Health conferences as a tool in health policy formulation and implementation

Transkript

1 Health conferences as a tool in health policy formulation and implementation Dr. Helmut Brand MSc EPHZ Institute of Public Health NRW, lögd helmut.brand@loegd.nrw.de

2 Map of Germany

3 Health System in Germany Social health insurance system since 1883 universal coverage system of self governance seperation of ambulant care, hospital care, public health iterative problem solving (one law per year) integrates medical/social progress into the insurance system (nursing care / new technologies)

4 Structure of the health care system in Germany

5 Who has the Power to regulate? Outpatient Care Hospital Care Public Health Law Federal Level Regional Level District Level Cave: self governing systems at work!!

6 Who has Power? Association of physicians ( ) (providers) Government ( ) Sickness funds ( ) (purchasers) Negotiation process!! Consensus society (Rheinischer Capitalism)

7 Policy Action Cycle and PH-Trias Assessment Evaluation Decision making (Policy development) Action (Assurance)

8 How to get into Politics Health Targets Health Reporting Health Conference Partners of the Health Care System

9 A new approach in NRW: Regional Coordination of Health State Health Conference Standing advisory committee Health Targets NRW Regional Health Reporting

10 NRW Health Targets Combat Cancer Tabacco, Alcohol Control

11 Local Coordination of Health and Social Care in NRW District Health Conference Local Health Targets District Health Reporting

12 General trends in New Public Management Process of Centralisation (EU) and Decentralisation (fine tuning on local level) at the same time Increase Transparency Improve Communication and Cooperation Problem of oversupply in health care Administrative Competence Gap is recognized Involve citizens / e.g. self help groups Financial problems

13 Local Co-ordination of Health and Social Care In each participating district (28/54) in North Rhine-Westfalia (18 Mio.) Round Tables of representatives from all health care organisations Working groups composed by experts Project Office providing support Financial support by regional government for the Project Office Support by the Institut of Public Health NRW Formal evaluation of the project by two universities

14 Targets of the Project developing and establishing new structures of health management at the community level (Health Policy at community level) improving the system of health reporting/health monitoring improving collaboration and co-ordination at the community level as well as between the community and the regional level improving planning and decision-making processes in health policy at the community level developing recommendations for community based programms implementation of programms

15 Round Tables Planning body at community level all actors of the local health care system sent representatives had to define priority targets to be dealt with by the working groups supervised the work of the working groups discussed and endorsed the input of the working groups by agreeing on specific recommendations recommendations were considered legitimate means

16 Project offices Set up in local health departments Supported communication flow between participants Carried out routine business on a daily basis Staffed with academic experts with training in public health Personnell financed by regional ministry

17 Major results of the evaluation / Conditions Initial conditions: Lack of transparency and co-ordination in the local health care system No regular local health monitoring / health reporting Later conditions: nearly all Organisations were involved in the project all communities started health reporting

18 Participating Institutions Institution: Rate of Participation (%) Local government 100 Physicians associations 94 Health insurance funds 93 Hospitals 89 Charities/Trusts 88 Political Parties 79 Self-help groups 41

19 Major results of the evaluation / Process The working climate during the meetings of the Round Table were positive The size of the Round Table interacts with communication: about 30 persons define an upper limit for active participation Some controversies and conflicts were particulary rude, especially so if economic interests were involved, but never thretened the project as a whole All 28 communities survived the process

20 Major results of the evaluation / Outcomes I/IV 70% of the participants stated that Round Tables are a useful tool.

21 Major results of the evaluation / Outcomes II/IV All communities succeeded in developing and enacting recommendations for action programmes: from information dissemination up to development of geriatric ambulatory rehabilitation 40% of all action programmes endorsed by Round Tables were already implemented during the study period.

22 Major results of the evaluation / Outcomes III/IV Probability of implementation was high if - good health related data were available - measures remained within the scope of the communities range of decision authority - health care providers accepted responsibility for the working groups Probability of implementation was low if - no good health related data were available - regional oder federal responsibilities were affected

23 Major results of the evaluation / Outcomes IV/IV Local health monitoring and reporting was set up by the Communities with regard to: - Health needs assessment - Utilisation of health care services Cooperation had improved in all participating communities: - increased transparency - more direct ways of communication

24 From project to continuity The results of the project Local Co-ordination of Health and Social Care ( ) are now implemented in the new law on Public Health Services in NRW (since 1998) Especially: - Round Table = local health conference - Local health reporting compulsary The new evaluation (September 2003) of the law on Public Health Services in NRW shows similar results as the evaluation of the project.

