The document discusses challenges facing health systems, including an aging population with multiple chronic conditions, rising costs, and technological advances. It focuses on reforms to improve coordination within and outside of hospitals to better manage chronic diseases. This includes strengthening primary care, public health interventions, and aligning payment systems to prioritize prevention and care outside of hospitals when possible. The goal is to improve outcomes and make more efficient use of resources.

1. MIHealth Forum, Health Management & Clinical Innovation
Barcelona, 24 June 2012
Adding value to health systems
through service delivery reforms
Matthew Jowett Ph.D.
Senior Health Financing Specialist & Acting Head,
WHO Barcelona Office for Health System Strengthening

2. Outline
The challenge
Hospitals: internal coordination
Hospitals: external coordination
Concluding messages

3. Increasing
diabetes
Downward Increasing
pressure on cancers
public
finances
HEALTH SYSTEMS
OPERATING
WITHIN A RAPIDLY
Technological
CHANGING Increasing
advances ENVIRONMENT COPDs
Ageing,
dementia & Increasing
growing co- CVDs
morbidities

6. Ageing, multiple morbidities and dementia
• of 65+ year olds in Australia have
80% three or more chronic conditions
• of general and acute hospital beds in
2/3 England used by 65+ year olds many
with dementia
• is the projected increase in dementia
93% suffers in Western Europe 2010-2050
6

7. The challenge
Hospitals: internal coordination
Hospitals: external coordination
Concluding messages

8. Role of the hospital under question
Growing quality and
patient safety Rural areas? What is
concerns. Specialists desirable / possible?
operating in silos.
Represents a large Decentralise where
fixed cost in the possible, centralise
health system where deemed
(inflexibility) necessary

9. The challenge
Hospitals: internal coordination
Hospitals: external coordination
Concluding messages

10. Unnecessary admissions - diabetes
Note: Rates are age-sex standardised to 2005 OECD population.
Source: OECD Health Data 2011.
OECD

11. Unnecessary admissions - asthma
Note: Rates are age-sex standardised to 2005 OECD population.
Source: OECD Health Data 2011.
OECD

12. Unnecessary admissions - COPD
Note: Rates are age-sex standardised to 2005 OECD population.
Source: OECD Health Data 2011.
OECD

13. PHC - room for improvement
• Two countries with free
and widely accessible
primary care (i.e. full
coverage)
• Why is there such poor
awareness of own blood
pressure, low treatment
rates, and poor control?
Source: Wolf-Maier, et al. 2004. “Hypertension treatment and control in five European countries, Canada, and the
United States” Hypertension 2004;43;10-17. CREDIT: M. JAKAB

14. The challenge
Hospitals: internal coordination
Hospitals: external coordination
Concluding messages

15. Tobacco Unhealthy
use diet
CORE RISK
FACTORS
UNDERLYING
MAJOR CHRONIC
ILLNESSES
Harmful
Physical
use of
inactivity
alcohol

16. Strengthen Multi-
population-based professional
Unhealthy teams
interventions
diet
FUTURE Harmful
Tobacco
use of
use ACTIONS alcohol
Physical
Align payment inactivity Family doctors as
mechanisms & “navigators”
strengthen fiscal throughout
instruments patient pathway

17. Dietary habits in Finland
Population aged 15-64 years (1978-2007)
% 80 80
Men Women
60 60
40 40
20 20
0 0
Butter on bread Vegetables daily Skimmed or 1 %-milk
Source: National Public Health Institute T (KL)/ Health Behaviour among the Finnish Adult Population (AVTK)

18. “Persistence of a model of primary
care which is fragmented and
Much spending on inpatient care
often consists of a single doctor
represents a significant
with limited support is no longer fit
misallocation of resources
for purpose” (Nigel Edwards, WHO
Europe, April 2012)
Better coordinated and Improvements in health
integrated health and literacy can add significant
social care value within health systems