Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses

Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a “diagonal approach.” We argue that the core challenge to health systems is chronicity of illness that requires ongoing and long-term health care. The example of breast cancer within the broader context of health system reform in Mexico is presented to illustrate effective universal health coverage along the chronic disease continuum and across health ...

Portugal - Country case study on the integrated delivery of long-term care (2020)

This report describes the current state of the delivery of health and social long-term care services in Portugal. The country has advanced the policy framework to achieve integrated services delivery. However, fragmentation in the governance, funding and delivery renders the long-term care system inequitable and inefficient. The main policy pointers to further advance integration include consolidating pathways and care transitions, promoting joint training and multi-profile teams and addressing the shortage of human resources, migration and working conditions. 

A model of integrated care of residents with dementia - A case of innovation in long-term with accomodation in Slovenia

In all parts of the world, the number of people with dementia is on the increase and dementia is becoming more and more of a challenge for social work, too. In the countries with well-developed care for older people, dementia is part of longterm care; therefore, it is essential to develop new methods of care also in the homes for older people that provide long-term care. Among the innovative forms of care, there is a model of integrated care, based on social work concepts. This model is presented through the case of care for the residents with dementia in one of the old people’s homes in Slovenia. The integrated care of residents with dementia puts an individual at the centre of care provided by the experts employed there. The resident of old people’s home and an expert there create a
partnership in which they seek out solutions stemming ...

Germany - Country case study on the integrated delivery of long-term care (2020)

This report describes the provision of long-term care in Germany, with an emphasis on identifying efforts to foster the integrated delivery of services. There is mandatory statutory or private long-term care insurance for the entire population; eligibility for long-term care is open to people with any restricted competencies in daily life. Long-term care encompasses cash benefits, benefits in kind or residential care. Health expenditure is high, and coordination of care across ambulatory, hospital, rehabilitative and long-term care remains a challenge. Although the system performs well by several measures, strengthening the role of general practitioners and primary care could result in reduction in amenable mortality and preventable hospitalization while fostering integration of care and case management in long-term care.

Romania - Country case study on the integrated delivery of long-term care (2020)

This report describes the main findings and policy pointers of an assessment of the current conditions of integrated delivery of long-term health and social services in Romania. The country has advanced in enacting legislation to regulate the provision of long-term care. Service provision is limited to social services, whereas the health component is not defined by law. The current provision of long-term care is insufficient, services are fragmented and there are no defined pathways of care. The system relies heavily on families to provide care, but services for unpaid caregivers are underdeveloped. There is an acute shortage of workers, caused by migration of workers to other European countries.

Who Cares? Attracting and Retaining Care Workers for the Elderly

This report presents the most up-to-date and comprehensive cross-country assessment of long-term care (LTC) workers, the tasks they perform and the policies to address shortages in OECD countries. It highlights the importance of improving working conditions in the sector and making care work more attractive and shows that there is space to increase productivity by enhancing the use of technology, providing a better use of skills and investing in prevention.

Integrated Care and Geriatrics: A Call to Renovation from the COVID-19 Pandemic

We are experiencing an unprecedented demographic change, in terms of speed. The population over 65 years of age corresponds to approximately 9% of the world population (Population Division of the Department of Economics and Social Affairs of the United Nations).
We know that the elderly population has a high risk of suffering from serious diseases.

Long-term care facilities (LTCFs) of geriatric care has been traditionally marginalized within healthcare networks. LTCFs have constantly been living in the ambiguity that their residential nature does not fit with the relevant clinical burden of care of their frail and complex residents.

Covid 19 presents us with a challenge: to establish an integrated system that includes LTFCs. This editorial makes a call to which we must go.

EFPC 2021 BERGEN CONFERENCE. Primary and long-term care in the age of changing boundaries: Policy, practice and imagination

Between Social Inclusion and Exclusion: Integration of Daycare Guests in the Nursing Home Setting

In integrated daycare, community-dwelling older people in need of care join existing groups in residential care facilities during the day. This study focuses on how nursing home residents experience the integrative care approach, exploring opportunities for social inclusion and mechanisms of exclusion.

Needs and resources of people with type 2 diabetes in peri-urban Cochabamba, Bolivia: a people-centred perspective

The rising prevalence of type 2 diabetes results in a worldwide public healthcare crisis, especially in low- and middle-income countries (LMICs) with unprepared and overburdened health systems mainly focused on infectious diseases and maternal and child health. This study identifies mostly contextual factors like low literacy levels, linguistic problems in care, the need to articulate people’s worldview including traditional use of natural remedies with the Bolivian health system and the lack of expertise on type 2 diabetes by primary health care providers. Understanding the needs and structuring them in different areas wherein action is required serves as a foundation for the planning and evaluation of an integrated people centred care program for people with type 2 diabetes. This participative method serves as a tool to implement the often theoretical concept of integrated people centred health care in health policy and program development.

