MIHealth Forum, Health Management & Clinical Innovation

Barcelona, 24 June 2012

Adding value to health systems

through service delivery reforms

Matthew Jowett Ph.D.

Senior Health Financing Specialist & Acting Head,

WHO Barcelona Office for Health System Strengthening

The challenge

Hospitals: internal coordination

Hospitals: external coordination

Concluding messages

Outline

HEALTH SYSTEMS OPERATING

WITHIN A RAPIDLY CHANGING

ENVIRONMENT

Increasing diabetes

Increasing cancers

Increasing COPDs

Increasing CVDs

Ageing, dementia & growing co-morbidities

Technological advances

Downward pressure on

public finances

6

Ageing, multiple morbidities and dementia

• of 65+ year olds in Australia have three or more chronic conditions 80%

• of general and acute hospital beds in England used by 65+ year olds many with dementia

2/3

• is the projected increase in dementia suffers in Western Europe 2010-2050 93%

The challenge

Hospitals: internal coordination

Hospitals: external coordination

Concluding messages

Role of the hospital under question

Growing quality and patient safety

concerns. Specialists operating in silos.

Rural areas? What is desirable / possible?

Represents a large fixed cost in the health system (inflexibility)

Decentralise where possible, centralise

where deemed necessary

The challenge

Hospitals: internal coordination

Hospitals: external coordination

Concluding messages

Unnecessary admissions - diabetes

Note: Rates are age-sex standardised to 2005 OECD population.

Source: OECD Health Data 2011.

OECD

Unnecessary admissions - asthma

Note: Rates are age-sex standardised to 2005 OECD population.

Source: OECD Health Data 2011.

OECD

Unnecessary admissions - COPD

Note: Rates are age-sex standardised to 2005 OECD population.

Source: OECD Health Data 2011.

OECD

PHC - room for improvement

• Two countries with free and widely accessible primary care (i.e. full coverage)

• Why is there such poor awareness of own blood pressure, low treatment rates, and poor control?

Source: Wolf-Maier, et al. 2004. “Hypertension treatment and control in five European countries, Canada, and the

United States” Hypertension 2004;43;10-17. CREDIT: M. JAKAB

The challenge

Hospitals: internal coordination

Hospitals: external coordination

Concluding messages

CORE RISK FACTORS

UNDERLYING MAJOR CHRONIC

ILLNESSES

Unhealthy diet

Harmful use of

alcohol

Physical inactivity

Tobacco use

FUTURE ACTIONS

Unhealthy diet

Multi-professional

teams

Harmful use of

alcohol

Family doctors as “navigators” throughout

patient pathway

Physical inactivity Align payment

mechanisms & strengthen fiscal

instruments

Tobacco use

Strengthen population-based

interventions

Dietary habits in Finland Population aged 15-64 years (1978-2007)

Butter on bread Vegetables daily Skimmed or 1 %-milk

Women

0

20

40

60

80

Men

0

20

40

60

80 %

Source: National Public Health Institute T (KL)/ Health Behaviour among the Finnish Adult Population (AVTK)

Much spending on inpatient care represents a significant

misallocation of resources

“Persistence of a model of primary care which is fragmented and

often consists of a single doctor with limited support is no longer fit for purpose” (Nigel Edwards, WHO

Europe, April 2012)

Better coordinated and integrated health and

social care

Improvements in health literacy can add significant

value within health systems