This a brief summary of the Primary Care level development at the Andalusia region, Spain, in the last 25 years, and a description of the current main features and outcomes in terms of accessibility, resources, patient's satisfaction, life expectancy, mortality and health expenditure.

1. PRIMARY CARE: Regional strategies to improve efficacy and equity while guarateeing economic sustainability W O R K S H O P José L. ROCHA General Secretary for Quality and Modernisation Regional Ministry of Health Government of Andalusia, Spain. [email_address] Strategies and results in Primary Healthcare in Andalusia

3. Andalusia and the Andalusian Public Healthcare System: Quick Facts

6. Andalusia: Social and Economic trends Source: Eurostat Source: Centro de Estudios Andaluces

7. Andalusian Public Healthcare System: Main features 1,146 Primary care centers 360 Auxiliary offices for primary care 47 Public Hospitals (16,821 beds) 102,000 Healthcare professionals 9,390 M € Health Budget 2011, 6.67% GDP

8. Primary Care in Andalusia Historic overview

10. Situation Before the reform: Individual work of general practitioners No specific training No health prevention/promotion/education Isolated rural medicine Hospital-centric model Lower salaries than specialists Low prestige and self-esteem

11. Primary Care in Andalusia Main Features

12. Primary Care in Andalusia: Main features Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

13. GP as a Gatekeeper Capitation: 1 GP/1,400 inhabitants Team of professionals working in a PC Centre Homogeneous territorial distribution Aggregation of PC Centres in “ Districts ” Supportive teams at Districts for Public Health purposes: Epidemiologists, Vets, Pharmacists… Professionals are civil servants Focus on health promotion and prevention

14. Primary Care in Andalusia: Main features Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

15. Accessibility 1146 Primary Care Centers (and 360 auxiliary offices) vs. 33 at 1986 Less than 15 min away for anybody 1 Family Physician every 1.400 people on average Primary care doctors represent 41% of APHS doctors (29% at 1986)

16. Primary Care in Andalusia: Main features Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

17. Primary Care in Andalusia: Main features: Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

18. Primary Care professionals Family Physicians Community Nurses Pediatricians Midwives Dentists Physiotherapists Social Workers Psychiatrists/psychologists Epidemiologists Community Pharmacists Veterinaries Administration workers Auxiliary workers

19. Primary Care in Andalusia: Main features: Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

20. Health Care Information and Management Integrated System Appointment Prescription Radiology Waiting lists Functional tests Pathology Lab tests Inpatient care Referrals Outpatient care Primary care Hospital admission Data warehouse Emergency care 105 Million of e-prescriptions/year 95 Million of appointments/year 7.9 Million of individual EHR 3 Million of e-referrals/year 3.5 Million of x-Ray images/year

21. Primary Care in Andalusia Outcomes

22. Outcomes: Life expectancy and amenable mortality

23. Mortality index in Andalusian municipalities vs. Spanish average Trend to convergence to Spanish average 96% of municipalities have an index equal or lower than the Spanish average for people 65 years old or less The south-west area of Andalusia shows a mortality index higher than the Spanish average for the group of 65-74 years old people The majority of municipalities have a mortality index higher than the Spanish’ one for people with more than 75 2005 - Women 15-44 years old 2005 - Women 45-64 2005 - Women 65-74 2005 - Women 75-84 Higher than Spanish average Non significative differences Lower than Spanish average Source : Atlas Interactivo de Mortalidad en Andalucía (AIMA). Revista Española de Salud Pública 2008; 82(4)

24. Outcomes: Health Expenditure OECD Health Data 2010.

25. Social and Economic Council of Spain, 2010. Outcomes: Health Expenditure Regional health expenditure (€ per capita). Spain 2007

26. Ministry of Health and Social Policy. Spain, 2010. Outcomes: Health Expenditure on Primary Care Andalusia Spain Catalonia Valencia Madrid

28. Outcomes: Efficiency The Swedish Healthcare System: How does it compare with other EU countries, the United States and Norway? Swedish Association of Local Authorities and Regions,2008 Desired direction

29. Health spending in OECD countries: Obtaining value per dollars. GF Anderson, BK Frogner. Health Affairs 2008; 27:1718-1727

30. Outcomes: Patient satisfaction General satisfaction on Primary care. Satisfied + Very satisfied (2/5). Institute for Social Studies of Andalusia. Spanish Scientific Research Council (CSIC)

31. Primary Care in Andalusia: Key factors: Universality Lack of economic barriers for people Decentralisation Equitable planning of public resources Coordination and integration of care Community focus Extended basket of services Teamwork Clinical Management Professional commitment Long-term policies

33. http://www.opimec.org/