Tebogo Phaleng
SUSTAINABLE HEALTHCARE THROUGH ACCOUNTABILITY
PROPOSED ROADMAP FOR THE PRIVATE HEALTH SECTOR
Agenda
1.
Background & Context
2.
Re-alignment | Private Healthcare  National strategic imperatives
3.
Output from Think Tank sessions
a.
Barriers to an improved health system
b.
Envisaged goals of the private health system
c.
Proposed industry roadmap for sustainable healthcare
Agenda
1.
Background & Context
2.
Re-alignment | Private Healthcare  National strategic imperatives
3.
Output from Think Tank sessions
a.
Barriers to an improved health system
b.
Envisaged goals of the private health system
c.
Proposed industry roadmap for sustainable healthcare
Prosperity
Governance & Accountability
Education
Healthcare
A state of good fortune
and successful social and
economic status
Opportunity/Entrepreneurship
Social Inclusion
Personal Freedom
Safety & Security
Economy
Source: Legatum Prosperity Index (2014)
Prosperity
1
Norway
2
Switzerland
3
New Zealand
4
Denmark
Commitment to 6 Core Principles
1.
2.
3.
4.
5.
6.
Protection of personal freedom
Social inclusion (Social Capital)
Safety & Security
Education
Access to economic opportunity / Entrepreneurship
Health: Spend wisely
Source: Legatum Prosperity Index (2014)
5
Canada
Prosperity
How does SA feature against its income peers?
Costa Rica
34
Governance & Accountability
Thailand
51
Education
Healthcare
66
Colombia
Personal Freedom
Safety & Security
72
Dominican Republic
81
South Africa
Source: Legatum Prosperity Index (2014)
Social Inclusion/Capital
Economy
Opportunity/Entrepreneurship
The Roadmap Drafting Process
• Catalyst: KPMG SA Health Industry Survey (2015)
• Key findings: SA health system rated as ineffective in the following areas
Providing equitable access to care
Allowing Health Citizens to
participate in decisions affecting
their health and health system
Source: KPMG, SA Health Industry Survey (2015)
Protecting Health Citizens
against financial consequences
of ill-health
Preventing ill-health through
promotion and prevention
campaigns
Improving the health status of
individuals, families and
communities
The Roadmap Drafting Process
Current State
1. Pre-Conference
Survey
•Leadership and
Governance
•Health information
systems
End State
Definition
2. Gap Analysis
Performance
Targets
Initiatives,
Prioritization
& Sequencing
3. Strategic
Think Tank
•Human Resources
•Medicines and
technologies
•
•
•
•
4. BHF Conference
Sustainability
Innovation
Access
Efficiency
•Healthcare financing
•Service Delivery
Consultation
& Consensus
Preliminary
Recommendations
Guiding
Principles
Quality
Value Creation
Affordability
Patientcentricity
1……
2…….
3……
4……
5……
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
Final
Roadmap
5. Private
Sector Plan
Agenda
1.
Background & Context
2.
Re-alignment | Private Healthcare  National strategic imperatives
3.
Output from Think Tank sessions
a.
Barriers to an improved health system
b.
Envisaged goals of the private health system
c.
Proposed industry roadmap for sustainable healthcare
National Development Plan
Vision for 2030
1. Increase life expectancy to at least 70 years
2. Radically reduce the quadruple burden of disease
a.
b.
c.
d.
e.
Under-20 generation largely free of HIV/AIDS
Progressively improve TB prevention and cure
Reduce maternal and child mortality
Reduce prevalence of non-communicable diseases (NCDs) by 28%
Reduce injury, accidents and violence by 50% (relative to 2010 levels)
3. Health system reforms – equity, efficiency, effectiveness and quality of care provision
4. Universal Health Coverage
5. Significant reduction in the risks posed by the ecological and social determinants of disease
National Health Strategic Plan
10 Point Plan
4 Strategic Outputs
1. Strategic leadership & social contract for better health
outcomes
2. Implementing NHI
3. Improving quality of health services
4. Overhauling healthcare system
5. Improving HR management, planning & development
6. Revitalising infrastructure
7. Accelerate HIV | AIDS | STD | TB and other
communicable plans
8. Reviewing the drug policy
9. Improving the effectiveness of the health system
10. Strengthening research and development
1.
