HEC Montréal, July 19 - 24, 2015
HEC Montréal, 19 July — 31 August 2015
ThD3 Regional Health Services
Jul 23, 2015 03:30 PM – 05:00 PM
Location: Banque Scotia
Chaired by Jan Vissers
03:30 PM - 04:00 PM
Designing the primary care system in the city of Turin, Italy, using open data
A primary care system delivers care for most of their everyday health needs. For each citizen, it represents the first contact point with the National Health System. An efficient and effective primary care system can have a positive impact on the overall population health. To this purpose, many countries started a re-organization process to improve efficiency and effectiveness of the system.
Primary care in Italy is delivered by General Practitioners (GP) in their own studio, sometimes helped by a secretary and/or by a trainee. Their studio open from 20 to 30 hours per weeks. Each GP serves about 1200 patients on average, and no more than 1500 patients. Capitation fees remunerates GPs. Same model for pediatricians but they can only serve no more than 800 patients aged from 0 to 14. In Italy, a new organizational model is introduced by a 2014 national law: the new model consists in gathering a number of GPs and pediatrician - assisted by a medical staff - in a single facility (AFT) in order to provide a 24/7 service.
In this paper we discuss an optimization model to design the new 24/7 primary care system in the city of Turin, Italy. Turin is a city in the northwest of Italy with about 900000 inhabitants currently served by 843 GPs and 113 pediatricians. Several constraints are taken into account when considering different age groups. For instance, we would like to evenly distribute elderly citizens among AFT. An extended version of the model should deal with GP and pediatrician preferences. Both models are feeded by open data available at http://www.dati.piemonte.it/ through the strategic EU MED project Homer. The use of open data aims at raising awareness and testing economic, social and political benefits of making public data open and reusable.
04:00 PM - 04:30 PM
Perinatal networks and healthcare pathway optimization in the Ile de France region: a challenge for regional health authority.
Social Security financing law planed 600 millions Euros savings for Ile de France (IDF) region health budget in the next 3 years.
Implementation of perinatal health networks, founded by public regional health authority, is now achieved in IDF region where one-fifth of french babies are born. 2015 is time for perinatal 5 years plan (2012-2017) half-way assessment.
Which organization allows efficient and effective spendings?
Material and Methods:
Use of data from annual perinatal network activity reports and routine data from Perinatal health Information System which combines hospital discharge summaries with national civil registration data.
The population of the 8 administrative districts, including Paris, is covered by 7 territorial perinatal networks (the population of a wide district is split between 2 other perinatal networks). The districts are diverse in population, number of deliveries, number and status of perinatal centers.
For a total population of 11 978 363 inhabitants in IDF, 3 003 914 women are in reproductive age, and 177555 gave birth in 2013.
3 thematic networks whose geographical catchment area cover all IDF, are devoted to
ambulatory voluntary pregnancy termination, vulnerable pregnant women, premature babies follow-up.
Total budget is 3,8 Millions euros: 2,2 M for territorial networks, 1 M for the three thematic networks.
A total of 180124 deliveries occur in the 92 maternities of IDF. 29% of the maternities have less than 1100 deliveries per year, which is defined as efficiency level, while 6 /15 public level III (with intensive neonatal care) have more than 4000 deliveries per year.
The relevance of administrative division applied to perinatal networks area is for debate.
Nevertheless, field experience and collective intelligence could help to find innovating solutions in maternity and neonatal care pathway and planning.
04:30 PM - 05:00 PM
Generic and Specific Modelling of Health Service Provider Networks. Methodology and Application.
Health services are increasingly delivered by disease focused networks of service providers collaborating in regional service delivery. We had the opportunity to study regional delivery systems for three diseases (diabetes type 2, stroke, hip osteoartritis) in six European countries (FI, GE, GR, NL, SP, UK), as part of the project Managed Outcomes which was funded by the European Union.
We developed a modelling framework which enables to explore systematically the relationships between operations and outcomes. The basis of the framework is formed by a general model from which disease specific models can be derived. For specific cases, instances of regional networks can be created which include the health service users. In addition to the modelling framework we propose analysis methods to analyze how the operational models can explain outcomes.
The models and analysis methods are applied to analyze networks for the three diseases in the six countries. This provided much insight into the relationship between operations and outcomes, but also on the contribution of the generic and specific models in explaining the variations in results.
The presentation will concentrate on the modeling framework for describing, analyzing and comparing regional health service delivery systems. Furthermore we will present the most important findings on the relationships between operations and outcomes, and on the contribution of the generic and specific modeling.
Keywords: generic and specific operational models, regional health service delivery, methodology, operations and outcomes