Erkki Vauramo: A network model for organising regional care


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In this slideshow, Professor Erkki Vauramo, Researcher and Professor, Aalto University, Finland, explores the issues facing Finland’s primary care and asks if they need a new network model for organising regional care.
Professor Vauramo spoke at the Nuffield Trust European Summit 2014, which was supported by KPMG.

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Erkki Vauramo: A network model for organising regional care

  1. 1. New Paradigm for organizing regional care – a network model? Erkki Vauramo Professor Aalto University, Department of Architecture Research Institute for Health Care Facilities
  2. 2. OECD Health data 2013 Total social and healthcare employment and hospital beds /1 000 inhabitants Orientation: Open care Orientation: Institutional care Norway Employees / 1000 inhabitants 97 Denmark 87 Netherlands Sweden 77 Iceland United Kingdom 67 United States 57 Finland Switzerland Australia Luxembourg Germany Belgium Ireland 47 Austria Israel 37 France Portugal Spain Italy 27 Estonia Greece Chile 17 Czech Republic Slovak Republik Hungary Korea Slovenia Mexico Turkey 7 1.5 2.5 3.5 4.5 5.5 6.5 Hospital beds / 1 000 inhabitants 7.5 8.5 9.5
  3. 3. Ageing population and available resources Finland 2014 -2040 250 Population 75+ Maximum taxation 200 Number of Number od deaths Year 2014 =100 Need of Social Care Taxation per one 75 Taxatio per one 75+ + 150 Need of Health Care Taxation per one death 100 50 0 2014 2020 2025 2030 2035 2040
  4. 4. Driving force: difficulties in Primary care Planned in 1972 To day Perspective Primary care hospital: 3 beds/1000 inhabitants Acute 1 bed, long term 2 beds / 1000 Long term beds will closed, system under evaluation Local ambulance service Organized by Central Hospital Acute patient flow and triage controlled by special care hospital Emergency 24 h local 24h/7d in central hospitals, only easy cases during office hours in primary care Imaging, local Controlled by central hospital Laboratory, local Controlled by central hospital Adult open care; 2-2,5 doctor visits per person Lack of physicians, from 1,8 visits to 1,3 per person Competition of MDs with insurance based adult clinics Acute care, Disease management Children and elderly care Chronic disease management Increasing consultations from special care Preventive medicine Realization by primary care Planning is coordinated by central hospital district No acute cases in primary care, focus on children and elderly Is special care all-embracing primary care close to death ?
  5. 5. New Health Care Act Objective: To integrate special care, primary care and social care services under one regional management and create one funding mechanism New structure for 5,5 million people and 330 000 km2: Social and Health Care integrated into 65 districts Districts with Acute Care Hospitals 18, over 80 000 inhabits Districts with limited Special Care Hospital (geriatric, rehabilitation), over 50 000 inhabitants Districts with local Open Care Services at primary level, care homes over 20 000 inhabitant Content is under development One channel funding is under discussion Testing: Tested during 6 years with highly positive results by Eksote Time table: Parliament will discuss 2014, in force late 2010’s
  6. 6. NEW SOCIAL AND HEALTH CARE REGION ACUTE CARE HOSPITAL Typically 200 000 inhabitants Local service facilities some 230 for 200 000 inhabitants NEAR-BY-SERVICE CENTRE SERVICE BLOCK CETRALISED SOCIAL SERVICES LOCAL HOSPITAL REHABILITAION, GERIATICS Minimum 50 000 inhabitants NEAR-BY SERVICE CENTRE WITH HEALTH AND SOCIAL CARE Minimum 20 000 inhabitants MOBILE HOME SERVICES MOBILE HOME SERVICES SERVICE HOMES Jarmo Suominen | Aalto Yliopisto | Arkkitehtuurin laitos 2014
  7. 7. New Health Care Act – open issues Administration of Social and Health care district: Regional organization or “Capital City” of county New structure for 5,5 million people: Acute care hospitals; 18 still too high, 11-15 might be better Role of University Hospital is not defined Primary care hospitals, now 150, will be closed towards 45, difficult to accept by municipalities Programme of new near-by-services undefined Funding: Several governmental funding channels treat citizens unequal but one channel funding hurts the interest of adult population
  8. 8. Questions Is WHO three level principle of care (primary, special, third level) overcame by IT–era networking? Role of primary care? Do we need a new service paradigm? NHS? WHO?