Health Service Delivery - Notes

Health Service Delivery

Objectives

• Improving people’s health and well being.
• Responding to people’s expectations.
• Providing protection against the costs of ill-health.
• Health systems: all the institutions, people and actions whose primary purpose is to improve health. WHO, 2000

Health System Functions

• Governance
• Financing
• Generation of Resources
• Service Delivery
• Health systems: all the institutions, people and actions whose primary purpose is to improve health. WHO, 2000

Health System vs. Health Services

• Healthcare provision or delivery of care is only one of the health systems functions.
• Health Services are the set of institutions and programs that provide:
  • Direct care to health and disease needs of individuals; and
  • Public Health Services for the protection of collective health, (i.e. the health of communities).

Major Systemic Challenges

• SEGMENTATION: The coexistence of subsystems with different modalities of financing, affiliation and healthcare delivery, each of them specializing in different strata of the population according to their type of employment, income level, ability to pay, and social status. PAHO, 2011
  • SEGMENTATION = INEQUITY
• FRAGMENTATION
  • Relates to the coexistence of several units or facilities that are not integrated into a single network and or services at different levels of care that are not coordinated among themselves.
  • Defines healthcare delivery that does not cover the entire range of promotion, prevention, care, rehabilitation and palliative care services and or services that do not continue over time. PAHO, 2011
  • FRAGMENTATION leads to: Poor Performance, Barriers to access, Poor Quality, Irrational/inefficient use, High Cost, Low Satisfaction
• Addressing Fragmentation:
  • New model of care
  • New ways of organizing and managing healthcare delivery services = IHSDNs PAHO, 2015

Universal Coverage & Access

• Universal Coverage: Sufficient organizational mechanisms and financing to cover the entire population. Not sufficient to ensure health, well-being, and equity in health.
• Universal Access: Absence of geographical, economic, sociocultural, organizational, or gender barriers.

Four Strategic Lines

• Equitable Access to Health Services
• Strengthening Stewardship and Governance
• Increasing financing with equity and efficiency
• Strengthening intersectoral coordination

Model of Care

• A logical framework that defines what services will be provided to address the health needs, demands and expectations of the population.

Organizational Model

• The structural organization and resources required for delivering of services in response to those needs, demands and expectations.

Model of Care vs. Organizational Model Relationship

• Health Systems Functions and Model of Care: Governance & Stewardship, Financing, Resource Generation, Model of Care, Health Services Organization and management, Services & Benefits

Transitioning Models of Care

Bio-Medical Model of Care

• Centered on acute episodic care.
• Supply driven and organized by levels that fragment care
• Hospital-based and dependent on costly technologies and specialist care
• Provision of curative services through fragmented process of care
• Lack of continuity, poor quality and safety
• Inefficient referral systems
• Generates of exclusion and dissatisfaction.

People-Centered Model of Care: Distinctive Elements

• People centered
• Integrated
• Comprehensive
• Continuous
• Life Course approach

Integrated Health Services Delivery Networks

• Defined as “a network of organizations that provides, or makes arrangements to provide, equitable, comprehensive, integrated, and continuous health services to a defined population and is willing to be held accountable for its clinical and economic outcomes and the health status of the population served.” (PAHO, adapted from Shortell et al)

Organizational Attributes of the Model of Care in IHSDNs

• People and community centered – planning and delivery based on needs
• Responsibility for an assigned population in a specific territory
• A network of facilities – determined by people’s needs and system’s response capacity
• Multidisciplinary teams at the First Level of Care
• Delivery of ambulatory specialized services at the most appropriate location, preferably in non-hospital settings
• Mechanism to coordinate care throughout the continuum.

Definitions

• PRIMARY HEALTH CARE vs. Primary Care vs. First Level of Care
  • A PHC-Based Health System is an overarching approach to the organization and operation os health systems that makes the right to the highest level of health its main goal while maximizing equity and solidarity. PAHO 2011
  • PHC as a strategic approach to the development, organization, management and financing of health systems.
• Integrated Care and Integrated Services
  • Integration is the combination of processes, methods and tools that facilitate integrated care.
  • Integrated care results when the culmination of these processes directly benefits communities, patients or service users.
  • Integrated services are the organizational structures and resources involved in facilitating integration processes. Nick Goodwin, 2014
• Comprehensive Care
  • Services and interventions that span the spectrum of promotive, preventive, curative, rehabilitative, palliative and social care in both levels of services (First Level and Specialized care), and are coherent with person’s life course
  • Integration of Public Health and healthcare delivery services.
• Continuity of Care
  • Continuity of Care: is the degree to which a series of discrete events in health care are experienced by persons as coherent and interconnected and addresses their health needs and preferences. (User perspective).
• Health Manager
  • “all persons in the health system who manage resources and in so doing are responsible for making decisions that influence health outcomes”
• Healthcare or Health Services Manager:
  • “are those responsible for the delivery of healthcare services (meso and micro) in networks and health facilities”

Health System Reform

• Common goal: “the improvement of the health conditions of the populations”.
• To promote equity in health conditions, access and coverage of services and financing of services;
• To improve quality of care from the technical standpoint and the user’s perspective;
• To increase the efficiency of health financing, and allocation and management of resources;
• To ensure sustainability
• To promote social participation in planning, management, delivery and evaluation of health services.

Key Take Away Ideas

• Semantics matter: strive to use the right terminology
• There is a difference between integration of services and integrated care.
• Integrated service delivery is a key strategy for the attainment of Universal Access to Health and Universal Health Coverage (Universal Health)
• Integrated care and Integrated Health Services implementation tends to be more successful where there is a commitment to the values and principles of Primary Health Care