•
Identified by rural people as high priority
Rural vs. Urban prevalence
Impact of the issue on mortality
Impact of the issue on morbidity
Risk factors on other health problems
Conditions causes are known
Solutions are available
Community interventions are known to work
Top 10 Health Concerns of People
Living in Rural Areas
• Access to Quality Health
Services
–
–
–
–
–
Physician access
Financial access
Transportation access
Cultural access
EMS, LTC
• Cancer in rural areas
• Diabetes in rural areas
• Heart Disease
• Maternal, infant & child
health issues
• Mental health and mental
disorders
• Nutrition & overweight
• Oral health
• Substance abuse
• Tobacco use
Other Areas of High Priority
in Rural Health
•
•
•
•
•
•
Education & community based programs
Public health infrastructure
Immunizations & infectious disease
Injury & violence prevention
Family planning
Environmental health
Access to LTC in Rural Areas
•
•
•
•
•
•
•
•
•
•
By 2030, elderly pop. will double
1/5 of US pop will be >age 65
75% of those >65 will suffer at least 1 chronic disease
22% of US elderly reside in rural areas
Rural elderly are 12.8% vs. urban pop elderly 12.3%
Elderly in rural areas receive fewer and narrower range of
services
Less well-educated, poorer
Assisted living – 76% urban
Nursing homes – highest rate in rural areas
Majority of LTC provided by informal network
Major Barriers to Health Care in Small
Communities
•
•
•
•
•
•
•
Lack of providers
Limited knowledge of resources
Isolation
Socioeconomic factors
Lack of coordination of services
Culture
Education
Ways to Improve Healthcare Delivery
•
•
•
•
•
•
•
•
Improve transparency
Better understand social determinants of health
Encourage better health behaviors
Reward primary care
Improve information technology, HIT, EHR
Implement a team approach to care
Empower patients – Patient-centered Health Care
Create a unified system of care.
New Technologies as Aids for Rural
Health Care - Telehealth
• EKG using smart phone apps + sensors
• Blood drops instead of test tubes of blood for
200 or more tests
• Blood pressure with smart phone
• Virtual consultations. Patient travels to
center to consult with specialist via internet
• E-visits through video or Skype with
telephone or computer.
• HIT, e-charts
7 Characteristics of Healthy People
• Eat breakfast
• High fiber, low saturated fat diet
•
•
•
•
•
with 3 meals and 3 snacks daily
Exercise 20-30 minutes
7 - 8 hours sleep
Don’t smoke
Drink only in moderation
Responsible sexual behavior
8 Tests to Save Your Life
•
•
•
•
•
•
•
•
Height, weight – BMI
BP
Mammogram
PAP or PSA
Lipid profile
Hgb A1C, HIV
ECHO, EKG
Colonoscopy
Strategies for Solutions to Common
Health Problems
•
•
•
•
•
•
•
•
Collaboration strategies
Educational strategies
Access strategies
Prevention strategies
Intervention strategies
Research strategies
Political strategies
Leadership strategies
5 C’s of Leadership – Clarity of vision,
Consistency, Competency, Commitment,
Control
What Do We Know?
Better Together
• Partners
–Program, Policies, Partnerships
–Aware, Advocate, Action plan
–Reach out, Responsible
–Technology, Together, Tools of commitment
–Network, Novel ideas
–Educate, Empower, Elucidate
–Research, Resources
–Successful, Services
What Is Our Role?
Save the Community
• THE END