Intersectional Regional Planning of Health Care in Baden-Württemberg (Germany)

Transkript

1 Rennes, 20 May 2015 Intersectional Regional Planning of Health Care in Baden-Württemberg (Germany) Dr. Andrea Kloster Dr. Torben Sammet

2 I. Health Care in Germany - Organization Organization and financing of health care in Germany is based on the traditional principles of 1. Decentralization and self-regulation 2. Social solidarity Folie 2

3 1. Health Policy Levels Supranational European Union National Regional Local Federal Republic of Germany The legislative framework for outpatient and inpatient sector (Code of Social Law V) Federal State Land Baden-Württemberg Supervising subordinated authorities, finanancing investment in the hospital sector Administrative districts, municipalities Health promotion, hospital planning Public health departments Folie 3

4 2. Health services, social insurance, health authorities Health services outpatient care general practitioners, specialists inpatient care hospitals, rehabilitation facilities care homes and hospices rescue services Social Insurance statutory insurance private insurance Health authorities Ministry - department of health public health departments public health service Folie 4

5 3. Inpatient / outpatient care ambulatory (outpatient care) hospital care (inpatient care) Physicians in private practice Responsible for planning and implementation: Association of the Statutory health insurance physicians. Finance: complex formal negotiation process between representatives of the sickness funds and physician and dental associations. independent, mostly non-profit hospitals Responsible: Länder Finance: must be listed on plans established by the Länder (financed by a dual system involving coverage of capital costs by the Länder and payment of operating costs by the statutory health insurance funds). Folie 5

6 II. Health policy Baden- Württemberg Population 10.6 Mio. Average age: 43 (2012) 45,7 (2030) Life expectancy: women 83.6, men 79.2 Fertility: 1.36 children per woman Health economics Health care expenditures: 35 billions per year Expenditure of Statutory health insurance funds:19,9 billions pa 11% of jobs Demographic trends Ageing society Folie 6

7 1. Challenges of the health care system Change of disease pattern Change of lifestyle Public Health Health as a factor in the competitiveness of regional and national economies Demographic change Folie 7

8 2. The demographic change population Folie 8

9 3. The demographic change medical staff in ambulatory care About 8000 general practicioners in Baden-Württemberg 2010 Inbalanced distribution of general practicioners inbetween urban an rural regions About 20 % of general practitioners are over 60 years old Source: Stat. Monatsheft BW 9/2010 Folie 9

10 III. Pilot Project Local planning of health policy Sponsor: Ministry of Labour and Social Affairs, Family, Women and Senior Citizens, Baden- Württemberg Management: State Health Office of Baden-Württemberg Folie 10

11 1. Contents 1. Six districts each work out a local plan of health policy at the local health conference, involving the citizens, for one of the following fields: health promotion and prevention of diseases medical care 2. The result is expected to be a transferable rough copy to work out a local plan of health policy for districts in Baden- Württemberg. Folie 11

12 2. Local health conferences Since 2010 local health conferences have been established in 37 out of the 44 districts in Baden-Württemberg. They are health-related management committees whose relevant players jointly analyse local strenghts and weaknesses, look for demand-related solutions and recommend their implementation to the district assembly. Usually, the conference is chaired by the head of a district. They are coordinated by the local health department. Each local health conference is faced with a complex variety of topics and players involved in the field of health. Folie 12

13 2. Local health conferences districts and rural districts of Baden-Württemberg with a local health conference Folie 13

14 2. Local health conferences Local health conferences consist of delegated representatives of local institutions of medical care (e.g. medical council), health insurance, self-help, social sector (e.g. charities), educational institutions and administrative departments (e.g. of social welfare) Folie 14

15 3. Key questions How is it possible to involve the many different players of the local health conference and the citizens in the complex processes of the local planning of health policy permanently? What contents and what procedures of the local planning of health policy are recommendable for Baden-Württemberg to support the local health conference in a structured way? Folie 15

16 4. Local planning of health policy The local planning of health policy is a planning process in which the different departments of a district (e.g. of social welfare, of youth welfare and of the environment) work together with the players of the local health conference and also involve the citizens. First, the local planning of health policy contains an assessment of the health challenges and of the resources in a district. Data on the health-related and social situation and on the medical care in districts are analysed. Folie 16

17 4. Local planning of health policy Second, it includes a policy-development with demandrelated objectives and steps in order to gradually solve the health challenges of the district and to improve the state of health of all citizens. Third, the steps and activities are carried out and documented. Fourth, the resulting effects on the state of health of citizens and on the medical care in districts are evaluated. The results of the evaluation are used for the permanent development of the local planning of health policy. Folie 17

18 4. Local planning of health policy Policydevelopment Assessment Cooperation Participation of Citizens Implemen- tation Evaluation Folie 18

19 4. Local planning of health policy cooperation and participation The two cross-topics cooperation and participation of citzens are a central feature at each stage of the local planning of health policy. The project and also the cross-topics in the six districts are coordinated by the local health department. The way of participation (e.g. citizens` forums and focus groups) is individually adapted to the topics and objectives. Folie 19

20 4. Local planning of health policy Assessment A SWOT-Analysis (Strengths, Weaknesses, Opportunities, Threats) of the health-related and social situation and of the medical care in the district is drawn up. Maps of the district depicting health-related data are made, e.g. maps of the distribution of medical institutions like hospitals and doctors and their location. hazards and risk factors such as overweight, vaccinations, frequency of accidents and pollution. potentials, such as an infrastructure that supports physical activities like sports fields, parks and playgrounds. Folie 20

21 Districts and rural districts of Baden-Württemberg Ministry of Labour and Social Affairs, Folie 21 Families and Senior Citizens Baden-Württemberg

22 IV. Pilot Project of comprehensive Health Care beyond sectors The project aims to find an answer to the challenges of the german health care system. The goal is to pilot a set-up with comprehensive health care beyond sectors. The pilot region will consist of at least 3 administrative districts in Baden-Württemberg Decision making authorities on regional and local level will be included as well as representatives of the citizens. Folie 22

23 1. Key Questions How can demand and supply within the pilot region be brought into balance? How can we optimize the cooperation between in- and outpatient services, including day care and health care prevention? How can we increase the rehabilitation programs and disease prevention programs provided by all health services providers? Is there an option to provide health care services beyond administrative regions while still covering the full geographic area at high levels (e.g. health care centers with different medical specialists, transferral of medical responsibilities to health service staff, future options for hospitals in rural areas)? Folie 23

24 2. Subprojects Subproject 1 We will start by analyzing the status quo of in- and outpatient health services. Additionally, we will estimate the future demand based on different scenarios. The analysis will cover all of Baden-Würtemberg as well as the pilot region in more detail. Subproject 2 We aim to develop a concept beyond administrative districts and supply beyond sectors, based on the data set derived in subproject 1. We will engage in citizen dialogues in the pilot regions. Folie 24

25 3. Overall Target The pilot project will develop a concept but not cover the implementation. The concept is addressing cross-sectoral supply concepts across several administrative districts in cooperation with all partners (e.g. government bodies, politicians, citizen representatives, hospitals, health care, association of practicioners, public health service, representatives of health professionals,.) The project will generate experience that can be transferred to other regions, if they develop similar supply concepts. The concept will be based on existing legal conditions. Target will be to establish a sustainable, economically feasible supply concept for the pilot region. Folie 25

26 4. Timeline Duration 2 Years First results of subproject 1 expected by the end of 2015 concept development thereafter key success factor: involvement of citizen representatives Folie 26

27 Thank you for your attention! Folie 27