TRASPASO DE INSALUD

Public Health System
Madrid Region
Belén Prado Sanjurjo
Deputy Minister of Health
Madrid Region
October 2011
Spain:
global and health data
Spanish global data
Population: just over 47 million inhabitants
Area: 504.645 m2
Gross Domestic Product (GDP): just over 1 billion €
Health data
Total hospitals: 794
Total number of beds: 161.022
In patient discharge: 5 million
Madrid Region:
global and health data
Madrid Region data
Population: just over 6,3 million inhabitants
Area: 8.000 m2
Gross Domestic Product (GDP): 190 thousand
million €
Health data
Total hospitals: 81
Total number of beds: 21.440
In patient discharge: 650.000
Public Health System
Madrid Region
Organization
Territorial organization: unique area of health
Family care
Specialised care
System to attend accidents and emergencies
SUMMA 112
Public Health System
Madrid Region
The Principal characteristics
Universal health care
Accesible
Free
Wide offer of services
High quality
Professionals with knowledge and accredited
scientific-medical preparation
Public Health System
Madrid Region
Principal numbers (1)
More than 6,3 million of citizens
426 family care centres
35 hospitals
33 speciality care centres
More than 82.000 people with an extraordinary
technical and scientific training
1.894 professionals and more than 770 mobile devices
to attend accidents and emergencies (SUMMA 112)
7.134 million euros budget in 2011
Public Health System
Madrid Region
Principal numbers (2)
Then has been lots of activity in 2010
More than 52 million family care consultations
More than 11 million specialist consultations
14 million diagnostic tests
More than 480.000 people admitted to hospitals
More than 400.000 surgical operations
2,6 million emergencies
729 solid organ transplants and around 2.000 of tissues
and hematopoyetic parents
Public Health System
Madrid Region
The main objectives
Improve health care quality: closer to citizens; more accessible; more efficient;
faster and more convenient for patients
Promote biomedical research: 19 research groups of hospitals of Madrid are
integrated into the Network of Biomedical Research Centres (CIBER). Five
Biomedical Research Instituts authorizeds
Intensify the technical training of health care professionals: to achieve the
complete adaptation; to increase their competence and achieve the professional
feel like a significant part of the organization
Taking maximum advantage of new technologies: all new hospitals incorporate
the most advanced technology; robot technologies in surgical procedures;
technological model of information systems; electronic médical prescription
Explore and integrate new forms of health management : Mixed model of private
public cooperation, combining the private financing initiative.
Public Health System
Madrid Region
The Madrid Region building 11 hospitals in 7 years
Initial situation
Growth
Accelerated expansion peripheral areas where the
population has been increased
Descentralized and dispersed population
Unique situation of the Puerta de Hierro Hospital, it
isn’t a new hospital, it’s a transfer
Madrid: situación 2004
Functional program conducted
Awarded preliminary
Land conditioning
The marked areas:
area of strong growth, future locations of hospitals
Hospital de Puerta de Hierro
Public Health System
Madrid Region
Health Infrastructure
In response to the needs
The plan includes:
11 hospitals
10 new construction
1 transfer
74 primary health care centres
Public Health System
Madrid Region
Specific to Madrid Region
Change in health-care models
Trends in the health care models: increased
efficiency (less resources to carry out the same activity)
Hospitals 2004
Rigid Buildings
Very structured
Hospitals large, highly centralized:
complexity of processes
generation of bottlenecks
poor assessment from users,
both patients and professionals
Vision of change for Madrid Region
Hospitals permeable to patients
Integration of different levels of care:
approach to family care
Decentralization of hospitals and adapted to
the needs of the population: beds and more
outpatient clinics
Public Health System
Madrid Region
PFI Models used
Care Provision and Non-Care
Provision PFI model
Non-Care Provision PFI Model
4 hospitals
Administrative concession of public services
30 years (extendable)
Retributive model:
Capita
7 hospitals
Administrative concession public works
30 years (extendable)
Retributive model: Maximum Annual Amount (MAA)
Fixed component: maximum of 40% of total
remuneration
Variable Components: the criteria have to complited
Concession services:
1. Comprehensive maintenance of the building
2. Urban waste management and sanitation
3. Security service
4. Comprehensive service laundry
5. Transportation and management assistant
6. Disinfection and pest control service
7. Management file clinical and administrative
documentation
8. Management Service staff
9. Service reception / information and switchboard
10. Road Maintenance and gardens
11. Cleaning Service
12. Comprehensive service sterilization
13. Warehouse and distribution management
14. Restoration management
Billing intercentre
Concession services:
All
Public Health System
Madrid Region
PFI model advantages for Public Administration
Allows System Sustainability
Size reduction of Public Administration: from provider to controller
Healthcare provision without increasing public debt
Stable rhythm of investment government in the evolution of public spending
Fairness among different generations
Reversion of the well preserved assets to Public Administration at the end of the concession
period: maintenance policy
Private sector specialization (partnerships of specialized
companies): innovation
Risk transfered to private sector
Public Health System
Madrid Region
Phases and activities for
2• Previous phase:
- Definition
o of the portfolio of hospitals.
