Problem: Political concern for the chronic disease burden and suboptimal population health outcomes; limited availability of health promotion or disease prevention services; concentration of service delivery in higher-level settings and weak gatekeeping at the primary level; fragmented delivery of services, with limited continuity of care for patients with chronic disease.
Solution highlights: Networks of primary-level integrated health care centres (IHCC) that co-locate providers and promote interdisciplinary team working are being developed and piloted; piloting of reforms will enable gradual introduction and testing of planned changes; a national-level framework provided the initiative with a strong starting base from which to develop, set clear goals for change and supported the alignment of activities; regional authorities will lead implementation of reforms to allow adaptations based on local needs; the creation of a new agency to provide analysis and implementation support increased the government’s capacity to lead change.
Description of practice
In 2012, the expectation for Healthy Life Years in Slovakia was just 52 years (10 years below the EU average). Chronic disease was the leading cause of mortality and morbidity and there was growing political concern over citizens’ involuntary exit from employment and experience of social exclusion in retirement. The existing hospital-centric model of care limited the availability of health promotion and disease prevention services, plus hindered effective management of patients with chronic disease in primary settings. Gatekeeping at the primary level was weak, evidenced by 80% of patients with chronic conditions being referred to outpatient specialists or inpatient hospital services following the first contact with general practitioners. Furthermore, poor communication between providers caused care delivery to be fragmented, leading to duplication of services and limiting continuity of care.
Growing political concern for the negative economic and social impact of suboptimal health outcomes pushed need for health system reform up the government agenda. The timely release of a European Commission report, published around the time that the Government of Slovakia was considering potential health reform strategies, helped illustrate how development of the health sector could improve economic sustainability and provided inspiration for reform. As a result, the Government of Slovakia committed to comprehensive health system reform to transition away from the hospital-centric model in place and work towards strengthening the role of primary care. Formalizing this ambition through the Strategic Framework of Healthcare 2014–2030, proposed changes included plans for the development of a network of primary-level integrated health care centres (IHCC) to co-locate providers and promote interdisciplinary team-working. Anticipated system-level adjustments to facilitate proposed changes include the introduction of performance-based financing mechanisms and strengthening of medical education. The area of Tren?ín has been selected as the pilot site to test reforms. A performance review of all health facilities in Tren?ín was conducted and a map-based analysis was used to determine the ideal number and geographic location of health facilities necessary to meet population needs. Based on the analysis conducted, four acute-care facilities, eight large IHCCs and eight small IHCCs were determined to be adequate for covering care needs in Tren?ín. Existing facilities will be renovated and modernized where possible, however approximately half of all facilities will need to be newly constructed in new locations. While implementation of the pilot project is only just beginning, it is expected that the reforms taking place will change health system dynamics to increase cost-effectiveness, reduce fragmentation and bring care closer to communities.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
The initiative is being led by the Ministry of Health through a top-down approach. The Government of Slovakia has focused on building internal capacity to enable implementation of reforms and has created the Institute of Health Policy as a means to provide analytical and implementation support. An expert steering committee has also been established to help oversee implementation.
As piloting of the initiative is only just beginning, information on outcomes is currently unavailable.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
Please click on the link below for more information about this practice.
- Stefan Mesaros
- Ministry of Health, Institute of Health Policy