Healthy ANDALUSIA

2008

Junta de Andalucía. Consejería de SaludAvda. de la Innovación s/n Edif. Arena 141020 Sevilla (SPAIN)Phone: +34 955 00 63 00Fax: +34 955 00 63 28portalsalud.csalud@juntadeandalucia.es

≥ 1

Andalusia, one of the largest regions in Europe, is located in the south of Spain, with

its coastline bathed by the waters of the Mediterranean and the Atlantic.

With a size of 87,597 square kilometers, and a population of 8.059.461 inhabitants,

Andalusia is the most populated autonomous community in Spain. 16,22% of the

population is younger than 15 years of age and 14,63% is older than 65.

Main figures

1.500 Primary care centres (387 Main PHC, 1.113 Local PHC)

44 Public hospitals (5 level I, 9 level II, 6 level III, 14 level IV, 10 proximity H)1

8 Transfusion centers

88.310 Healthcare professionals

9.518,91 M € Health budget

Life expectancy at birth (2006):

Men 76,4 years, Women 82,5 years

1 Level I (≥1.000 beds), Level II (500-1.000 beds), Level III (250-500 beds), Level IV (≤250 beds); Proximity Hospitals in remote areas.

ANDALUSIA

≥ 2

IMprove the publIc healthcare SySteM,

based on the values of universality, access to good quality care, equity and solidarity.

ModernIze health organIzatIonS,

making them more flexible and citizen – centred, ensuring good governance and

transparency.

IncreaSe the value of the publIc ServIce SySteM.

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HEALtH PoLIcy GoALS

≥ 3

Quality as the driving force:

• A strongly coordinated and efficient public system in continuous growth.

• Quality-driven for response time, accessibility, continuity, familiarity, comfort,

human touch, high technology, safety and efficient performance.

Accesibility and Transparency:

• More and better-informed citizens with increased freedom to make decisions,

take greater responsibility over their own health, and gain equal opportunities

through transparent and accurate information.

Social Control:

• Active social participation on an individual and collective basis.

• An organization that listens to its citizens as allows them to participate in

decisions making.

Professional Participation:

• obtaining, recognizing and stimulating commitment by professionals is the key

to success and to secure their essential participation.

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BASIc INSPIrING PrINcIPLES

≥ 4

citizens are the center of the Andalusian Public Health System. they show great

sympathy for the health care received, the professionals and the organization, which is

measured with an annual user - satisfaction survey.

Different measures have been designed to empower citizens and patients with

new rights in health care:

SeConD MeDICAL oPInIon:• in case of severe diseases, citizens have the right to

demand a qualified second opinion, which is provided by experts within 30 days

since the application.

LIVIng wILLS:• Andalusian citizens have the right to record their wills, on a specific

registry, about the limits to health care when being in situations of not possible

communication. Physicians have the obligation to consult this registry before

applying special treatment to patients not able to communicate.

DenTAL CAre for CHILDren AnD PregnAnT woMen:• free from 6 to 15 years

old, and women during pregnancy.

Surgery wAITIng LISTS:• the Andalusian government has been the first in our

area to introduce the legal right to a guaranteed maximum waiting period for

surgery (180 days). recently it has been updated, reducing the waiting time for

the most common interventions to 120 days. the information is available at the

Department of Health web page.

ouTPATIenT SPeCIALIzeD CAre AnD DIAgnoSTIC ProCeDureS wAITIng LISTS:•

legal rights has been extended to guarantee a maximum delay for outpatient

specialized care (60 days for first referral from primary health physician) and the

most common diagnostic procedures (30 days).

PreIMPLAnTATIonAL geneTIC DIAgnoSIS (PgD):• the Public Health care System

has included PGD to avoid the transmission of genetic disorders. this service is

offered in a public hospital.

geneTIC CounSeLIng:• among a number of measured listed in the Andalusian

Genetic Plan, new integrated genetic units, providing genetic testing and

counseling, are being implemented.

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cItIzENS at the center of the Health System

≥ 5

DenTAL CAre for HAnDICAPPeD:• the coverage by the public dental care services

has been extended to handicapped people.

CHILDren neeDS In HeALTH CAre fACILITIeS AnD SerVICeS:• health care

facilities and services are being adapted to the special needs and requirements

of children and newborns, such as being accompanied by a close relative (mother

or father) during their stay in hospitals.

eLDerLy AnnuAL CHeCk-uP:• people over 65 years old are being contacted, in

order to assess their health status, and are being offered with the health services

they may need.

PoDIATrIC/CHIroPoDIC CAre for PeoPLe wITH DIAbeTeS,• under the Diabetes

care Plan.

family support measures

chronic homecare plans and community nursing activities•

Extension of rehabilitation units throughout the territory, including mobile units •

for home rehabilitation care.