UN Decade of Healthy Ageing – The Platform

The United Nations has proclaimed 2021–2030 the Decade of Healthy Ageing, with WHO leading international action to improve the lives of older people, their families and communities. The UN Decade of Healthy Ageing is a global collaboration that brings together diverse sectors and stakeholders including governments, civil society, international organizations, professionals, academic institutions, the media and the private sector to improve the lives of older people, their families and communities. The collaboration focuses on four action areas that are strongly interconnected:

Area 1. Combatting Ageism: changing how we think, feel and act towards age and ageing;

Area 2. Age-friendly Environments: developing communities in ways that foster the abilities of older people;

Area 3. Integrated Care: delivering person centred integrated care and primary health services responsive to older people; and

Area 4. Log-term Care: providing older people who need it with access to long-term care. To make the Decade of ...

Framework for countries to achieve an integrated continuum of long-term care

The framework for countries to achieve an integrated continuum of long-term care identifies key aspects necessary to achieve an integrated continuum of long-term care service provision and to facilitate the integration of long-term services within existing health and social care systems.

The framework will guide countries in assessing system-level components to implement sustainable and equitable long-term care actions. By applying this framework, countries can begin to develop and shape their long-term care systems as part of their universal health coverage programmes and promote investment in long-term care and the health workforce, including carers.

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How do nurses support chronically ill clients’ participation and self-management in primary care? A cross-country qualitative study

In the context of the advancement of person-centered care models, the promotion of the participation of patients with chronic illness and complex care needs in the management of their care (self-management) is increasingly seen as a responsibility of primary care nurses. It is emphasized that nurses should consider the psychosocial dimensions of chronic illness and the client’s lifeworld. Little is known about how nurses shape this task in practice. The aim of this analysis is to examine how primary care nurses understand and shape the participation of patients with chronic illness and complex care needs regarding the promotion of self-management. Guided interviews were conducted with nurses practicing in primary care and key informants in Germany, Spain, and Brazil with a subsequent cross-case evaluation. 

Rebuilding for sustainability and resilience: strengthening the integrated delivery of long-term care in the European Region

The pandemic of coronavirus disease 2019 (‎COVID-19)‎ has revealed and accentuated important gaps in the provision of appropriate, community-based, long-term care services for a rapidly growing number of people experiencing decline in functional ability, across the WHO European Region. As countries work to rebuild and strengthen health and long-term care systems, it is essential to support broad dialogue, a common vision forchange and focused interventions to bridge existing divides. This policy brief proposes a conceptual framework that maps long-term care actions within the health and social policy landscape and highlights the need and potential for deeper integration and coordination across systems.

Improving home care sustainability in Ireland. Are user charges a promising option?

There are often concerns that population ageing will cause health and long-term care expenditures to grow uncontrollably. A key question facing decision-makers is what, if anything, can be done in response? In this report we consider whether user charges would improve the financial sustainability of home care in Ireland, a country which is ageing at a rate similar to other high income countries.

We find that user charges are an inefficient tool to try to reduce the home care financing gap. Evidence suggests that the revenues raised for home care through user charges are negligible in other high income countries. Additionally, while user charges may cause some people to reduce their demand for care, service-users are typically unable to distinguish between high-value and low-value care. Some service-users who do continue to use services will experience financial hardship if required to pay user charges out-of-pocket, while others will forgo care. In ...

Regional technical meeting on integrated care delivery

This report summarizes the discussion that took place during the Regional technical meeting on integrated care delivery. It represents a continuation of the discussion held as part of the Regional technical meeting on strengthening the integrated delivery of long-term care in the European region, in December 2021, bringing an expanded focus on integration as a transversal issue for health and long-term care systems and an important stepping stone for achieving universal health coverage. Participants discussed and shared evidence and lessons learned on the principles, the practice, the enablers and on-going challenges to improving coordination within and across health and long-term care systems, with particular attention to integration of primary care and community-based long-term care services.

Person-centred long-term care for older persons: a new Lancet Commission

The UN declared 2021–30 to be the Decade of Healthy Ageing, and efforts are being made to maximise the functional ability of people over their life course. Yet older people are marginalised and perceived as a burden, particularly those with ongoing loss in capacity. Nowhere is this more conspicuous than in the context of long-term care (LTC) worldwide, where older people in some settings encounter a loss of independence and other violations of their human rights. Such experiences can range from deprivation of liberty and loss of legal capacity and consent to coerced institutionalisation, exposure to abuse, neglect,and disrespect, and persistent use of restraints.