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EUprimecare : Quality and Costs of Primary Care in Europe

Grant Agreement no. 241595. EUprimecare : Quality and Costs of Primary Care in Europe. Dr. Antonio Sarría-Santamera (ISCIII) Sonia García (ISCIII) Eleonora Corsalini (UB). September 2012, Gothenburg (Sweden) European Forum Primary Care. Background.

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EUprimecare : Quality and Costs of Primary Care in Europe

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  1. Grant Agreement no. 241595 EUprimecare: Quality and Costs of Primary Care in Europe Dr. Antonio Sarría-Santamera (ISCIII) Sonia García (ISCIII) EleonoraCorsalini (UB) September 2012, Gothenburg (Sweden) European Forum Primary Care

  2. Background • The goals of any healthcare system: • Deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources

  3. Background • The Tallin Charter • Strengthening of health systems to improve people's health but keeping equity. • Primary Care • Basic structure of health system • Eliminating health disparities

  4. Background • Common frameworkto describe Primary Care models in the EU is not available • Not yet developed a trans-national consensus on how to define quality of Primary Care • Cost of Primary Careare not well identified in national accounting systems

  5. Objectives • To contribute to improving the knowledge regarding Primary Care in Europe: • exploring the relationships that could exist between Quality and Costs of different models and systems of organizing and delivering PC across Europe

  6. Partners • Institute of Health Carlos III. ISCIII. Spain • Universität Bielefeld. UNIBI. Germany • University of Tartu. UTartu. Estonia • National Institute for Strategic Health Research. ESKI. Hungary • OrszágosAlapellátásiIntezet. OALI. Hungary • Institute for health and Welfare. THL. Finland • Kaunas University of Medicine. KMU. Lithuania • UniversitáCommerciale Luigi Bocconi. UB. Italy

  7. WP 5 & 6 WP2 Identify a methodology to measure the PC quality To measure the health quality in PC COORDINATION WP 1 DISSMINATION WP 8 WP 7 WP 3 & 4 Identify a methodology to measure costs in PC To measure costs in PC Evaluation of PC models Conceptual structure

  8. Approach • Costs • Quality:

  9. Work package 2: Evaluation of PC models in Europe Methodological Approach of a Classification System of PC Models in Europe : Germany, Spain, Estonia, Finland, Hungary, Italia and Lithuania.

  10. WP2: Methodology • Literature review • Structure or process of PC in Europe • Control knobs: financing, regulation, payment, organization, and organizational behavior • Selection of indicators=> template design: • 5 variables (Control knobs) to optimize healthcare systems results: • Range of services • DescriptiveAnalysis& Principal Component Analysis

  11. Descriptive analysis (I) Mixed model (Hungary) 16% Double coverage FINANCING 7% Uninsured BISMARCK SS (Estonia, Germany, Lithuania) BEVERIDGE NHS (Finland, Italy, Spain) 10,5% Expenditure in HC as GDP 10,6% Private Insurance 18,8% Double coverage Expenditure in PC 6,1% 6,6% 24% 5,7%

  12. Descriptive analysis (II) REGULATION • Formal mechanisms to guarantee accessibility, equity and quality of healthcare • Gate-keeping systems, except in Germany ORGANIZATION • Facilities: • Mostly public: Finland, Spain, Hungary and Lithuania • Totally private: Germany, Estonia and Italy • Clinical practice: • Integrated network: Finland and Spain • Solo and group practices: Germany, Estonia, Italy, Lithuania, Hungary

  13. Descriptive analysis (III) ORGANIZATIONAL BEHAVIOUR • Process to monitoring and improving the quality of medical practice: • Quality management systems measuring clinical and no clinical quality indicators • Clinical practices guidelines • Continuing education

  14. Quantitative analysis (PCA) Financing • Provision of services through national/regional/local health systems (Yes/No) • Private voluntary health insurance (Yes/No) • Geographical distribution of PC services (Yes/No) Regulation • Professional income (Capitation/Salary/Fee for service/Out of pocket) Payment • Gatekeeping for specialist (Yes/No) • Type of facilities (Public/private) • Type of clinical practice (Solo practice/Group practice/ Network) Organization • Improvement programs & Quality management systems (Yes/No) • Continuing clinical education program (Yes/No) • Local adaptation of clinical practice guideline(Yes/No) Organizational behavior

  15. Range of services

  16. Results of Qualitative analysis Results • Based on a functional perspective, allowed to proposing 5 functional models: • Model 1: Direct access to any GP or specialist (Germany) • Model 2: Referral required from GP, mainly solo-practices in PC (Hungary, Italy) • Model 3: Referral required from GP, mainly group-practices in PC (Estonia, Lithuania) • Model 4: GPs working mainly in health care centres (Finland, Spain) • Model 5: Polyclinics (Shemasko). Not necessarily GPs at all Based on a functional perspective, allowed to proposing 5 models: Direct access to specialist Referral required from GP, mainly solo-practices in PC Referral required from GP, mainly group-practices in PC Health care centers Polyclinics

  17. Validation models of PC in Europe (24 countries EU )

  18. * *Predominance

  19. * Predominance

  20. Conclusions • Framework for classification of health systems based on PC • Multidimensional => more complex => more realistic • Healthcare services provision • Basic coverage • Gate-keeping • Private insurances • Professional payment • Type of facilities • Type of practice

  21. Work package 3&4: Costs of Primary Care Systems

  22. Methodology Micro-costing • 4 clinical vignettes representing the main areas of activity of PC: • Acute care • Chronic care • Health promotion • Prevention (vaccination)

  23. Methodology Macro-costing • Actual costs: Real not estimated • Usual accounting principles and practices • Indicated in the estimated overall budget

  24. Work package 5&6: Quality of Primary Care Systems

  25. Methodology Quality Indicators • Focus Group Discussion : • Patients (n= 53) • Primary care professionals (n= 64) • 7 countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania, Spain. • Helped to understand the views about quality in the different partner countries and to set a list of quality criteria. • Non-clinical indicators for each criteria were identified from the literature review and prioritized by scoring according to importance and measurability.

  26. Methodology Quality Indicators • 60 Quality Indicators (aprox) selected to measure Quality of PC in Europe

  27. Methodology Quality at the Population Level • Population Survey: • A sample of 3.020 persons • 25-75 years old • 7 countries participating in the project • Domains: • Socio-demographic • Satisfaction • Self-perceived health • Utilization of services • Prevention and health promotion interventions

  28. Methodology Quality at the Clinical Level • Professional survey: • Medical records: • Diabetes and blood pressure high • 14 indicators • Specific approach for extracting data in each country (sample)

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