Improvement of mental health care services.•

The citizens’ voice

Area Health committees by province.•

Annual survey on user satisfaction.•

Virtual office • –InterS@S-, where the user can choose a primary health care

physician or center, update his/her personal data, make requests,…

call center: single telephone number, where demands and suggestions can be •

made, as well as asking for medical appointments or basic medical advice.

citizens’ expectations Bank: web site to foster citizens’ participation as well as •

associations and other health system stakeholders.

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≥ 6

III andaluSIan health plan (2003-2008)

• Strategic initiativetoreachthegoalssetoutasaresultoftheanalysisofthe

health problems in our region. It follows the recommendations of the XXI Health

Policy by WHo-Europe.

Specific Health Promotion Programmes:

• FoodSafetyandQuality

• EnvironmentalHealthActivities

Health Programmes:

• YoungPeople(YoungForm):promoteshealthylifestyleprovidingconsultation

services in high schools.

• Immigrants: specifichealthcareservices,minimizing languageandcultural

barriers, with the active participation of NGo.

• Deafnessscreening:earlydetectionofhearingimpairmentatbirth.

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ProtEctING Health and Promoting Wellness

≥ 7

Integrated and coMprehenSIve planS have been designed to compile the

different measures and actions adopted in a wide range of fields, in respond to

major health problems. Some highlights of the different Plans are detailed below.

• DiabetesCarePlan: information for the public and patients, improve health

care services, including early detection for major complications (retinopathy),

prevention and health education, citizens participation, training and research.

• OnCOlOgyPlan: health promotion activities, oncology day care in all hospitals,

palliative care, new radiotherapy units, improve social and emotional support.

research and training.

• CarDiOvasCularDiseaseCarePlan: secondary prevention and rehabilitation

programme, pediatric surgery, adult congenital cardiovascular disease unit,

training and research.

• MentalHealtHPlan: mental welfare promotion, information for the public, increase

accessibility, community mental health units, day care units, training and research.

• tObaCCOPlan: media campaigns, web portal and telephone service supporting

tobacco cessation, training programmes for health professionals, education and

work, special smoking cessation units at primary and specialized care, special

situations (mental health patients, prisons), training and research. Legal actions

(suit) against tobacco companies.

• DePenDentPeOPlestrategy: designed to support people with special needs.

coordinated with the Social Welfare Department.

• alZHeiMer’sDiseasePlan: in collaboration with associations of relatives and

caregivers, includes different programmes designed for the needs of these

patients and their families, such as healthcare, family support, stimulation and

reeducation, training, volunteering and research.

• infant Obesity Plan: includes more than a hundred preventive, healthcare,

training and research measures. School dining rooms support services.

• aCCiDentsHealtHCarePlan: different measures in order to reduce accidents,

and to minimize their consequences.

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• Patientsafetystrategy: designed to improve the management, training and

information systems. Includes an observatory on Patient Safety and a registry on

adverse events.

• genetiCsPlan: establishes a network for providing genetic services for the

population, identifying and optimizing the available resources, and opening new

lines for the development for research and health care.

• rareDiseasesPlan: early identification of rare diseases, structured health care

network within the health system, coordination with different units involved.

• Palliative Care Plan: designed to attend patients at end stages of their

diseases, under a common protocol, and to support their families and close

carers.

• PainCarePlan: standardizes care and pain relief throughout the Andalusian

health system.

• assisteDrePrODuCtiOnPrOgraMMe: extension of public health care services

of assisted reproduction techniques in the public hospitals and centers for those

who need them, including women without male partners.

≥ 8

≥ 9

In 2005, the Department of Health launched its Second Quality Plan for the Andalusian

Public Health System, continuation of the first comprehensive Quality and Efficiency

Plan of 2002. this Second Healthcare Quality Plan echoes the vocational search for a

different, more modern organization, placed at the service of the Andalusian public,

that strives to provide a public service committed to guaranteeing the best possible

care, imbuing the Andalusian Public Health System of an entrepreneurial attitude with a

view to taking on new challenges to ensure survival of a public healthcare system that

is caring, fair and sustainable.

This second Healthcare Quality Plan has a process-based structure. five major

strategic processes have been pinpointed:

• To ASSuMe CITIzenS’ neeDS AnD exPeCTATIonS: defines the relationship

between citizens and the APHS, and points to the public’s central role in the

system, as well as the duty to establish a set of guidelines to safeguard that

principle. the plan suggests developing new rights and fresh mechanisms to step

up citizen’s participation and decision-making powers, as well as their clinical

safety, fostering projects that will enhance interaction between citizens and the

system in a more individualized, transparent and interactive manner.