2.
3.
4.
Increase life expectancy
Reduction in maternal | child mortality rates
Combating HIV | AIDS | TB
Improving health system effectiveness
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Revitalisation of Primary Health Care
Improved Physical Infrastructure
Improved Patient Care and Satisfaction
Accreditation of health facilities for quality
Enhanced Management of Health Facilities
Improved access to Human Resources for Health
Improved Health Care Financing
Strengthened Health Information Systems (HIS)
Improved health services for the Youth
Expanded access to Home Based Care
and Community Health Workers
Lessons from Global Experience
4 key strategic interventions
1.
2.
3.
4.
Healthcare | 3 practical steps
Good governance
•
Enabling policy environment
•
Effective institutions of accountability
Healthy competition
Expanding access to education
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
Source:
• Legatum Prosperity Index (2014)
• “Why Nations Fail” - J. Acemoglu, J.A. Robinson
Source: Coalesce Knowledge Repository
1.
Healthy, empowered mom
2.
Healthy birth & childhood
3.
Education & employment
Lessons from Global Experience
Relevance
1.
2.
3.
Mindfulness of (changing) local context
Accountability and responsiveness to needs of
our Health Citizens
Use of technology to effect meaningful change
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 sessions
a.
Barriers to an improved health system
b.
Envisaged goals of the private health system
c.
Proposed industry roadmap for sustainable healthcare
Barriers to an Improved Healthcare System
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
Envisioned Goals of the Private Healthcare System
Coherent legislation and supportive policy framework
•
•
•
•
•
•
Reduce the burden of
disease and trauma
Improve life expectancy
Reduce (relative) costs
Improve quality & outcomes
Payer marketplace
consolidation
Product simplification
•
•
•
•
•
Universal Health Coverage
Access to high quality, low
cost healthcare for all in SA
Leadership
Improve management
capabilities
Health Leadership Academy
•
•
•
Supply side restructuring
Stronger processes
Value-based purchasing
Build relationships of Trust within the healthcare environment
Coherent legislation and supportive policy framework
Trust and Trustworthiness
Placed
Trust
Process
Trust
Trust, Trustworthiness and Accountability
Being Trustworthy
1.
2.
3.
Competence
Honesty
Reliability
Placed
Trust
Systems (and Institutions)
of Trust & Accountability
1.
Information
•
•
2.
Alignment to Health Citizens‘ needs
Performance (Value)
Sanctions
•
•
•
Regulated provisions
Industry Charter / Code of Ethics
Selective (value based) purchasing
Process
Trust
Source:
• “Trust” – Baroness Onora O’Neill (2013)
• “Accountability and Health Systems” – D. Brinkerhoff, Partners for Health Reformplus (2003)
Envisioned Goals of the Private Healthcare System
Coherent legislation and supportive policy framework
•
•
•
•
•
•
Reduce the burden of
disease and trauma
Improve life expectancy
Reduce (relative) costs
Improve quality & outcomes
Payer marketplace
consolidation
Product simplification
•
•
•
•
•
Universal Health Coverage
Access to high quality, low
cost healthcare for all in SA
Leadership
Improve management
capabilities
Health Leadership Academy
•
•
•
Supply side restructuring
Stronger processes
Value-based purchasing
Build relationships of Trust within the healthcare environment
Coherent legislation and supportive policy framework
A well functioning Healthcare System
Structure of the proposed
roadmap is based on the WHO
framework for a well
functioning healthcare system
Source: Coalesce Knowledge Repository
Adapted from “Key Components of a Well Functioning Health System” - World Health Organization (2010)
Proposed Roadmap
Towards Sustainable Healthcare in South Africa
DESIRED FUTURE STATE
Quality, relevant,
timely information
Financial
sustainability &
affordability
Sustainable, integrated,
patient-centric health
system
Quality, affordable
medical & human
resources
Transparent,
accountable care
Patient-centric care,
increased life expectancy
& decreased BoD
CURRENT STATE
Fragmented,
unsustainable, stagnant,
high cost, variable quality
Proposed Roadmap
Towards Sustainable Healthcare in South Africa
Information streams and research
2017
2020
2025
DESIRED FUTURE STATE
Quality, relevant,
timely information
Financial
sustainability &
