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The different dimensions of universal         coverage and access to care           Prof. Dr. J. De Maeseneer, MD, PhD, FR...
The different dimensions of universal coverage andaccess to care 1. The basics 2. Social determinants of Health, universal...
The different dimensions of universal coverage andaccess to care 1. The basics 2. Social determinants of Health, universal...
http://www.who.int/social_determinants/resources/csdh_media/primary_health_care_2007_en.pdf
Healthy life expectancy in Belgium                                                     (Bossuyt, et al. Public Health 2004...
vzw De Keeting,          vzw De Willers, Willebroek   Mechelen      Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
Sara Willems – 14/12/2005
The need for integrated care: health and welfare.
CSO
CSO
COPC-example: dental problems: periodontaldiseaseRisk factor for:•   Diabetes•   Coronary Heart Disease•   Preterm birth a...
Community Health Centre:- Family Physicians; nurses;  dieticians; health promotors;  dentists; social workers; …- 6000 pat...
COPC-project : from individual care        to community health care             Identifying health problem:Family physicia...
COPC-project : DENTAL FITNESS     A dentist?                          Focus Group sessions –I cannot afford that.         ...
COPC-project : DENTAL FITNESSWorking together with…
COPC-project : DENTAL FITNESSResults research children 30 months                 old: • 18,5 % early symptoms of childhood...
COPC-project : DENTAL FITNESS       Childhood caries:• Information and Sensibilisation  • Involving providers, social   wo...
COPC-project : DENTAL FITNESSAccessible primary dental care       Centre for Primary Oral Health Care         Botermarkt L...
Integration of personal and community health careThe Lancet 2008;372:871-2
“Towards Unity for Health”                             www.the-networktufh.org
Intersectoral action for health: the communityLedeberg (8.700 inh.)•   Platform of stakeholders•   Implementing COPC-strat...
Platform of stakeholders:                        • 40 to 50 people                        • 3 monthly                     ...
The different dimensions of universal coverage andaccess to care 1. The basics 2. Social determinants of Health, universal...
Multimorbidity becomes the rule, not theexception•   More than half of the patients with COPD have either    cardiovascula...
The challenge: vertical disease- orientedprograms and multimorbidity• Create duplication• Lead to inefficient facility uti...
The need for a shift in chronic care: from "Chronic     Disease Management" to "Participatory Patient                     ...
“Inequity by disease” becomes anincreasing problem both in developedand developing countries[ see www.15by2015.org ]
Thank you…jan.demaeseneer@ugent.be             WHO          Collaborating         Centre on PHC
The Future of Primary Health     Care in Europe IV  Welcome to Gothenburg, Sweden       September 3-4, 2012
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
Rt 1 The different dimensions of universal coverage and access to care
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Rt 1 The different dimensions of universal coverage and access to care

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Presentation by Prof. Dr. J. De Maeseneer, MD, PhD, FRCGP (Hon) Department of Family Medicine and PHC- Ghent University, Belgium at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

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Transcript of "Rt 1 The different dimensions of universal coverage and access to care"