• To guArAnTee HeALTH CAre SerVICeS QuALITy MAnAgeMenT: attempts to

build up the innovations in service management that have unfolded in Andalusia

over the last few years. Indeed, clinical management, process-based management

and skills management, continue to be vital tools that need to be enhanced by

implementing actions that will lead to their definitive consolidation in the system.

It incorporates an Andalusian Accreditation Model, reinforcing the Andalusian

Healthcare Quality Agency.

• To guArAnTee QuALITy In PubLIC HeALTH PoLICIeS: intends to bring about

a system of public guarantees on the basis of three processes; foster policies

targeting health promotion and disease prevention, boosting quality in public

health surveillance policies and promote quality policies in health protection.

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QUALIty-DrIVEN cArE

≥ 10

• knowLeDge MAnAgeMenT: the health system is a knowledge factory, an

intelligence system, implementing a health information strategy, promoting and

consolidating research excellence in Andalusia.

• InnoVATIon AnD MoDernIzATIon of THe SySTeM: innovation is a cross-cutting

process influencing the entire array of actions to be unfurled by the Second

Healthcare Quality Plan.

two major strategic strands are established: horizontal innovation policies and

information and technology management.

It is a proposal to address the Healthcare System challenges in an efficient

manner. The challenges can be summarized as follows:

• Improve all aspects concerning relations with the public.

• create an organization in line with the healthcare targets.

• continue process-based work, so that all healthcare activities revolve around

the patient.

• Make further progress in skills management for professionals.

• Strive towards the integration of healthcare in a knowledge-based society.

• Enhance the system’s overall transparency – financial, operational, quality, etc

–in the eyes o the public, bearing in mind at all times that we are managing vast

and increasing, albeit limited resources.

• Boost organizational research and Innovation.

• Provide added value to the Second Modernization Plan for Andalusia by

contributing to well-being and creativity while fostering a more modern public

administration, which is closer to community grassroots.

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≥ 11

one of the strategic objectives of the Ministry of Health of the Andalusian regional

Government is to foster the generation of knowledge within the Andalusian Public

Health System, in particular biomedical research. therefore, the Strategic Plan for

research, Development and Innovation for the period 2006-2010 has been launched

by the regional Ministry of Health, which is aligned with and coordinated by existing

programmes at a European, national and regional level, including all parties actively

involved in the innovation system. the Plan’s structure reflects the articulation of

biomedical r+D+i in its triple perspective: of resources, production and the transfer of

research results.

Legal framework for stem cell research: Law for cellular reprogramming for therapeutic

purposes. Support to clinical trials, pre-implantation genetic diagnosis in Andalusian

public hospitals.

research centers and institutions: combining basic research (at universities

and the Spanish research Council) and applied research (health professionals

at the Andalusian Public Health System) with the biotechnology sector.

• new THeMATIC reSeArCH CenTerS: linked to the main research areas in the

region, molecular biology and regenerative medicine, genetics and nanomedicine.

1. regenerative Medicine (cABIMEr - Andalusian Molecular Biology and regenerative

Medicine center) is a groundbreaking multidisciplinary biomedical research

center in Andalusia, drawing together basic and applied research with the aim

of transforming the results of the scientific work carried out there into direct

improvements to citizens’ health and quality of life, Seville.

2. Genomics and oncology (GENyo), Granada. *

3. Nanomedicine (BioNAnd), Malaga.*

4. Advanced technologies in Medical traning (cMAt), Granada.

* construction in process

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rESEArcH and Innovation

≥ 12

• MultiDisCiPlinaryresearCHinstitutes:

1. IBIS (Biomedical research Institute of Seville) is a model in which basic and

applied research live together, within a big hospital complex, Seville. *

2. Maimonides Institute, cordoba. *

3. IMABIS, Malaga (in project).

4. cádiz (in project).

• bIobAnkS:

1. Andalusian Stem cell Bank, central node of the Spanish Sc Bank.

2. Andalusian tumor Bank (network).

3. Andalusian Human DNA Bank (network).*

• sPeCifiCsuPPOrtPlatfOrMs:

1. olive oil and Health Excellence center, Jaen.

2. tobacco Smoking, Seville.

3. Sports and health (in project).

* construction in process

research foundations (fIbAo, fAbIS).

Virtual Library of the Andalusian Public Health System.

Three-fold increase in the scientific production of our region from 1992 to

2004.

Within the framework of Innovation and Modernization Policies in Andalusia, the

regional Ministry of Health has assumed a firm commitment to continue its promotion

of scientific knowledge and place itself at the forefront of high-quality research in the

fields of biomedicine and biotechnology.

