The future of public health:

Integrating prevention and curative health services

Prof. Peter P. Groenewegen PhDNIVEL – Netherlands Institute for Health Services

Research

Why integrate prevention and

curative health services?

• Decreasing returns to investments in health

• Changing patterns of disease- increased prevalence of chronic disease

- genetics, life style and environment

• Changing insights in effective preventionstrategies

- targetting

- risk communication

- trust

- multiple strategies

Changing disease patterns (left)Need for targetting and integration (right)

0

20

40

60

80

100

55-64 65-74 75-84 85-94

% with multimorbidity

Prevention and curative health

service provision

Prevention:

Universal

• Whole population

Selective

• Population at risk

Indicated

• Early symptoms

Curative health service:

‘Repair medicine’

• Diagnosis

• Treatment

‘Maintenance care’

• After care,

rehabilitation

• Chronic disease

management

Who’s currently responsible?

Symptom based

Curative health

services

Selective

?

Variation in

organization and responsibility

Universal

Municipal/

regional public

health

organisations

What is needed to fill the gap between prevention and

curative services?

• Population-based approach

• Adequate information systems

• Incentives for providers

• Organisation and task delegation

• Attitudes, professional norms, regulation

Who’s able to fill the gap?

• Integration of public health and curativehealth services is probably best possible in modern primary care

• But ….traditional primary care (read GP) attitude: my patients are healthy unlessproved differently

• Needed: shift from reactive to pro-activeand out-reaching

Conditions: population-based

approach

• Responsibility for the health of a well-defined population

• List system for primary care

• Close cooperation of primary care disciplines

Conditions:

Information systems for integrated

preventive and curative services

• Integrated or shared electronic medicalrecord

• Identification of high risk patients

• Decision Support Systems

• E.g. cardiovascular risk management

Conditions:

Incentives and payment systems

• Inviting and reminders for screening workbest when done from GP paractice

• Extra work in prevention needs to beremunerated

• Prevention as part of the insurance basket

• Targets

Organisation of primary care:

Transformation from cottage

industry to modern community

health service

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www.euprimarycare.org

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