Supportive legal, financial and quality frameworks for Health Promoting Hospitals

1. Supportive legal, financial and quality frameworks for Health Promoting Hospitals 13th International Conference on Health Promoting Hospitals 18-20 May 2005 Dublin, Ireland Oliver Gröne, Technical Officer, Hospitals Programme Country Policies, Systems and Services Division of Country Support WHO Regional Office for Europe

2. Outline Discussion on sustaining HPHs have taken place previously, focusing on organization, evidence, evaluation, quality management, and financing. How can HPH development be sustained in the future? - Describe how the HPHs are positioned in and influenced by the overall health system, - Outline possibilities and new projects that could help linking HPHs to health system development.

3. Where are HPHs within the health system boundaries? Health Promoting Hospitals

4. To what health system goals do HPHs contribute? Health Promoting Hospitals

5. Health system functions Sustaining Health Promoting Hospitals?

6. Resource generation • Def.: Production of inputs - particularly human resources, physical resources such as facilities and equipment, and knowledge. • Education of healthprofessionals is not conducive to health system orientation, • Selection of students (not only by academic achievement, but for breadth of interest and communicative skills), • Professional training oriented towards specialization and fragmentation, • Development of more relevant and practice-oriented curricula with early training on prevention, populationmedicine, social and behavioralsciences.

7. Financing • Def.: Health system financing includes revenue collection, fund pooling, and purchasing. • Are purchasers paying for quality or for delivery of diagnostic and therapeutic services? • Difficulties in calculating capitation formulae to support integrated working. • Lack of diagnostic codes for health promotion activities. • Readmissions • Complications • Lack of health gain orientation

8. Payment mechanisms and provider response Lack of incentives from line-item budgets to DRGs.

9. Stewardship • Def.: Setting, implementing and monitoring health system actions, and identifying strategic directions for the health system. • Stewardship is often a neglected function in many health systems. • Improvement of system outcomesmay have perverse effectsfor some stakeholders (loss of power, control or income). • Lack of reliable timely data and information for health system planning and reform. • Quantification of return on investment: benefits of investment may be reaped at other levels of care or in othersectors or at a different point in time.

10. Conclusion Lack of financial incentives to provide health promotion services to patients or to engage hospital staff in health promotion. HPHs are worthwhile investments but perverse incentives and system dynamics prevent development. Tool development supports quantification of results and negotiation with stakeholders. HPH Task force on reimbursement through DRGs. “Stewards” not strong enough to balance the interests of stakeholders?

11. Thank you! Oliver Gröne Technical Officer, Hospital Programme WHO Regional Office for Europe Email ogr@es.euro.who.int Web www.euro.who.int/healthpromohosp