Execution of purchases of
equipment
- Implementation of functional programs.
- Search for lands, contact with local councils.
- Other studies.
3• - Bidding and award phase of work.
4•
5•
Year 1
- Construction Project.
- Monitoring works.
Year 2
Year 3
Year 4
Year 5
6•Strategic decisions:
Health infrastructure
Centralizadad
outsourcing
Detection of the needs
Analysis of the impact on the health care
-
-
Information Systems
-
Centralized Unit Diagnostic Imaging
-
Clinical Analysis
í Laboratory
Purchase of equipment.
Opening
Public Health System
Madrid Region
PFI Models used
Care Provision and Non-Care
Provision PFI model:
Administrative Concession
Contract
The dealership is committed to:
Drafting of the Implementation of public
works
 Implementation and supervision of work
 Allocation of necessary equipment (defined
by the Administration)
 Provision of the clinical furniture (defined by
the Administration)
 Specialized Health Service Provision
 Providing Health Services not
 Maintenance and replacement of furniture,
equipment and building
Not included:
 Transplant
 Oxygen Theraphy
 Medical Transport
Non-Care Provision PFI Model : Exploitation
concession contract and public works
The dealership is committed to:
Drafting of the Implementation of public works
 Implementation and supervision of work
 Allocation of necessary equipment (except high-tech and electro)
 Provision of the clinical furniture (defined by the Administration)
 Keeping the construction, equipment and electromedical
equipment: replacement of equipment and furniture
 Exploitation of additional areas and commercial spaces
Not included:
 Provision of medical services and medical diagnostic activities
 Provision and maintenance of high-tech medical equipment and
electro
 Provision and maintenance of Information Systems
Public Health System
Madrid Region
Non-Care Provision PFI Model: Administration
Control
Office of Monitoring for Implementation of Work
Technical Unit Control (TUC)
Functions TUC
Monitor, control and evaluate the services exploited for the work
Determine the deduction for non-compliance with quality and
performance indicators set out in Specific Technical Specification
Hospitals
Monitor the economic literature, technical and financial dealerships
Reviewing the various Plans of the Dealers (Quality, Training,
Environmental and Occupational Hazards)
Public Health System
Madrid Region
Non-Care Provision PFI Model: Stipulation of
Quality and Performance Indicators
Defined Specific Technical Specification
Model: define the level of service delivery through nondeduction guidelines target indicators set
Indicators of Complains
Control parameter: For each indicator
Failures of the control parameter (Types: Readiness, Quality)
Accounting for Failure: response times and time correction
Correction factors: evaluated hospital area and category of
service
Joint Weighting
Measurement
of Failure
Corresponding
reduction on MAA
(Maximum Annual Amount)
Effective
Compensation
Public Health System
Madrid Region
Explotation of strategic opportunities
Information Systems
Outsourcing
Hospitals Non-Care Provision PFI Model
Management
Software
nursing
Hospitalization
Admission
Outsourcing:
HCE
EMR (HISTORIA
(ELECTRONICCLINICA
MEDICAL
ELECTRONICA)
RECORD)
Clinical
history of patients
Emergency
Medical
software for clinical
Management
of patients
Operation room
Clinical analysis
laboratory
Clinical
Management
Software
Software and hardware
for hospital pharmacy
(unit dose)
Software
and hardware
Pathological
Anatomy
Appointments
software
Mailing of clinical
test results on Internet
G
P
Systems
Diagnostic
imaging
A
Software Requests
BILLING
hosting
maintenance
service management
user support
integration between
systems
Public Health System
Madrid Region
Explotation of strategic opportunities
 Centralized Unit Diagnostic Imaging
Public Company
Reference Population: 1.1 million
Focal Points: 6 Hospitals in networked
Central Unit/
Laboratory
More than 5 million radiological examinations
More than 1.800 radiological examinations per
day
 Clinical Analysis Laboratory
Family
Care
Specialty
Care
H. Infanta Sofía
H. Infanta
Leonor
H. Henares
H. Infanta
Cristina
H. SurEste
H. Tajo
Private Company; concession management of the activity
Reference Population: 1.1 million
Focal Points: 6 Hospitals in networked, family care and some residential aged care of the area of influence
Public Health System
Madrid Region
