sustainable healthcare through accountability proposed roadmap for the private health sector tebogo...
TRANSCRIPT
SUSTAINABLE HEALTHCARE THROUGH ACCOUNTABILITYPROPOSED ROADMAP FOR THE PRIVATE HEALTH SECTOR
Tebogo Phaleng
Agenda
1. Background & Context
2. Re-alignment | Private Healthcare National strategic imperatives
3. Output from Think Tank sessionsa. Barriers to an improved health systemb. Envisaged goals of the private health systemc. Proposed industry roadmap for sustainable healthcare
Agenda
1. Background & Context
2. Re-alignment | Private Healthcare National strategic imperatives
3. Output from Think Tank sessionsa. Barriers to an improved health systemb. Envisaged goals of the private health systemc. Proposed industry roadmap for sustainable healthcare
Prosperity
A state of good fortune and successful social and economic status
Governance & Accountability
Personal Freedom
Safety & Security
Healthcare
Education
Social Inclusion
Economy
Opportunity/Entrepreneurship
Source: Legatum Prosperity Index (2014)
Prosperity
1. Protection of personal freedom2. Social inclusion (Social Capital)3. Safety & Security4. Education5. Access to economic opportunity / Entrepreneurship6. Health: Spend wisely
Norway
New Zealand
Switzerland
Denmark
Canada
Commitment to 6 Core Principles
Source: Legatum Prosperity Index (2014)
1
2
3
4
5
ProsperityHow does SA feature against its income peers?
Costa Rica
Thailand
Colombia
Dominican Republic
South Africa
Governance & Accountability
Personal Freedom
Safety & Security
Healthcare
Education
Social Inclusion/Capital
Economy
Opportunity/Entrepreneurship
Source: Legatum Prosperity Index (2014)
34
51
66
72
81
The Roadmap Drafting Process
• Catalyst: KPMG SA Health Industry Survey (2015)
• Key findings: SA health system rated as ineffective in the following areas
Source: KPMG, SA Health Industry Survey (2015)
Protecting Health Citizens against financial consequences
of ill-health Improving the health status of individuals, families and
communities
Preventing ill-health through promotion and prevention
campaigns
Providing equitable access to care
Allowing Health Citizens to participate in decisions affecting their health and health system
The Roadmap Drafting Process
Preliminary
Recommendations
Current State End State Definition
Initiatives, Prioritization & Sequencing
Consultation & Consensus
Final Roadmap
• Leadership and
Governance
• Health information systems
• Healthcare financing
• Service Delivery
• Human Resources
• Medicines and technologies
Performance Targets
Guiding Principles
3. Strategic Think Tank
Sustainability
Quality
Affordability
Patient-centricity
Access
2. Gap Analysis 4. BHF Conference
1……2…….3……4……5……
5. Private Sector Plan
Value Creation
Innovation
Efficiency
• The process of building the roadmap is collaborative, exploratory and iterative • Involves extensive consultation, imaginative proposals tangible milestones & outputs• Aims to create a safe space for ideas, collaboration encourage enhanced investment in healthcare• Permission to fail, so the we can be released from the paralysis caused by fear
1. Pre-Conference Survey
Agenda
1. Background & Context
2. Re-alignment | Private Healthcare National strategic imperatives
3. Output from Think Tank sessionsa. Barriers to an improved health systemb. Envisaged goals of the private health systemc. Proposed industry roadmap for sustainable healthcare
National Development Plan
Vision for 20301. Increase life expectancy to at least 70 years2. Radically reduce the quadruple burden of disease
a. Under-20 generation largely free of HIV/AIDSb. Progressively improve TB prevention and curec. Reduce maternal and child mortalityd. Reduce prevalence of non-communicable diseases (NCDs) by 28%e. Reduce injury, accidents and violence by 50% (relative to 2010 levels)
3. Health system reforms – equity, efficiency, effectiveness and quality of care provision4. Universal Health Coverage5. Significant reduction in the risks posed by the ecological and social determinants of disease
National Health Strategic Plan
10 Point Plan1. Strategic leadership & social contract for better health
outcomes2. Implementing NHI3. Improving quality of health services4. Overhauling healthcare system 5. Improving HR management, planning & development6. Revitalising infrastructure7. Accelerate HIV | AIDS | STD | TB and other
communicable plans8. Reviewing the drug policy9. Improving the effectiveness of the health system10. Strengthening research and development
4 Strategic Outputs1. Increase life expectancy2. Reduction in maternal | child mortality rates 3. Combating HIV | AIDS | TB4. Improving health system effectiveness