  1. 1. The different dimensions of universal coverage and access to care Prof. Dr. J. De Maeseneer, MD, PhD, FRCGP (Hon)Department of Family Medicine and PHC- Ghent University, Belgium General Practitioner (part-time), Community Health Centre , Ledeberg-Ghent (Belgium) Chairman European Forum for Primary Care Secretary-General The network Towards Unity for HealthDirector International Centre for PHC and FM – Ghent University, Belgium WHO-Collaborating Centre on PHC Prof. Dr. S. Willems, MA, PhD The Hague, 30.11.2011
  2. 2. The different dimensions of universal coverage andaccess to care 1. The basics 2. Social determinants of Health, universal coverage and access to care 3. The new challenge: inequity by disease
  3. 3. The different dimensions of universal coverage andaccess to care 1. The basics 2. Social determinants of Health, universal coverage and access to care 3. The new challenge: inequity by disease
  4. 4. http://www.who.int/social_determinants/resources/csdh_media/primary_health_care_2007_en.pdf
  5. 5. Healthy life expectancy in Belgium (Bossuyt, et al. Public Health 2004) Socio-economic inequalities in health Healthy life expectancy in Belgium, 25 years, men555045 45,940 42,635 383025 28,120 basic secundary secundary university/higher school: 1st cycle school: 2nd education cycle
  6. 6. vzw De Keeting, vzw De Willers, Willebroek Mechelen Sara Willems – 14/12/2005
  7. 7. Sara Willems – 14/12/2005
  8. 8. Sara Willems – 14/12/2005
  9. 9. Sara Willems – 14/12/2005
  10. 10. Sara Willems – 14/12/2005
  11. 11. Sara Willems – 14/12/2005
  12. 12. Sara Willems – 14/12/2005
  13. 13. Sara Willems – 14/12/2005
  14. 14. Sara Willems – 14/12/2005
  15. 15. Sara Willems – 14/12/2005
  16. 16. Sara Willems – 14/12/2005
  17. 17. Sara Willems – 14/12/2005
  18. 18. The need for integrated care: health and welfare.
  19. 19. CSO
  20. 20. CSO
  21. 21. COPC-example: dental problems: periodontaldiseaseRisk factor for:• Diabetes• Coronary Heart Disease• Preterm birth and low birth weight• Osteoporosis
  22. 22. Community Health Centre:- Family Physicians; nurses; dieticians; health promotors; dentists; social workers; …- 6000 patients; 60 nationalities- Capitation; no co-payment- COPC-strategy
  23. 23. COPC-project : from individual care to community health care Identifying health problem:Family physicians/nurses: problematic oral condition of todlers, leading to feeding problems, crying, not sleeping,...
  24. 24. COPC-project : DENTAL FITNESS A dentist? Focus Group sessions –I cannot afford that. involving the community I don’t know where to find a dentist My child is to afraid of the dentist and to be I’m doing Fristi in his honest, me too bottle to stop him cry
  25. 25. COPC-project : DENTAL FITNESSWorking together with…
  26. 26. COPC-project : DENTAL FITNESSResults research children 30 months old: • 18,5 % early symptoms of childhood caries (7,4 % – 29,6 %) • 100% need for treatment! Correlation with • deprivation • nationality (Eastern-Europe) • no previous dentist consultations
  27. 27. COPC-project : DENTAL FITNESS Childhood caries:• Information and Sensibilisation • Involving providers, social workers, parents, schools… Strategies: Community oriented, intersectoral, participation. Educational platform for students in dentistry
  28. 28. COPC-project : DENTAL FITNESSAccessible primary dental care Centre for Primary Oral Health Care Botermarkt Ledeberg (CEMOB)Started 01/09/2006 Towards accessible oral health care ! Ghent University
  29. 29. Integration of personal and community health careThe Lancet 2008;372:871-2
  30. 30. “Towards Unity for Health” www.the-networktufh.org
  31. 31. Intersectoral action for health: the communityLedeberg (8.700 inh.)• Platform of stakeholders• Implementing COPC-strategy, taking different sectors on board• Accessible, comprehensive, quality local health care facility: a multidisciplinary Primary Health Care Centre
  32. 32. Platform of stakeholders: • 40 to 50 people • 3 monthly • Exchange of information • “Community diagnosis” Intra-family violence
  33. 33. The different dimensions of universal coverage andaccess to care 1. The basics 2. Social determinants of Health, universal coverage and access to care 3. The new challenge: inequity by disease
  34. 34. Multimorbidity becomes the rule, not theexception• More than half of the patients with COPD have either cardiovascular problems, or diabetes• Patients with COPD have a 3- to 6-fold risk to have all these problems (Eur Respir J 2008;32:962-69)• 50 % of 65+ have at least 3 chronic conditions• 20 % of 65+ have at least 5 chronic conditions (Anderson 2003)
  35. 35. The challenge: vertical disease- orientedprograms and multimorbidity• Create duplication• Lead to inefficient facility utilization• May lead to gaps in patients with multiple co- morbidities• Lead to inequity between patients
  36. 36. The need for a shift in chronic care: from "Chronic Disease Management" to "Participatory Patient Management". • In many countries, specific access to services is conditioned by the diagnosis of the patient. This may lead to a new kind of "inequity", the "inequity by disease".• It is worthwhile studying what is the actual presentation of this phenomenon, and what could be done to handle it appropriately. How will market forces and commercialisation play a role in this development?
  37. 37. “Inequity by disease” becomes anincreasing problem both in developedand developing countries[ see www.15by2015.org ]
  38. 38. Thank you…jan.demaeseneer@ugent.be WHO Collaborating Centre on PHC
  39. 39. The Future of Primary Health Care in Europe IV Welcome to Gothenburg, Sweden September 3-4, 2012
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