1 Study on the Coverage of Chronic Diseases in Social and Health Protection Systems: A Comparative Analysis of Trends in Developed Countries and in the Region of the Americas Jaime Espín, PhD Professor Andalusian School of Public Health TECHNICAL WORKSHOP ECONOMIC DIMENSIONS OF NONCOMMUNICABLE DISEASES IN LATIN AMERICA AND THE CARIBBEAN REGION – DISEASE CONTROL PRIORITIES PROJECT (DCP3) June 24th – 25th, 2013

2 Agenda Objective Background Analysis of Experiences in Developed Countries (mainly Europe) Analysis of Experiences in the Region of the Americas Conclusions Recommendations

3 Objective To provide a description and analysis of experiences in the development of policies, plans and programs for prevention and care of patients with chronic health problems in Europe and in the Region of the Americas and see the evolution and main trends in the last decade

4 Some background information

5 Health Spending Projection by Chronic Condition in Brazil Fuente: Glassman 2010

6 Risk Factors and Chronic Diseases Fuente: Ministry of Health and Long-Term Care. Preventing and Managing Chronic Disease: Ontario´s Framework. May 2007

7 Example of Patient distribution by number of chronic diseases and age Fuente: Vivas et al

8 Deaths by causes (%) – 2008 Fuente: Own elaboration with data from WHO - Global Burden of Disease

9 Deaths from NCDs as a share of total deaths, Source: Chronic Emergency: Why NCDs Matter. Health, Nutrition, and Population Discussion Paper Washington DC: World Bank.

10 Projected global deaths (millions) for major chronic disease groups and other causes of death in 23 selected countries Fuente: Abegunde et al These 23 countries account for about 80% of the total burden of chronic disease mortality in developing countries. Between these countries are are Brazil, Argentina, Mexico and Colombia.

11 Methodology

12 Literature Review (I)

13 Literature Review (II)

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17 Results

18 Europe – Political Commitment

19 Death rate due to chronic diseases - Per persons Fuente: Eurostat

20 Source: Busse et at, 2010

21 Chronic Disease Management: Population Management Source:

22 Region of the Americas

23 Political Commitment

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26 Source: Own elaboration with data from WHO - Global Health Observatory Data Repository

27 Summary of key innovative strategies for care and self-care of patients with chronic diseases, identified by experts, Latin America, 2007 Source: Sapag, 2010.

28 Brazil Number of Ambulatory Care-Sensitive Hospitalizations for Chronic Conditions, by Age and Sex, Brazil Fuente: Macinko J et al Article Name : Major expansion of primary care in Brazil linked to decline in unnecessary hospitalization

29 What we know from the Evidence

30 Summary of evidence on effectiveness of Chronic Care Model components Source: Busse et at, 2010

31 Summary of Evidence for Disease Management Program Outcomes by Conditions Source: Mattke et al, 2007

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33 Comparative Analysis of the Results There is general concern about the need for addressing chronic care by all health care systems Two have been the main forms to address chronic care in the European context: through a national strategy or through parallel strategies. The national strategy is mainly based on the Chronic Care Model (as in the UK) and parallel strategies in the use of Disease Management Programs (as in Germany). In LAC the experiences are mainly small scale experiments, except in some countries (as Brazil). However, there is few evidence, in economic and health outcomes, of the implementation of the chronic care strategies, especially when we are talking about global plans. There is some documentation of successful experiences published in journals and in some general publications, but not much about initiatives that have been undertaken and have not produced the outcomes expected.

34 Comparative Analysis of the Results (II) Despite all efforts, more or less successful, there has still a problem of coordination of healthcare, which continues to prioritize attention to acute pathologies rather than continuous attention to mild pathologies with preventive activities of public health (healthy habits in eating and exercise, etc..) that shows clear evidence of efficiency. In this situation, those countries that have always been with strong commitment to primary care (UK, Holland, etc..) or have done reforms in recent years for its strengthening (Brazil, etc..) are best placed to address chronic care.

35 Recommendations

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37 The ten characteristics of the high- performing chronic care system Ensuring universal coverage Free provision of care Health systems should focus on the prevention of ill health’ and not just the treatment of sickness Priority is given to patients to self manage their conditions with support from carers and families Priority is given to primary health care

38 The ten characteristics of the high- performing chronic care system (II) Population management is emphasized through the use of tools to stratify people with chronic diseases according to their risk and offering support commensurate with this risk Care should be integrated to enable primary health care teams to access specialist advice and support when needed. The need to exploit the potential benefits of information technology in improving chronic care To ensure that care is effectively coordinated These nine characteristics into a coherent whole as part of a strategic approach to change

39 Thanks for your attention!!