affordability
Sustainable, integrated,
patient-centric health
system
Quality, affordable
medical & human
resources
Health workforce, medical
products & technology
Healthcare financing and
contracting
Transparent,
accountable care
Patient-centric care,
increased life expectancy
& decreased BoD
CURRENT STATE
Fragmented,
unsustainable, stagnant,
high cost, variable quality
Health workforce, medical products & technology
Leadership, governance and regulation
Service delivery
Proposed Roadmap
Towards Sustainable Healthcare in South Africa
Information streams and research
2017
2020
2025
DESIRED FUTURE STATE
Quality, relevant,
timely information
Sustainable, integrated,
patient-centric health
system
Financial
sustainability &
affordability
Quality, affordable
medical & human
resources
Health workforce, medical
products & technology
Healthcare financing and
contracting
Transparent,
accountable care
Patient-centric care,
increased life expectancy
& decreased BoD
Integrated care
Improve
quality of
service
delivery
Public sector
revitalization –
competitor to private
services
CURRENT STATE
Public-private
cooperation
Fragmented,
unsustainable, stagnant,
high cost, variable quality
Health workforce, medical products & technology
Include a primary
health care
entitlement in a
mandatory package
Leadership, governance and regulation
Patient empowerment
Integrated Care for
chronic NCDs &
infectious diseases;
remove barriers that
lead to nonadherence
Support
Provider
Reform
Target waste,
fraud &
avoidable
conditions or
medical errors
Service delivery
Provider profiling
linked to
reimbursement with
patient satisfaction
metrics
Group practices &
multi-disciplinary
practices
Define
standardised
quality measures
to do value-based
assessments
Proposed Roadmap
Towards Sustainable Healthcare in South Africa
2020
Information streams and research
2017
2025
DESIRED FUTURE STATE
Quality, relevant,
timely information
Sustainable, integrated,
patient-centric health
system
Financial
sustainability &
affordability
Quality, affordable
medical & human
resources
Health workforce, medical
products & technology
Healthcare financing and
contracting
Transparent,
accountable care
Patient-centric care,
increased life expectancy
& decreased BoD
Robust National
Monitoring & Evaluation
Health
IT
degrees
CURRENT STATE
Fragmented,
unsustainable, stagnant,
high cost, variable quality
Health workforce, medical products & technology
Create a
consultative
platform to
debate changes
in legislation
Strengthen
engagement
platforms
Collaborate with
International
Universities on health
management courses
Develop strong, diverse,
inclusive, accountable,
capable leadership
Improve
Create a uniform health
hospital
management programme efficiency;
single protocol management
implement
structure to create common
care
language between public
pathways
and private
Leadership, governance and regulation
Integrated care
Publish variations in
clinical practice
Improve
quality of
service
delivery
Increase trust &
support for
leadership
Public sector
revitalization –
competitor to private
services
Public-private
cooperation
Include a primary
health care
entitlement in a
mandatory package
Patient empowerment
Integrated Care for
chronic NCDs &
infectious diseases;
remove barriers that
lead to nonadherence
Support
Provider
Reform
Target waste,
fraud &
avoidable
conditions or
medical errors
Service delivery
Provider profiling
linked to
reimbursement with
patient satisfaction
metrics
Group practices &
multi-disciplinary
practices
Define
standardised
quality measures
to do value-based
assessments
Proposed Roadmap
Towards Sustainable Healthcare in South Africa
2020
2025
Information streams and research
2017
Sustainable, integrated,
patient-centric health
system
Financial
sustainability &
affordability
Healthcare financing and
contracting
Develop elderly,
mental health &
home-based services Integrate into
social services
Regional training
institutes
Allied Health
professional
training
Increase production
& motivation of
Healthcare workers
Health workforce, medical
products & technology
DESIRED FUTURE STATE
Quality, relevant,
timely information
CURRENT STATE
Fragmented,
unsustainable, stagnant,
high cost, variable quality
Mid level worker
deployment
framework recognizing prior
learning Health
Workers
Price
regulation of
products
Closer
cooperation
between state
and private
Get coding