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≥ 13

the Andalusian Public Healthcare System has adopted corporate information systems as a

strategy, given the increasing mobility of the citizens and the participation of many professionals

in attending to the processes, forming complex multidisciplinary teams. All this, linked to the

integrated concept of health and the leading role of the citizen in democratic societies, leads

to the concept of the Single Health record and the use of unified procedures.

DIrAyA

computer system for information and care management support. Diraya integrates all

the information of each user, into a Single Health record, so that it is available where

and when it is needed for his/her care. It also facilitates accessibility to all the services

and provisions of the health system, and ensures that all the relevant information is

structured. Diraya, meaning “knowledge” in Arabic, is the outcome of the organization’s

shared knowledge.

Diraya consists of a set of related modules that share information

• basiCCOMPOnents:

- User Data Base (UDB): supply every citizen with a Single Andalusian Health

record Number (NUHSA), to which all his/her information is linked. 7.96

millions registered users (98.8% of the population).

- centralized operator Access Module (coAM).

- Structure Module, including departments and functional units as well as

physical locations.

• singleHealtHreCOrD, in 682 primary health care centers, covering 7,373,409

inhabitants (93.7% total population); 6.6 millions with relevant clinical data (90%).

In specialized care: 71.1% emergency episodes, 14.4% outpatient visits.

• PresCriPtiOnXXi: electronic prescription: in 653 primary health care centers,

covering 7,272,090 inhabitants (92.4% total population), 3,496 pharmacies

(97.8%), and 70 millions prescriptions (38%).

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e-HEALtH Strategy

≥ 14

• aPPOintMent: manages primary care, outpatient specialized consultations

and diagnostic procedures agendas. 73.439.928 appointments in Diraya during

2007.

• InterS@S: Public Health System Virtual office, allows users to change doctor, to

see and update their personal data, or request a second medical opinion.

HeALTH reSPonDS (SALuD reSPonDe)

Information and Service center, available 24 hours a day all days of the year. Multi-channel

access to the Public Health System of Andalusia, designed to satisfy the information and

service needs of citizens and health professionals, improving the capacity of response

of the health system and making it faster. It services include medical appointments

for primary care, information of the Public Health System of Andalusia, information

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≥ 15

about the health smart card, dental health programme, free choice of hospial, second

medical opinion, community link nursing, living will statement, health campaigns, follow-

up on fragile patients after hospital discharge or heat waves, and medical advice. It also

offers SMS information services (health campaigns, appointments reminder, health

prevention measures,...), information on tobacco (quit-line), citizens’ service line for

health technology and devices.

InforMArSe.eS SALuD

Health information service using multichannel platforms such as internet, mobile phones,

tV and other media. A new model of communication in health, based on innovation,

assuring information accuracy and quality, and accessible trough different channels

and platforms.

oPInAr.eS SALuDAbLe

New tool for the reception and knowledge of citizens’ expectations. People can leave

opinions, suggestions and needs. It helps the Health System to seek what the citizenship

expect from the services provided, and the initiatives launched.

InnoVATIVe PrACTICe bAnk

Strategy for the identification, sharing and acknowledgement of innovative professional

practices. It includes a network of agents among the health professionals in the

organization. It promotes the development of innovation forums ,ideas contests and

best practices identification and diffusion.

obSerVATory of InnoVATIVe PrACTICeS In CHronIC DISeASe MAnAgeMenT

created as a network focused on the identification, process, synthesis and dissemination

of innovative practices in Spain and the world. Accessible at a web page, it supports

knowledge management, as well as collaboration between excellence focuses. Developed

in open source technology.

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≥ 16

activity figures 2007

gP and pediatricians consultations 57.933.420

nurses home visits 2.812.821

Admissions 557.970

Hospital stays 4.142.563

outpatient specialist consultations 10.094.015

emergencies PHC 5.658.895

emergencies hospitals 3.599.682

Surgical interventions 503.806

Ambulatory major surgery 149.556

organ transplantations 595

kidney 344

Liver 175

Heart 37

Lung 26

Pancreas 13

“The modern Andalusian public health system is a sector of public policy closely affecting the daily concerns of its citizens. It is also an element of primary importance in welfare policy which is founded on the principles of equality and solidarity.”

Mª Jesús Monteroregional Minister of HealthAndalucia, Spain

w w w . j u n t a d e a n d a l u c i a . e s / s a l u d

ANDALUSIAN PublicHealthcare System

Healthy ANDALUSIA

2008

Junta de Andalucía. Consejería de SaludAvda. de la Innovación s/n Edif. Arena 141020 Sevilla (SPAIN)Phone: +34 955 00 63 00Fax: +34 955 00 63 28portalsalud.csalud@juntadeandalucia.es