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Strategy 3: Reorienting the model of care

 

Reorienting the model of care means ensuring that efficient and effective health care services are designed, purchased and provided through innovative models of care that prioritize primary and community care services and the co-production of health. This encompasses the shift from inpatient to outpatient and ambulatory care. It requires investment in holistic and comprehensive care, including health promotion and ill-health prevention strategies that support people’s health and well-being. It also respects gender and cultural preferences in the design and operation of health services.

 

Strategic approach Policy options and interventions

3.1 Defining service priorities based on life-course needs, respecting people’s preferences. This approach means appraising the package of health services offered at different levels of the care delivery system, covering the entire life course. It uses a blend of methods to understand both the particular health needs of the population, including social preferences, and the cost-effectiveness of alternative health interventions, guiding decision making on allocation of resources to health care. It also includes health technology assessment.

  • Local health needs assessment

  • Comprehensive packaging of services for all population groups

  • Gender, cultural and age-sensitive services

  • Health technology assessment

3.2 Revaluing promotion, prevention and public health. This approach means placing increased emphasis and resources on promotive, preventive and public health services. Public health systems include all public, private, and voluntary entities that contribute to the delivery of essential public health functions within a defined geographical area.

  • Monitoring population health status

  • Population risk stratification

  • Surveillance, research and control of risks and threats to public health

  • Health promotion and disease prevention

  • Public health regulation and enforcement

3.3 Building strong primary care-based systems. Strong primary care services are essential for reaching the entire population and guaranteeing universal access to services. Building such services involves ensuring adequate funding, appropriate training, and connections to other services and sectors. This approach promotes coordination and continuous care over time for people with complex health problems, facilitating intersectoral action in health. It calls for interprofessional teams to ensure the provision of comprehensive services for all. It prioritizes community and family-oriented models of care as a mainstay of practice.

  • Primary care services with a family and community-based approach

  • Multidisciplinary primary care teams

  • Family medicine

  • Gatekeeping to access other specialized services

  • Greater proportion of health expenditure allocated to primary care

3.4 Shifting towards more outpatient and ambulatory care. Service substitution is the process of replacing some forms of care with those that are more efficient for the health system. The approach means finding the right balance between primary care, specialized outpatient care and hospital inpatient care, recognizing that each has an important role within the health care delivery system.

  • Home care, nursing homes and hospices

  • Repurposing hospitals for acute complex care only

  • Outpatient surgery

  • Dy hospitals

  • Progressive patient care

3.5 Innovating and incorporating new technologies. Rapid technological change is enabling the development of increasingly innovative care models. New information and communication technologies allow new types of information integration. When used appropriately, they can assure continuity of information, track quality, facilitate patients’ empowerment and reach geographically isolated communities.

  • Shared electronic medical record;

  • Telemedicine; and

  • M-health

Extract from: WHO. Framework on integrated people-centred health services: report EB138/37. Geneva: World Health Organization; 2015, available online at: http://apps.who.int/gb/ebwha/pdf_files/EB138/B138_37-en.pdf, accessed 12 January 2016