fixed
Health
IT
degrees
Create a
consultative
platform to
debate changes
in legislation
Patient-centric care,
increased life expectancy
& decreased BoD
Integrated care
Publish variations in
clinical practice
Strengthen
engagement
platforms
Collaborate with
International
Universities on health
management courses
Develop strong, diverse,
inclusive, accountable,
capable leadership
Improve
Create a uniform health
hospital
management programme efficiency;
single protocol management
implement
structure to create common
care
language between public
pathways
and private
Leadership, governance and regulation
Transparent,
accountable care
Robust National
Monitoring & Evaluation
Increase local
manufacturing
capabilities
Healthcare Mentoring &
Development programs
Enabled, effective
Quality monitoring body
Health
technology
assessment merits & pricing
Health workforce, medical products & technology
Prioritize
Investment in
Research &
Development
Multi- disciplinary
medical homes
Quality, affordable
medical & human
resources
Improve
quality of
service
delivery
Increase trust &
support for
leadership
Public sector
revitalization –
competitor to private
services
Public-private
cooperation
Include a primary
health care
entitlement in a
mandatory package
Patient empowerment
Integrated Care for
chronic NCDs &
infectious diseases;
remove barriers that
lead to nonadherence
Support
Provider
Reform
Target waste,
fraud &
avoidable
conditions or
medical errors
Service delivery
Provider profiling
linked to
reimbursement with
patient satisfaction
metrics
Group practices &
multi-disciplinary
practices
Define
standardised
quality measures
to do value-based
assessments
Proposed Roadmap
Towards Sustainable Healthcare in South Africa
Information streams and research
2017
Increase
transparency outcomes
reporting
Define mandatory
package
Regulatory Reform
Urgent Assessment:
Increasing availability of
resources; better
utilization of resources &
mechanisms to increase
prepayment
Create more
effective incentives
to improve quality
of care provision
CURRENT STATE
Fragmented,
unsustainable, stagnant,
high cost, variable quality
Stabilise risk
pools & crosssubsidization
Value-based contracting
Mandatory
membership based
on income-level
Control Costs
(price, utilization)
Increase production
& motivation of
Healthcare workers
Health workforce, medical
products & technology
2025
DESIRED FUTURE STATE
Quality, relevant,
timely information
Reserving
Healthcare financing and
contracting
2020
Allied Health
professional
training
Mid level worker
deployment
framework recognizing prior
learning Health
Workers
Price
regulation of
products
Closer
cooperation
between state
and private
Health workforce, medical products & technology
Regional training
institutes
Get coding
fixed
Multi- disciplinary
medical homes
Health
IT
degrees
Create a
consultative
platform to
debate changes
in legislation
Transparent,
accountable care
Patient-centric care,
increased life expectancy
& decreased BoD
Integrated care
Publish variations in
clinical practice
Strengthen
engagement
platforms
Collaborate with
International
Universities on health
management courses
Develop strong, diverse,
inclusive, accountable,
capable leadership
Improve
Create a uniform health
hospital
management programme efficiency;
single protocol management
implement
structure to create common
care
language between public
pathways
and private
Leadership, governance and regulation
Quality, affordable
medical & human
resources
Robust National
Monitoring & Evaluation
Increase local
manufacturing
capabilities
Healthcare Mentoring &
Development programs
Enabled, effective
Quality monitoring body
Health
technology
assessment merits & pricing
Develop elderly,
mental health &
home-based services Integrate into
social services
Tax reform
Prioritize
Investment in
Research &
Development
Universal
Health
Coverage
Sustainable, integrated,
patient-centric health
system
Financial
sustainability &
affordability
Improve
quality of
service
delivery
Increase trust &
support for
leadership
Public sector
revitalization –
competitor to private
services
Public-private
cooperation
Include a primary
health care
entitlement in a
mandatory package
Patient empowerment
Integrated Care for
chronic NCDs &
infectious diseases;
remove barriers that
lead to nonadherence
Support
Provider
Reform
Target waste,
fraud &
avoidable
conditions or