a. Revitalisation of Primary Health Careb. Improved Physical Infrastructure c. Improved Patient Care and Satisfactiond. Accreditation of health facilities for qualitye. Enhanced Management of Health Facilitiesf. Improved access to Human Resources for Healthg. Improved Health Care Financingh. Strengthened Health Information Systems (HIS)i. Improved health services for the Youthj. Expanded access to Home Based Care
and Community Health Workers
Lessons from Global Experience
1. Good governance
• Enabling policy environment
• Effective institutions of accountability
2. Healthy competition3. Expanding access to education4. Expanding access to healthcare
• Health Economic Performance
• +10% life expectancy +0.4% economic growth
• Link health policy/regulations with interactions
between health system and the broader economy
4 key strategic interventions
1. Healthy, empowered mom
2. Healthy birth & childhood
3. Education & employment
Healthcare | 3 practical steps
Source: • Legatum Prosperity Index (2014)• “Why Nations Fail” - J. Acemoglu, J.A. Robinson Source: Coalesce Knowledge Repository
Lessons from Global Experience
1. Mindfulness of (changing) local context2. Accountability and responsiveness to needs of
our Health Citizens3. Use of technology to effect meaningful change
Relevance
Private Healthcare | Perhaps a New Agenda is due?
1. Government’s policy position on the role of the private health sector
2. Coherence: Consensus position on a shared vision for the private health sector
3. Private health sector to revisit its mandate and obligations to
a. Making healthcare more accessible and affordable to Health Citizens
b. Making a lasting contribution to broader national development imperatives
4. Identify key barriers to an improved healthcare system
5. Open and constructive engagement within the healthcare industry
a. Define new model(s) for collaborative accountability
b. Debate, achieve consensus on a proposed plan of action for the private health sector
Agenda
1. Background & Context
2. Re-alignment | Private Healthcare National strategic imperatives
3. Output from Think Tank sessionsa. Barriers to an improved health systemb. Envisaged goals of the private health systemc. Proposed industry roadmap for sustainable healthcare
Legislation
• Lack of alignment and clear legislation as a basis for a sustainable healthcare system
• Regulatory environment does not encourage healthy competition
Process
• The lack of a unifying roadmap for the industry• No clear process for engaging other stakeholders
outside the funding industry
Functioning of the Health System
• Healthcare reforms are not data driven• Lack of data sharing to facilitate striking of a good
balance between Accessibility-Quality-Affordibility
Barriers to an Improved Healthcare System
• Universal Health Coverage• Access to high quality, low
cost healthcare for all in SA
• Reduce the burden of disease and trauma
• Improve life expectancy
• Reduce (relative) costs • Improve quality & outcomes
• Supply side restructuring• Stronger processes • Value-based purchasing
• Leadership • Improve management
capabilities• Health Leadership Academy
• Payer marketplace consolidation
• Product simplification
Build relationships of Trust within the healthcare environment
Coherent legislation and supportive policy framework
Coherent legislation and supportive policy framework
Envisioned Goals of the Private Healthcare System
Trust and Trustworthiness
PlacedTrust
ProcessTrust
Trust, Trustworthiness and Accountability
1. Competence2. Honesty3. Reliability
PlacedTrust
ProcessTrust
Being Trustworthy
Systems (and Institutions) of Trust & Accountability
1. Information• Alignment to Health Citizens‘ needs• Performance (Value)
2. Sanctions• Regulated provisions• Industry Charter / Code of Ethics• Selective (value based) purchasing Source:
• “Trust” – Baroness Onora O’Neill (2013)• “Accountability and Health Systems” – D. Brinkerhoff, Partners for Health Reformplus (2003)
• Universal Health Coverage• Access to high quality, low
cost healthcare for all in SA
• Reduce the burden of disease and trauma
• Improve life expectancy
• Reduce (relative) costs • Improve quality & outcomes
• Supply side restructuring• Stronger processes • Value-based purchasing
• Leadership • Improve management
capabilities• Health Leadership Academy
• Payer marketplace consolidation
• Product simplification
Build relationships of Trust within the healthcare environment
Coherent legislation and supportive policy framework
Coherent legislation and supportive policy framework
Envisioned Goals of the Private Healthcare System
A well functioning Healthcare SystemStructure of the proposed roadmap is based on the WHO framework for a well functioning healthcare system
Source: Coalesce Knowledge RepositoryAdapted from “Key Components of a Well Functioning Health System” - World Health Organization (2010)
