Colloquium "40 xρόνια από τη Διακήρυξη της Alma-Ata και την Παγκόσμια Στρατηγική Υγεία για Όλους", ΕΣΔΥ 12-9-2018

1. Η Aναγκαιότητα της Oλικής Eπαναφοράς
στις Aξίες της Alma-Ata.
Αναζήτηση Ομοφωνίας
Ευάγγελος Α. Φραγκούλης, MD, MSc
Γενικός/ Οικογενειακός Ιατρός
Αντιπρόεδρος Β’ ΕΛΕΓΕΙΑ
Αν. Αρχίατρος ΕΔΟΕΑΠ

2. Societies and environments that
prioritize and protect people's
health
Health care that is available and
affordable
for everyone, everywhere
Health care of good quality that
treats people with respect and
dignity
People engaged in their own
health.

3. Astana Declaration on Primary Health Care:
From Alma-Ata towards Universal Health Coverage and
the Sustainable Development Goals

5. STRONGER Primary Care …
Health
outcomes
Cost-
control
Responsiveness
Starfield, 1994; Doescher, 1999; Delnoij, 2000; Shi, 2002; Macinko, 2003

6. Primary Health Care
PHC is the most
approach to enhance health,
making it a necessary foundation to achieve UHC
effective efficient equitable

7. “Inverse care law”
“The availability of good
medical care tends to vary
inversely with the need for it
in the population served.
This inverse care law operates
more completely where
medical care is most exposed
to market forces, and less so
where such exposure is
reduced.”

8. Universal Health Coverage
all people, including those who are marginalized or
vulnerable,
should have access to quality health services that put
their needs at the centre,
without financial hardship.

9. Leaving no one behind!
Together on the road to universal health coverage. A CALL TO ACTION. WHO 2017

11. How could health care be anything other
than high quality?
• The care that people receive is often
inadequate, and poor-quality care is
common across conditions and
countries, with the most vulnerable
populations faring the worst
• Improving quality should be a core
component of UHC initiatives,
alongside expanding coverage and
financial protection.
• Health systems should measure and
report what matters most to people,
such as competent care, user
experience, health outcomes, and
confidence in the system

12. High quality health system framework
Kruk M et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution.
The Lancet Global Health Commission, September 05, 2018

13. We need PHC that:
• empowers people and communities as owners of their
health, as advocates for the policies that promote and
protect it, and as architects of the health and social
services that contribute to it
• Addresses the social, economic, environmental and
commercial determinants of health through evidence-
based policies and actions across all sectors
• ensures strong public health and primary care
throughout people’s lives, as the core of integrated
service delivery.

14. Empower people to take ownership of
their health and health care
• enable people and communities to pursue the knowledge,
skills and resources needed to take care of their own
health, including the use of digital technologies
• create conditions in which people participate in health
promotion, choosing healthy lifestyles, and in decisions
about their health care, in line with their goals and
objectives
• engage people and communities in the design, planning
and management of their health systems and enable them
to hold decision makers accountable for results.

16. Determinants of Health

17. HEARTS Technical package for cardiovascular disease management in primary health care:
healthy-lifestyle counselling; Geneva: World Health Organization; 2018

19. Cost effective public health interventions
WHO 2013

20. Put Public Health and Primary Care at the centre of UHC
• enhance capacity
and infrastructure
for Public Health
functions
• develop quality
Primary Care that is
continuous,
comprehensive,
coordinated,
community-oriented
and people-centred
• prioritize disease
Prevention and
Health Promotion

21. Prevention is better than cure
• Prevention is the key to avoid
ill health and achieve a high
level of mental and physical
well-being effectively and
efficiently
• A shift in focus from sickness
and cure to prevention and
the social determinants of
health is needed
State of Health in the EU. ec.europa.eu/health/state

22. • adequate public health and primary care workforce
(including PHC nurses, family physicians, midwives, allied
health professionals, and non-professional community
health workers) working in teams with competencies to
address modern health needs
• adequate compensation, meaningful opportunities for
professional development and career progression
• appropriate medicines, products and technologies
• allocate sufficient resources to research, evaluation and
knowledge management, promoting the scale up of
effective strategies for multisectoral action, public health
and primary care.
Put Public Health and Primary Care at the centre of UHC

23. Integrated Health Care
• Integrated care seeks to improve patient
experience, outcomes of care and effectiveness
of health systems (known as "triple aim") through
linkage or coordination of services and providers
along the continuum of care.
• all people have access to health services that are
provided in a way that are coordinated around
their needs, respects their preferences, and are
safe, effective, timely, affordable, and of
acceptable quality.

27. Μεταρρύθμιση στην ΠΦΥ
• Οικογενειακός γιατρός για όλους τους
πολίτες με λίστα ασθενών
• Σύστημα αναφοράς από τον οικογενειακό
γιατρό προς την εξειδικευμένη φροντίδα,
περιπατητική ή νοσοκομειακή
• Διεπιστημονική ομάδα υγείας στις ΤΟΜΥ
• Ελλιπής χρηματοδότηση του συστήματος
πέρα των ΤΟΜΥ

28. Ελλιπής χρηματοδότηση
• αποζημίωση για τον συμβεβλημένο με τον
ΕΟΠΥΥ ιδιώτη οικογενειακό γιατρό
αναντίστοιχη με τον όγκο και τη
σπουδαιότητα του ρόλου που καλείται να
αναλάβει.
• 0.8 € μικτά/ μήνα/ ασθενή εγγεγραμμένο στη
λίστα του
• 5.5 € μικτά/ επίσκεψη ασθενούς στο γιατρό

29. Σλοβακία 2,8 € / pt /month

30. • 900 pts/ παιδίατρο  100.000 € / έτος
• 1.300 pts/ προσωπικό ιατρό για ενήλικες 110.000 € / έτος
• Κατά κεφαλήν αμοιβή
• Αμοιβή για συγκεκριμένες πράξεις και
• Αμοιβή βάσει δεικτών απόδοσης

31. Αττική: 156 γενικοί γιατροί, παθολόγοι για 1054 θέσεις

32. • μερική και όχι πλήρη κάλυψη των αναγκών υγείας των πολιτών
που θα έχουν καταφέρει να εγγραφούν σε έναν ιδιώτη
συμβεβλημένο οικογενειακό γιατρό.
• 20 ώρες/ εβδομάδα που δεσμεύει ο ΕΟΠΥΥ σε κάθε γιατρό δεν
επαρκούν για 2250 ασφαλισμένους (απαιτούνται 35-40 ώρες/
εβδομάδα).
• Οι ασφαλισμένοι θα βρεθούν να πρέπει να επιλέγουν ανάμεσα σε
κόστος χρόνου (μακρές λίστες αναμονής για δωρεάν ραντεβού)
και κόστος χρήματος (για να παρακάμψουν τη λίστα)
• Το σύστημα αναφοράς προς την εξειδικευμένη φροντίδα δεν
μπορεί να λειτουργήσει υπό συνθήκες μερικής κάλυψης του
πληθυσμού
Ελλιπής χρηματοδότηση