medical errors
Service delivery
Provider profiling
linked to
reimbursement with
patient satisfaction
metrics
Group practices &
multi-disciplinary
practices
Define
standardised
quality measures
to do value-based
assessments
Proposed Roadmap
Towards Sustainable Healthcare in South Africa
Information streams and research
2017
m/eHealth to
increase education,
engagement &
adherence
EMR
Develop and implement
more healthcare quality
& outcome indicators
Innovative
technologies to
improve
service delivery
Data systems / tools to
support alternate
reimbursements
Define mandatory
package
Reserving
Healthcare financing and
contracting
2020
Data Interoperability and
governance standards set
Urgent Assessment:
Increasing availability of
resources; better
utilization of resources &
mechanisms to increase
prepayment
CURRENT STATE
Fragmented,
unsustainable, stagnant,
high cost, variable quality
Standardised
database of Health
outcome indicators
private & public
sectors
Increase
Transparency
Access to Standardised
international best
practices protocols
Stabilise risk
(Pvt/Public system) Web
pools & crossIncrease
subsidization
transparency outcomes
reporting
Value-based contracting
Mandatory
membership based
on income-level
Create more
effective incentives
to improve quality
of care provision
Increase production
& motivation of
Healthcare workers
Health workforce, medical
products & technology
Morbidity Mortality
Quality of Life data
Control Costs
(price, utilization)
Regulatory Reform
2025
Allied Health
professional
training
Mid level worker
deployment
framework recognizing prior
learning Health
Workers
Price
regulation of
products
Closer
cooperation
between state
and private
Regional training
institutes
Prioritize
Investment in
Research &
Development
Get coding
fixed
Universal
Health
Coverage
Create a
consultative
platform to
debate changes
in legislation
Sustainable, integrated,
patient-centric health
system
Financial
sustainability &
affordability
Develop elderly,
mental health &
home-based services Integrate into
social services
Multi- disciplinary
medical homes
Health
IT
degrees
Transparent,
accountable care
Patient-centric care,
increased life expectancy
& decreased BoD
Integrated care
Publish variations in
clinical practice
Strengthen
engagement
platforms
Collaborate with
International
Universities on health
management courses
Develop strong, diverse,
inclusive, accountable,
capable leadership
Improve
Create a uniform health
hospital
management programme efficiency;
single protocol management
implement
structure to create common
care
language between public
pathways
and private
Leadership, governance and regulation
Quality, affordable
medical & human
resources
Robust National
Monitoring & Evaluation
Increase local
manufacturing
capabilities
Healthcare Mentoring &
Development programs
Enabled, effective
Quality monitoring body
Health
technology
assessment merits & pricing
Health workforce, medical products & technology
Tax reform
DESIRED FUTURE STATE
Quality, relevant,
timely information
Improve
quality of
service
delivery
Increase trust &
support for
leadership
Public sector
revitalization –
competitor to private
services
Public-private
cooperation
Include a primary
health care
entitlement in a
mandatory package
Patient empowerment
Integrated Care for
chronic NCDs &
infectious diseases;
remove barriers that
lead to nonadherence
Support
Provider
Reform
Target waste,
fraud &
avoidable
conditions or
medical errors
Service delivery
Provider profiling
linked to
reimbursement with
patient satisfaction
metrics
Group practices &
multi-disciplinary
practices
Define
standardised
quality measures
to do value-based
assessments
Next Steps
Current State
1. Pre-Conference
Survey
•Leadership and
Governance
•Health information
systems
End State
Definition
2. Gap Analysis
Performance
Targets
Initiatives,
Prioritization
& Sequencing
3. Strategic
Think Tank
•Human Resources
•Medicines and
technologies
•
•
•
•
4. BHF Conference
Sustainability
Innovation
Access
Efficiency
•Healthcare financing
•Service Delivery
Consultation
& Consensus
Preliminary
Recommendations
Guiding
Principles
Quality
Value Creation
Affordability
Patientcentricity
1……
2…….
3……
4……
5……
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
Final
Roadmap
5. Private
Sector Plan
Leadership and Collaborative Accountability
The road towards sustainable healthcare in South Africa