Quality, relevant, timely information
Quality, affordable medical & human
resources
Transparent, accountable care
DESIRED FUTURE STATE
Sustainable, integrated, patient-centric health
system
CURRENT STATE
Fragmented, unsustainable, stagnant,
high cost, variable quality
Financial sustainability &
affordability
Patient-centric care, increased life expectancy
& decreased BoD
Proposed RoadmapTowards Sustainable Healthcare in South Africa
Quality, relevant, timely information
Quality, affordable medical & human
resources
Transparent, accountable care
DESIRED FUTURE STATE
Sustainable, integrated, patient-centric health
system
CURRENT STATE
Fragmented, unsustainable, stagnant,
high cost, variable quality
Financial sustainability &
affordability
Patient-centric care, increased life expectancy
& decreased BoD
Proposed RoadmapTowards Sustainable Healthcare in South Africa
Info
rmati
on st
ream
s an
d re
sear
ch
Leadership, governance and regulation
2020 2025
Hea
lth w
orkf
orce
, med
ical
pr
oduc
ts &
tech
nolo
gy
2017
Health workforce, medical products & technology
Hea
lthca
re fi
nanc
ing
and
cont
racti
ng
Service delivery
Info
rmati
on st
ream
s an
d re
sear
ch
Leadership, governance and regulation Service delivery
Quality, relevant, timely information
Quality, affordable medical & human
resources
Transparent, accountable care
DESIRED FUTURE STATE
Sustainable, integrated, patient-centric health
system
CURRENT STATE
Fragmented, unsustainable, stagnant,
high cost, variable quality
2020 2025
Hea
lth w
orkf
orce
, med
ical
pr
oduc
ts &
tech
nolo
gy
Financial sustainability &
affordability
2017
Patient-centric care, increased life expectancy
& decreased BoD
Include a primary health care
entitlement in a mandatory package
Define standardised
quality measures to do value-based
assessments
Health workforce, medical products & technology
Hea
lthca
re fi
nanc
ing
and
cont
racti
ng
Public-private cooperation
Group practices & multi-disciplinary
practices
Support Provider Reform
Integrated Care for chronic NCDs &
infectious diseases; remove barriers that
lead to non-adherence
Improve quality of
service delivery Provider profiling linked
to reimbursement with patient satisfaction
metrics
Patient empowerment
Integrated care
Target waste, fraud &
avoidable conditions or
medical errors
Public sector revitalization –
competitor to private services
Proposed RoadmapTowards Sustainable Healthcare in South Africa
Info
rmati
on st
ream
s an
d re
sear
ch
Leadership, governance and regulation Service delivery
Quality, relevant, timely information
Quality, affordable medical & human
resources
Transparent, accountable care
DESIRED FUTURE STATE
Sustainable, integrated, patient-centric health
system
CURRENT STATE
Fragmented, unsustainable, stagnant,
high cost, variable quality
2020 2025
Hea
lth w
orkf
orce
, med
ical
pr
oduc
ts &
tech
nolo
gy
Financial sustainability &
affordability
2017
Patient-centric care, increased life expectancy
& decreased BoD
Collaborate with International
Universities on health management courses
Health IT
degrees
Create a consultative platform to
debate changes in legislation
Create a uniform health management programme -
single protocol management structure to create common
language between public and private
Strengthen engagement
platforms
Publish variations in clinical practice
Include a primary health care
entitlement in a mandatory package
Define standardised
quality measures to do value-based
assessments
Health workforce, medical products & technology
Hea
lthca
re fi
nanc
ing
and
cont
racti
ng
Public-private cooperation
Group practices & multi-disciplinary
practices
Support Provider Reform
Integrated Care for chronic NCDs &
infectious diseases; remove barriers that
lead to non-adherence
Improve quality of
service delivery Provider profiling linked
to reimbursement with patient satisfaction
metrics
Increase trust & support for leadership
Develop strong, diverse, inclusive, accountable,
capable leadership
Patient empowerment
Integrated care
Robust National Monitoring & Evaluation
Target waste, fraud &
avoidable conditions or
medical errors
Public sector revitalization –
competitor to private services
Improve hospital
efficiency; implement
care pathways
Proposed RoadmapTowards Sustainable Healthcare in South Africa
Info
rmati
on st
ream
s an
d re
sear
ch
Leadership, governance and regulation Service delivery
Quality, relevant, timely information
Quality, affordable medical & human
resources
Transparent, accountable care
DESIRED FUTURE STATE
Sustainable, integrated, patient-centric health
system
CURRENT STATE
Fragmented, unsustainable, stagnant,
high cost, variable quality
2020 2025
Hea
lth w
orkf
orce
, med
ical
pr
oduc
ts &
tech
nolo
gy