Thus, prior to the introduction of an PFI Model
There is no standard model of PFI, adaptation to:
Particular objectives of the government
Existing resources in the country
Model used so far
Leeway in the transfer of risks:
Transfer to the dealership the conditioning of the plot and execution
of the rush
Pay system that includes the degree of compliance with the
requirements of quality, coverage, accessibility and efficiency
Creating an audit body to assess the results
continuously:
Monitoring and evaluation of the initiative
Comparison PFI-traditional systems
Public Health System
Madrid Region
Construction investment:
1,288 million € by the dealerships
The total investment in PFI included in the 11 hospitals:
Civil works
Facilities
Furniture
In addition, four hospitals Care Provision and Non-Care Provision PFI
model includes investment in medical equipment
PFI MODEL
HOSPITAL
H. Infanta Leonor
H. Infanta Sofía
H. Infanta Cristina
Non-Care Provision PFI Model
H. del Henares
H. del Sureste
H. el Tajo
H. Puerta Hierro
H. Infanta Elena
H. Torrejón
Care and Non-Care Provision PFI Model
H. Villalba
H. Móstoles
TOTAL
No Beds
264
283
210
194
125
98
613
106
220
164
284
2,561
Investment made(€)
87,790,000
91, 602,000
71,987,000
80,135,000
65,653,000
44,525,000
182,828,000
61,099,000
169,347,375
201,322,884
232,225,148
1,288,514,407
Public Health System
Madrid Region
Achievements have allowed benefits in brief
11 hospitals built in 7 years
Strategic opportunities:
Integrated hospital information systems
Centralized outsourcing of the clinical laboratory:
Reduction of per capita costs
Increased efficiency in the use of human and material resources
Better health care quality
Improvement in the time of response for the diagnosis results
Radiodiagnosis centralization
Reduction of the cost per test
Better efficiency in the use of human and material resources
Immediate satisfaction of the demand (no waiting lists)
Centralization of equipment purchasing (economy of scale):
Negotiation, maintenance and extension of other health
establishments
Public Health System
Madrid Region
Achievements and benefits (example)
is 100% variable in 7 of the 11 hospitals:
For decision dealerships
ensures quality
Presentation of the m2 constructed, reference population (2007) in the time allotted for opening and MAA (2005) for each hospital
MODEL
HOSPITALS
Non-Care Provision
PFI Model
H. Infanta Leonor
H. Infanta Sofía
H. Infanta Cristina
H. del Henares
H. del Sureste
H. el Tajo
H. Puerta Hierro
Care and Non-Care
Provision PFI Model
H. Infanta Elena
TOTAL
m2 Reference population MAA (award) MAA (variable)
85,066
84,290
56, 811
58,149
45,033
38,015
172,263
314,225
299,686
150,000
170,000
138,853
63,073
540,426
15,448,178
17,859,968
13,792,400
14,964,000
9,912,709
9,006,528
44,548,550
100%
100%
100%
100%
100%
100%
100%
43,504
101,845
25,242,360
100%
583,131
1,778,108
150,774,693
Economic benefits of granting of medical care management in laboratory
SERVICE
Laboratorio Clínico
Capita Hospital Public Laboratory
Madrid Region
38,7
Maximum Capita
22,1 €
Capita
award
15,9 €
Savings
-59%
Comparative data for cost per person for administration depending on the nature (public or private) service provider (2008)
Public Health System
Madrid Region
Achievements and benefits:
Satisfaction of users (2011)
OPINION SURVEY OF NEW HOSPITALS OF MADRID REGION
HOSPITAL
GLOBAL
HOSPITALS
Outpatient
m2
Emergencies
MAA
Hospitalization
MAA (variable)
DEL TAJO
88,3 %
95,5 %
79,9 %
87,4 %
INF. ELENA
85,8 %
83,9 %
83,1 %
86,9 %
INF. CRISTINA
87,2 %
97,6 %
76,4 %
86,8 %
INF.LEONOR
81,3 %
81,4 %
71,9 %
84,2 %
DEL SURESTE
80,2 %
72,8 %
73,0 %
87,3 %
INF.SOFÍA
81,6 %
76,4 %
69,4 %
90,4 %
DEL HENARES
85,6 %
93,8 %
72,9 %
86,9 %
PUERTA DE HIERRO
83,9 %
90,6 %
65,2 %
88,3 %
AVERAGE
84,2 %
86,5 %
74,0 %
87,3 %
GLOBAL
85,6 %
89,0 %
74,9 %
85,9 %
Public Health System
Madrid Region
Conclusion
40% of the Community of Madrid budget goes to health
care. With this money, we are carrying out projects
with an extraordinary impact and significance, both in
the field of human resources and in health and
communication infrastructures. The aim is that our
Public Health System be able to respond, day by day,
to the health care needs in a rapid way, and with the
highest quality service
Today Madrid has the best medical attention of Spain, the longer
live expectancy and the best results in the treatment of diseases
such as cancer and cardiovascular disease