25 Health conferences as a tool in health policy formulation And implementation Dr. Helmut Brand MSc EPHZ

26 Anzahl der GA/UGB bis u.m. Anzahl der KGK-Mitglieder (abolute Anzahl der GA/UGB)

27 Themen der AG Veränderung Anzahl AG des relativen Anteil ( %) Anteil ( %) Anteil ( %) Themen Gewichts Sucht/Drogen/Abhängigkeitserkrankungen 17,0 15, ,0 chronisch Kranke (Herz-/Kreislauferkrankungen, 8,9 4,8 10 4,6 Diabetes Mellitus) Kinder- und Jugendgesundheit 8,0 11, ,8 Allgemein-/Erwachsenenpsychiatrie 7,1 7,1 16 7,3 Gerontopsychiatrie 6,3 5,2 11 5,0 Kinder- und Jugendpsychiatrie 5,4 5,7 10 4,6 Selbsthilfe(gruppen)- und -förderung/ KISS 4,5 3,8 12 5,5 Qualitätssicherung 3,6 3,8 9 4,1 GBE 3,6 3,8 12 5,5 Gesundheitsförderung 3,6 7,6 17 7,8 Planung Psychiatrie allgemein 2, Information der Bevölkerung 2,7 6,7 17 7,8 Impfstrategien/-aktionen 2,7 4,8 12 5,5 Planung Sucht/Drogen 1, Notfallversorgung 1,8 3,8 5 2,3 Altenhilfe/-pflege/Geriatrie/Hospiz 1,8 5,7 10 4,6 Krebsvorsorge/psychosoziale 1,8 2,9 8 3,7 Beratung/Rehabilitation von Krebskranken Planung Krankenhausversorgung 0,9 1,9 5 2,3 sonstiges 16,1 5,7 12 5,5 Insgesamt 100,0 100, ,0 -

28 Kategorie 1: Kategorie 2a: Kategorie 2b: Kategorie 3: Empfehlungen betreffen ausschließlich örtliche Zuständigkeiten und sind deshalb in kommunaler Verantwortung umzusetzen Empfehlungen berühren Vertragskompetenzen auf Landesebene, stellen Modifikationen oder Konkretisierungen im Rahmen bereits geltender Verträge auf Landesebene dar und bedürfen deshalb der Zustimmung der auf Landesebene zuständigen Körperschaften Empfehlungen berühren die Vertragskompetenz auf Landesebene, sind in der Umsetzung auf Landesebene durch die Vertragspartner zu entscheiden und müssen deshalb durch die Institutionen auf Landesebene geprüft werden Empfehlungen beziehen sich auf Themen, die wegen des Innovationsgrades oder der grundsätzlichen Bedeutung nicht allein durch Verträge geregelt werden können und müssen deshalb zur Klärung und Abstimmung dem Vorbereitenden Ausschuss der Landesgesundheitskonferenz zugeleitet werden.

29 Insgesamt kreisfreie Städte ab EW kreisfreie Städte bis EW Kreise HE nach Kategorien vom Anz. Kom. % Anz. Kom. % Anz. Kom. % Anz. Kom. % Kategorie , , , ,2 Kategorie 2a 26 14,6 5 22,7 5 9, ,8 Kategorie 2b 9 5,1 1 4,5 4 7,3 4 4,0 Kategorie 3 4 2,2 1 4,5 1 1,8 2 2,0 Insgesamt , , , ,0

30 Berichtstyp/Themenfeld Insgesamt Kreise Städte bis EW Städte ab EW abs. in % abs. in % abs. in % abs. In % Basisberichte 11 7,0 6 7,1 3 7,0 2 6,5 themenspezifische Gesundheitsberichte Kinder- und Jugendgesundheit 28 17, , ,6 5 16,1 Sucht/Drogen 27 17, ,7 7 16,3 6 19,4 Psychiatrie allgemein 15 9,5 8 9,5 3 7,0 4 12,9 Zahngesundheit 10 6,3 6 7,1 4 9,3 - - Psychosoziale Versorgung 8 5,1 5 6,0 3 7,0 - - AIDS 6 3,8 5 6, ,2 Sozial Benachteiligte 5 3,2 3 3,6 1 2,3 1 3,2 Impfstrategien 5 3,2 3 3,6 2 4,7 - - Gerontopsychiatrie 6 3,8 2 2,4 3 7,0 1 3,2 Gesundheit im Alter 6 3,8 2 2,4 1 2,3 3 9,7 Erkrankungen von Herz/Kreislauf 4 1,9 1 1,2-2,3 3 3,2 Selbsthilfe(-Gruppen) 3 1,9 1 2,4 1 2,3 1 - Umwelt und Gesundheit 3 2,5 2 1, ,7 Dekubitus 2 1,3 1 2, TBC 2 1,3 2 2, Diabetis mellitus 2 1,3 2 1,2-2,3 - - Kinder- und Jugendpsychiatrie 2 1,3 1 1, ,2 Kommunale GBE Geriatrische Rehabilitation 1 0,6 1 1, Sonstige Themen 12 7,6 7 8,3 2 4,7 3 9,7 Anzahl der Berichte , , , ,0