|Implemented in this survey?|
The importance of accessing primary care as an entry door to the health public system and the current context defined by lack of professionals and limited resources has generated the need to incorporate organisational innovations that provide this service in a decisive and efficient form. The consortium CASAP, though under public ownership, has its own judiciary and managerial autonomy and is the new organisational formula developed in the Catalan health system to attend to these demands.
The purpose of this policy is to promote new organisational forms in primary care which would improve the efficiency and the quality of services, by creating entities that enjoy autonomy and greater managerial capacity. In addition, it seeks to involve local authorities in the organisation and responsibility of health services within their domain.
Provide greater managerial capacity and autonomy to the primary care centres (PCC).
Involve local authorities in the organisation of health resources.
Increase the efficiency and quality of services provided by the PCC.
Improve staff management, in particular to increase motivation and performance.
Strengthen the gate-keeping role of the PCC in the health system and extend the decisive capacity of the primary care.
Particular legal framework
Financial management autonomy
Staff management and contracting in the labour regime
Capacity to offer a portfolio of complementary activities and private services
Autonomy in the establishment of agreements with different providers
Patients, Professionals, Health autorities
|Medienpräsenz||sehr gering||sehr hoch|
This initiative can potentially benefit the primary care system in three ways.
The current conjuncture arising from the lack of professionals and the resource limitation in the public health system, has made necessary to search for new organisational forms that improve the management of the primary care centres and reinforce their gate-keeping function in the health care system. Since the promulgation of the LOSC (Health Care Organisation in Catalonia Act) in 1990, the primary care public services in Catalonia have been based on a model that separates provision and purchase.
The public purchaser, CatSalut, has three models of service provision for primary care.
Unlike the previous policy of the Autonomous Government of Catalonia, which promoted the diffusion of the ABE, the new government, headed by the socialist party, chose to design another organisational form that had autonomy, but kept public ownership and counted on the participation of Local Authorities.
CASAP provides services to approximately 24,000 inhabitants of Castelldefels' city.
|Implemented in this survey?|
The Consorci Castelldefels Agents de Salut D'Atenció Primària (CASAP) is a new organisational form developed in the Catalan health system in 2005. The consortium is constituted of the regional health authority CIH (70 %) and the local authority (30 %). It has been defined as a legal public entity, and has the freedom to operate under both public and private law.
The idea was generated beforehand both by local authorities and the Catalan Institute of Health (CIH), the autonomous health services' main public provider. There's no such organisation in their setting.
It differs from other organisational models in the Catalan Primary Care System by not being linked to a hospital entity (unlike the SIO model) and by keeping its public ownership (unlike the ABE).
This organisational form grants autonomy on financial management and on the hiring of staff under the same labour rules as for private organisations. The consequences of these specific issues allows them develop a more agile and flexible management to provide services adapted to the needs of their respective populations.
The approach of the idea is described as:
The Catalan Health Service, the autonomous organisation for the purchase of public services, agreed to the idea. There was no reaction from other organisations, though health professionals in surrounding Catalan Health Institute primary care teams were suspicious of it. Professionals were selected for building the team in order that they have a vested interest. The manager was hired some months in advance of its opening, both for selection of human resources and connecting with other levels of care.
|Catalan Ministry of Health||sehr unterstützend||stark dagegen|
|Local Authorities||sehr unterstützend||stark dagegen|
|Catalan Health Institute (CIH)||sehr unterstützend||stark dagegen|
|CatSalut||sehr unterstützend||stark dagegen|
|Patients||sehr unterstützend||stark dagegen|
There were not significant influences during the legislation process.
|Catalan Ministry of Health||sehr groß||kein|
|Local Authorities||sehr groß||kein|
|Catalan Health Institute (CIH)||sehr groß||kein|
In 2005, CASAP was formally constituted, comprised of the CIH and the Local Authority of Castelldefels. Its function was to manage the new primary care centre of the locality. They selected a management team, composed of a director-manager, an assistant director and a financial manager, and established the selection criteria of skills and attitudes used to evaluate candidates for other staff positions, with evaluation delegated to the management team.
Subsequently, diagnostic resources were acquired and the additional pathologies the centre would solve (programmes of dietetic advice, day surgery, nicotine addiction, etc.) were determined which there was extended the public provision of services, and since the consortium constitution, and they elaborated a portfolio of private services (dentistry, speech therapy, psychology and acupuncture).
No special mechanism of periodic monitoring has been established to evaluate implementation, but the public purchaser has defined yearly objectives, some of them clinical and others organisational. The managers of the centre also have internal management indicators to monitor performance (assistance results, questionnaires on the motivation and training of professionals, and the degree of satisfaction of their patients).
The centre has got good clinical results with no waiting lists. Quality survey and professional qualitty survey give good results, too. The motivation of the staff is increased up to the level of the ABE's centers.
The introduction of this new organisational form facilitates an improvement in the efficiency and quality of services provided by primary care centres, by means of an organisational structure that stimulates improved stakeholder performance.
Explanations for this improvement are:
Another benefit is the maintenance of public ownership since it reduces the adverse incentives to the unjustified derivation of cases to other health care levels.
The most prominent obstacles of its generalisation are political interference and controversies that block these organisations' operation, or the generalisation of territorial consortia that are turned into one more funding level exercising the functions of public purchaser, instead of those of planning.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
The impact of this initiative can be considered positive due to the potential gains in efficiency and service quality, which lead to an increase in user satisfaction and are an advantage in the context of a global cost reduction.
Since the experience has thus far been restricted to a single centre, impact of the initiative is limited; nevertheless future generalisation may be predicted in light of this centre's favourable results.
Gabriel Ferragut Ensenyat