Financial sustainability &
affordability
2017
Patient-centric care, increased life expectancy
& decreased BoD
Increase production & motivation of
Healthcare workers
Health technology
assessment - merits & pricing
Mid level worker deployment framework -
recognizing prior learning Health
Workers
Price regulation of
productsCollaborate with
International Universities on health management courses
Health IT
degrees
Multi- disciplinary medical homes
Create a consultative platform to
debate changes in legislation
Create a uniform health management programme -
single protocol management structure to create common
language between public and private
Strengthen engagement
platforms
Publish variations in clinical practice
Include a primary health care
entitlement in a mandatory package
Healthcare Mentoring & Development programs
Define standardised
quality measures to do value-based
assessments
Prioritize Investment in
Research & Development
Closer cooperation
between state and private
Allied Health professional
training Get coding
fixed
Health workforce, medical products & technology
Hea
lthca
re fi
nanc
ing
and
cont
racti
ng
Public-private cooperation
Group practices & multi-disciplinary
practices
Support Provider Reform
Integrated Care for chronic NCDs &
infectious diseases; remove barriers that
lead to non-adherence
Improve quality of
service delivery Provider profiling linked
to reimbursement with patient satisfaction
metrics
Increase trust & support for leadership
Develop strong, diverse, inclusive, accountable,
capable leadership
Develop elderly, mental health &
home-based services Integrate into social services
Patient empowerment
Integrated care
Enabled, effective Quality monitoring body
Robust National Monitoring & Evaluation
Target waste, fraud &
avoidable conditions or
medical errors
Public sector revitalization –
competitor to private services
Regional training institutes
Improve hospital
efficiency; implement
care pathways
Increase local manufacturing
capabilities
Proposed RoadmapTowards Sustainable Healthcare in South Africa
Info
rmati
on st
ream
s an
d re
sear
ch
Leadership, governance and regulation Service delivery
Quality, relevant, timely information
Quality, affordable medical & human
resources
Transparent, accountable care
DESIRED FUTURE STATE
Sustainable, integrated, patient-centric health
system
CURRENT STATE
Fragmented, unsustainable, stagnant,
high cost, variable quality
2020 2025
Hea
lth w
orkf
orce
, med
ical
pr
oduc
ts &
tech
nolo
gy
Financial sustainability &
affordability
2017
Patient-centric care, increased life expectancy
& decreased BoD
Increase production & motivation of
Healthcare workers
Health technology
assessment - merits & pricing
Mid level worker deployment framework -
recognizing prior learning Health
Workers
Price regulation of
productsCollaborate with
International Universities on health management courses
Health IT
degrees
Multi- disciplinary medical homes
Create a consultative platform to
debate changes in legislation
Create a uniform health management programme -
single protocol management structure to create common
language between public and private
Strengthen engagement
platforms
Publish variations in clinical practice
Include a primary health care
entitlement in a mandatory package
Healthcare Mentoring & Development programs
Define standardised
quality measures to do value-based
assessments
Prioritize Investment in
Research & Development
Closer cooperation
between state and private
Allied Health professional
training Get coding
fixed
Health workforce, medical products & technology
Hea
lthca
re fi
nanc
ing
and
cont
racti
ng
Public-private cooperation
Group practices & multi-disciplinary
practices
Support Provider Reform
Integrated Care for chronic NCDs &
infectious diseases; remove barriers that
lead to non-adherence
Improve quality of
service delivery Provider profiling linked
to reimbursement with patient satisfaction
metrics
Increase trust & support for leadership
Develop strong, diverse, inclusive, accountable,
capable leadership
Develop elderly, mental health &
home-based services Integrate into social services
Patient empowerment
Integrated care
Enabled, effective Quality monitoring body
Robust National Monitoring & Evaluation
Target waste, fraud &
avoidable conditions or
medical errors
Public sector revitalization –
competitor to private services
Regional training institutes
Improve hospital
efficiency; implement
care pathways
Increase local manufacturing
capabilities
Proposed RoadmapTowards Sustainable Healthcare in South Africa
Urgent Assessment:Increasing availability of
resources; better utilization of resources & mechanisms to increase
prepayment
Mandatory membership based
on income-level
Universal Health
Coverage
