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A PPROACH TO DEVELOPMENT OF INTEGRATED CARE IN MEXICO.

A PPROACH TO DEVELOPMENT OF INTEGRATED CARE IN MEXICO. Galileo Pérez-Hernández , MD. National Center of Preventive Programs and Disease Control, Ministry of Health, Mexico. Gloria M. Quiñones , MD. Professor of Integrated Medicine Course, Anahuac University, Mexico.

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A PPROACH TO DEVELOPMENT OF INTEGRATED CARE IN MEXICO.

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  1. APPROACH TO DEVELOPMENT OF INTEGRATED CARE IN MEXICO. Galileo Pérez-Hernández, MD. National Center of Preventive Programs and Disease Control, Ministry of Health, Mexico. Gloria M. Quiñones, MD. Professor of Integrated Medicine Course, Anahuac University, Mexico. Henry Pérez, MD. National College of Integrated Medicine Specialists, Mexico. Alba Uribe, MD. National College of Integrated Medicine Specialists, Mexico, Alba Arevalo, MD, MPH. Diabetes Clinic, Health Services of the Federal District, Mexico.

  2. CONTENT • Introduction. • Exploratorystudy. • Cases description. • Case description 1: IntegratedCarePolicy. • Case description 2: UNEME EC Project. • Case description 3: Integrated Medicine Residency. • Conclussions.

  3. INTRODUCTION

  4. INTRODUCTION: MEXICO

  5. INTRODUCTION: BASIC DEMOGRAPHIC, SOCIOECONOMIC, AND HEALTH CHARACTERISTICS, MEXICO 2000–10

  6. INTRODUCTION: HEALTH SYSTEM • Health systems in the Americas are characterized by highly fragmented health services. • For a long time, Mexican Health System was organised around a segmented model and marked by the separation of health-care rights between the insured in the salaried, formal sector of the economy and the uninsured. “Integrated Health Service Delivery Networks: Concepts, Policy Options and a Road Map for Implementation in the Americas” Washington, D.C.: PAHO, 2011. Frenk J, González-Pier E, Gómez-Dantés O, Lezana MA, Knaul FM. Comprehensive reform to improve health system performance in Mexico. Lancet 2006; 368: 1525–34.

  7. INTRODUCTION: HEALTH SYSTEM • There is currently a public debate in Mexico concerning ways to achieve the functional integration of the system (including the creation of a unified system funded by general taxation) and to eliminate the inefficiencies the existing fragmentation creates.

  8. INTRODUCTION: MEXICAN HEALTH CARE SYSTEM. STRUCTURE, FINANCING AND COVERAGE. Fed/State Govern. Gral. Taxes Fed. Govern. General Taxes Employers Payroll Contributions Employees Payroll Contributions Employers Direct Payment Family fees Individuals Out-of-Pocket Financing Ministry of Health / National Commission of Financial Protection in Health ISSSTE Army / Navy PEMEX IMSS Private Insurance Operation Ministry of Health of each state Private Hospitals, Clinics and Physicians Fee for Service Hospitals & Clinics owned by the Social Security Salaried Physicians Delivery Public Hospitals & Clinics owned by the Ministries of Health Salaried Physicians Any citizen High & Medium Income Poor Unemployed Self-employed Workers families Retirees Salaried Workers Beneficiaries Structure Social Security Popular Insurance Private Sector

  9. INTRODUCTION: HEALTH CHANGE IN MEXICO AGE PATTERN CAUSES OF DEATH TRANSITION 100% 100% 80% 80% 60% 60% 40% 40% 20% 20% 0% 0% 1950 1960 1970 1980 1990 2000 2010 2025 1950 1960 1970 1980 1990 2000 2010 2025 Communicable Non Communicable Injuries 0-14 15-65 65+

  10. EXPLORATORY STUDY IntegratedCare in Mexico

  11. Metodología METHODOLOGY Phase 2 Phase3 Phase 1 Study integration experiences of Mexican Health System Final report and recommendations for development of Integrated Care in Mexico. Systematic review • Functional integration of health systems: • Concepts and dimensions • Mechanisms • Levels/ Types / Degrees • Results • Challenges/Complications • Recognize: • Improvements • Difficulties • Challenges

