Introduction to theCatalan Healthcare System

Albert AlonsoDirecció de Recerca i Innovació

Hospital Clínic Barcelona

A successful system? Life expectancy

OECD/EU (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris. https://doi.org/10.1787/health_glance_eur-2018-en

A successful system? Life expectancy

OECD/EU (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris. https://doi.org/10.1787/health_glance_eur-2018-en

Spanish Health Care System

• Funded by taxes

• Decentralized to regional autonomies

• Universal coverage

• Free access

• Very wide range of publicly covered services

• Co-payment in pharmaceutical products

• Services provided mainly in public facilities

• Interterritorial Board

A successful system? Life expectancy

Source Catalunya: Idescat; Departament de Salut. Source Espanya, zona euro i Unió Europea: Eurostat.

Catalonia: basic data

Capital: Barcelona

Population: 7,508,106 inhabitants (2015)

Population density: 233.8 inhab/km2 (2015)

Surface area: 32.108,2 km2

GDP: 214,927 millions of euros (2015)

GDP per capita: 27.663 euros (2015)

Immigration rate: 13.69% (2015)

Government: Generalitat of Catalonia

National Anthem: Els Segadors (The Reapers)

Official languages: Catalan, Spanish and Aranese

National day: September 11th

Patron Saint: Sant Jordi (Saint George)

Patroness: Mare de Déu de Montserrat

Catalan Healthcare System

• Universal coverage

• Public financing of the services

• The Catalan healthcare model is a multi-provider one integrated in a unique public network.

• Separations for Purchaser and Provider. It enhances the autonomous management of each provider.

• Co-payment for pharmaceutical products

• Access equity

• Continuity of care

• Integration and coordination

Catalan Healthcare System

FundingResourcesObjectives

InsurancePurchase of

services

Provision

Parliament

Department of Health

Network of providers

Catalan Health Service

Assigns budget

Elaborates Health Plan

Transfers economic resources

Provide healthcare

Guarantees healthcare quality

Catalan Healthcare System

Insurance Services

USE

RCATALAN

HEALTHCARE SERVICE CONTRACTED

PROVIDERS

100%

• The history of the Catalan healthcare system, made it highly fragmented at a healthcare supply level: Around 80% of the specialized care and around the 20% of the primary care is provided by suppliers not belonging to the Department of Health

• Inexistent common Information System for all the healthcare suppliers due to the healthcare system diversification

• ICT’s Strategic component of the Healthcare System

20%SupplementaryPrivate Insurers

CATALAN INSTITUTE OF HEALTH

Private Centres

20%

70%

10%

Primary Care Centres

Functions

• Health promotion, prevention and care

• Primary healthcare and homecare

• Emergencies

• Research and specialist training

Primary care centres (CAP)

• Composed of: GP, Nurse, Paediatrician, Gynaecologist/obstetrics, Midwifery, Dentist, Social worker

• Close to point of residence: 1/25000 inhabitants

• Team work, led by medical coordinator and nurse coordinator.

• Open morning and afternoon

• Patient can choose their GP.

Tertiary – High Tech Hospitals+ Neurosurgery+ Cardiac surgery+ Transplants+ Burned

Hospitals

Regional Hospitals+ ICU+ Specialties

Local HospitalsSpecialistsManagement servicesMedical technologyEmergenciesResearch & training

Contract of health services

Catalan Health ServiceCatSalut

Providers

ContractLong term (multiannual)Yearly revision (clauses)

Health PlanPortfolio of services

Health objectivesActivityEconomic amountRate (pricing)Invoicing systemEvaluation system

SPECIALISEDHEALTHCARE

PRIMARYHEALTHCARE

BASICSOCIAL

SERVICES

SPECIALISEDSOCIAL

SERVICES

VERTICALINTEGRATION

HORIZONTALINTEGRATION

The triple integration

Health Plan 2011-2015: Consensus on chronicity

Strategy

Terminology

Conceptual

Identification

Provision of services

Health Plan 2011-2015: Strategy on chronicity

People Services Action lines

• People at the centre

• Co-designed with citizens

• Double focus: Health and social care

• Population-based

• Territorial agreements

• CatSalut leads

• Team-up with providers

• Clinical leadership

• Process redesign

• Promotion of innovation

• Community based

• Promotion of alternatives to institutionalised care

• Admission accessible from PC

• Homecare with different intensity

Health Plan 2011-2015: Identification

Prevention

Healing

Palliative care

Co-ordination of services

Patientautonomy

Healthy33%

Chronic No Complex 62%

PCC3,5%

MACA3,5%

Terminal Mourning

Health Plan 2011-2015: Identification

Healthy33%

Chronic No Complex 62%

PCC3,5%

MACA1,5%

Terminal Mourning

PCCComplex Chronic PatientClinical management is difficult

MACAPoor prognosis survival limited, additional needs, focus on palliative care, need to plan advanced decisions

Health Plan 2011-2015: Identification

PCC

MACA

1Patient’s profile

Health+Social needs

2Professionals’ assessment

3Expectedoutcomes

GoodHealth

End of life(days / weeks)

Palliative approach

Cure approach

Health Plan 2017 -2020: PIAISS

Model of integratedcare at home

Integrated care in residential homes

Integrated care Mental Health

Integrated health information systems

Model of integrated care in the community

Health Plan 2017 -2020: PIAISS

• Integrated care in residential homes, people with disabilities, mental health

• Development of an integrated (health / social) care model at home

• Development of an interactive model between primary health care and primary social care

• Development of an integrated care model (social – mental health) for patients in need of long-term care

• Integrated health information systems including healthcare and social care data

• Integrated model to promote personal autonomy in people with disabilities / dependence

• Integrated care model (health / social) for children with disabilities, mental illnesses and rare diseases.

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