Define mandatory package
Increase transparency -
outcomes reporting
Regulatory Reform
Stabilise risk pools & cross-subsidization
Value-based contracting
Create more effective incentives to improve quality of care provision
Reserving
Control Costs(price, utilization)
Tax reform
Info
rmati
on st
ream
s an
d re
sear
ch
Leadership, governance and regulation Service delivery
Quality, relevant, timely information
Quality, affordable medical & human
resources
Transparent, accountable care
DESIRED FUTURE STATE
Sustainable, integrated, patient-centric health
system
CURRENT STATE
Fragmented, unsustainable, stagnant,
high cost, variable quality
2020 2025
Hea
lth w
orkf
orce
, med
ical
pr
oduc
ts &
tech
nolo
gy
Financial sustainability &
affordability
2017
Patient-centric care, increased life expectancy
& decreased BoD
Increase production & motivation of
Healthcare workers
Health technology
assessment - merits & pricing
Mid level worker deployment framework -
recognizing prior learning Health
Workers
Price regulation of
productsCollaborate with
International Universities on health management courses
Health IT
degrees
Multi- disciplinary medical homes
Create a consultative platform to
debate changes in legislation
Create a uniform health management programme -
single protocol management structure to create common
language between public and private
Strengthen engagement
platforms
Publish variations in clinical practice
Include a primary health care
entitlement in a mandatory package
Healthcare Mentoring & Development programs
Define standardised
quality measures to do value-based
assessments
Prioritize Investment in
Research & Development
Closer cooperation
between state and private
Allied Health professional
training Get coding
fixed
Health workforce, medical products & technology
Hea
lthca
re fi
nanc
ing
and
cont
racti
ng
Public-private cooperation
Group practices & multi-disciplinary
practices
Support Provider Reform
Integrated Care for chronic NCDs &
infectious diseases; remove barriers that
lead to non-adherence
Improve quality of
service delivery Provider profiling linked
to reimbursement with patient satisfaction
metrics
Increase trust & support for leadership
Develop strong, diverse, inclusive, accountable,
capable leadership
Develop elderly, mental health &
home-based services Integrate into social services
Patient empowerment
Integrated care
Enabled, effective Quality monitoring body
Robust National Monitoring & Evaluation
Target waste, fraud &
avoidable conditions or
medical errors
Public sector revitalization –
competitor to private services
Regional training institutes
Improve hospital
efficiency; implement
care pathways
Increase local manufacturing
capabilities
Proposed RoadmapTowards Sustainable Healthcare in South Africa
Urgent Assessment:Increasing availability of
resources; better utilization of resources & mechanisms to increase
prepayment
Mandatory membership based
on income-level
Universal Health
Coverage
Define mandatory package
Increase transparency -
outcomes reporting
Regulatory Reform
Stabilise risk pools & cross-subsidization
Value-based contracting
Create more effective incentives to improve quality of care provision
Reserving
Control Costs(price, utilization)
Tax reform
Data Interoperability and governance standards set
EMR
Data systems / tools to support alternate reimbursements
Develop and implement more healthcare quality & outcome indicators
Standardised database of Health outcome indicators
private & public sectors
Morbidity Mortality Quality of Life data
Access to Standardised international best
practices protocols (Pvt/Public system) Web
Innovative technologies to
improve service delivery
m/eHealth to increase education,
engagement & adherence
Increase Transparency
Next Steps
Preliminary
Recommendations
Current State End State Definition
Initiatives, Prioritization & Sequencing
Consultation & Consensus
Final Roadmap
• Leadership and
Governance
• Health information systems
• Healthcare financing
• Service Delivery
• Human Resources
• Medicines and technologies
Performance Targets
Guiding Principles
3. Strategic Think Tank
Sustainability
Quality
Affordability
Patient-centricity
Access
2. Gap Analysis 4. BHF Conference
1……2…….3……4……5……
5. Private Sector Plan
Value Creation
Innovation
Efficiency
1. Pre-Conference Survey
• The process of building the roadmap is collaborative, exploratory and iterative • Involves extensive consultation, imaginative proposals tangible milestones & outputs• Aims to create a safe space for ideas, collaboration encourage enhanced investment in healthcare• Permission to fail, so the we can be released from the paralysis caused by fear
Leadership and Collaborative Accountability The road towards sustainable healthcare in South Africa