  12. SYSTEMATIC REVIEW Searches in databases and bibliographies for systematic review 213 summariesidentified and screened 93 discarded 120 shortlisted • 38 No full text availability • 24 lack of relevance or appropriateness • 31 Missing value added 120 full texts screened paired 36 discarded 84 Evaluated • 27 lack relevance or pertinence • 9 missing value added 24 textsrelevantqualified 60 textsessentialqualified 12 discarded 72 included • 7 lack of relevance or appropriateness • 5 missing value added

  13. CASE DESCRIPTION 1 IntegratedCarePolicy in Mexico

  14. MEXICAN HEALTH SYSTEM POLICY National Health Program 2002 -2006 National Health Program 2007 -2012 Before 2000 Latest generation of health reforms Integrated Model of Health Care (MIDAS) Functional Integration ? Secretariat of Sanitation and Assistance Undersecretary of integration and development of the health sector Undersecretary for Innovation and Quality

  15. Study case 1: A) National Health Program 2000 -2006 • In 2003, the government revised the General Health Law to create the SPSS and its main pillar, Popular Health Insurance (PHI).

  16. The objectives of this reform were: • Increase funds to the public health system and decrease the inequities in public expenditures across public insurance schemes and states. • Improve health outcomes, reduce out-of-pocket payments for health services, and provide protection against catastrophic health expenditure. • Reform the organization and functioning of the state health systems. Frenk J, González-Pier E, Gómez-Dantés O, Lezana MA, Knaul FM. Comprehensive reform to improve health system performance in Mexico. Lancet 2006; 368: 1525–34.

  17. Before 2000

  18. Reorganization of MexicanHealthSystem

  19. Study case 1: A) National Health Program 2002 -2006 Integrated Model of Health Care (MIDAS) • Centered patient care • Interdisciplinary teamwork • Integrated Health Delivery Networks • Primary Care Oriented Services Integrated Model of Health Care. Ministry of Health, Mexico 2006.

  20. Study case 1: B) National Health Program 2007 -20012 Integrated Care Policy based on: • Funding: Pooling of funds • Administrative: Consolidation of functions, inter-sectoral planning. • Service delivery: Integrated Information System. • Clinical: Common decision support tools (National Guideline catalogue)

  21. CASE DESCRIPTION 2 UNEME EC Project

  22. Study case: UNEME EC Project • The burden of disease for noncommunicable diseases is increasing quickly due to population aging and increased exposure to unhealthy diets, physical inactivity, tobacco use, and alcohol abuse. Diabetes and cardiovascular diseases are the main causes of death and disability in Mexico.

  23. Study case: UNEME EC Project • Care model created by Ministry of Health to strengthen primary care for chronic diseases. • Since 2008, it has been implemented throughout the country. • Model integrates prevention and care actions in community and clinical context.

  24. Study case: UNEME EC Project • UNEME EC Project considers the principles of: • Patient-centered care, • Continuity of care, • Collaborative approach to health teams • Telemedicine

  25. CASE DESCRIPTION 3 HumanresourcesforIntegratedHealhCare: Integrated Medicine Residency

  26. Study case: Integrated Medicine Residency • Integrated Medicine medical residency is a post-graduate program designed to train and educates professionals to provide Integrated Health Care. • The initiative is the result of a collaboration between the Department of Health and 19 universities who since 2006 operating the academic program.

  27. Integrated Medicine Residency • The program is a key educational component of health care reform and is focused in patient, oriented on care of teenagers and adults, centered on chronic and aging diseases, mental health and emergent infectious diseases.

  28. The integrated care physician is a… Integrated Model of Health Care. Ministry of Health, Mexico 2006.

  29. Integrated Medicine Residency • 2 years of training based on clinical and community activities. • New kind of specialist able to operate the structural reform of Mexican Health System in the context of Integrated Health Service Delivery Networks. • Specialist will be leaders in the management and care of the health of marginalized communities.

  30. CONCLUSIONS • Analyzed cases contain essential elements of integrated care such as universal coverage and access, first contact, integrated and continuing care, optimal organization and management and community orientation. • The large inequalities in health outcomes and health resources across Mexican states remain

  31. CONCLUSIONS The main barriers to the development of strategies were: • Institutional segmentation. • Decentralization of health services that fragments the levels of care. • Extreme separation of public health services from the provision of personal care. • Problems with the quantity, quality and allocation of resources.

  32. CONCLUSIONS • Integrated Care is useful framework to guide the next health reforms. • Population aging, chronic diseases and comorbidities, and an increase in citizen’s expectations require more equitable, comprehensive, integrated, and continuous responses.

  33. VIELEN DANK FÜR IHRE AUFMERKSAMKEIT

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