Informing Options for Scalingup Innovation Session 3 Addressing health equity and disparities across diverse communities Policy implications amp Discussion Jonathan Foley Westcott Partners LLC ID: 781569
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Slide1
Advancing the Science of Transformation in Integrated Primary Care:Informing Options for Scaling-up Innovation
Session 3:
Addressing health equity and disparities across diverse communities: Policy implications & Discussion
Jonathan Foley, Westcott Partners LLC
Slide2PurposeDescribe the use of certain indicators of need in a primary health care funding formula in the context of a comprehensive reform of New Zealand’s primary health care system; and, Assess the impact of this funding approach on primary health care delivery systems and populations served by those systemsComment on the implications of New Zealand’s experience to efforts to address social determinants in the United States
Slide3ContextPrimary Health Care Strategy – comprehensive reform of the way primary health care was delivered, financed, and governed.Specific objectives included:Making primary health care affordable with co-pays reduced or, in some cases, eliminated
Increasing utilization of needed services, especially preventive services and health screenings
Promoting better coordination of care
Reducing health inequalities through new models of care
Primary Health Organizations (PHOs) – GP practices and clinics aggregated in local areas to be focal point. Non-profit with community representation.
Needs-based population funding formulae – means for allocating government subsidy; incorporates ethnicity and area deprivation index
Slide4Health disparities
New Zealand Ministry of Health, “Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980–1999,” 2003
http://www.moh.govt.nz/notebook/nbbooks.nsf/0/37A7ABB191191FB9CC256DDA00064211/$file/EthnicMortalityTrends.pdf
New Zealand Ministry of Health, “Decades of Disparity II: Socioeconomic mortality trends in New Zealand, 1981-1999,” 2005.
http://www.rangahau.co.nz/assets//decades_disparity/disparities_report2.pdf
, income is weighted by ethnicity.
Slide5Health Disparities (cont.)
Disease/ condition
Gender
Maori
Pacific
European/
other
Asian
Heart disease
Male
13.6
5.99.48.1Female10.67.98.54.6StrokeMale2.5n/a2.0n/aFemale2.8n/a1.4n/aDiabetesMale9.58.13.48.1Female6.711.92.48.7AsthmaMale21.69.420.86.3Female27.210.825.98.7COPDMale6.0n/a4.6n/aFemale6.3n/a5.9n/aHigh blood pressureMale23.716.217.614.4Female23.918.219.213.1High cholesterolMale15.99.514.613.4Female12.011.113.212.3ObesityMale29.038.018.04.3Female27.547.819.86.9Current SmokerMale42.934.821.318.9Female51.131.619.93.6Seen GP in last yearMale67.875.177.763.8Female82.583.787.073.8MammogramFemale69.057.176.955.6Cervical screenFemale72.854.477.543.1
Percent of NZ Health Survey (2002/2003) respondents answering positively to selected questions (age standardized)
New Zealand Ministry of Health, “A Portrait of Health: Key results of the 2002/03 New Zealand Health Survey,” 2004
Http://www.moh.govt.nz
For the most recent version, see “NZDep2013 Index of Deprivation,” June Atkinson, Clare Salmond, and Peter Crampton, published by the Department of Public Health, University of Otago, Wellington, May, 2014.
http://www.otago.ac.nz/wellington/otago069936.pdf
Health equity innovationFunding formulae allocate more money to PHOs with greater concentrations of Maori, Pacific Islanders, and most deprived enrolleesPHOs use funding to:Lower fees for enrolleesDevelop outreach programs that improve access – e.g., transportation services, nurse clinics on marae or remote locations, community health workers
Run health promotion services and campaigns that influence health behaviors – e.g., smoking cessation, safe driving, healthy eating
Connected to mainstream medical care through PHO
Slide8Pacific women as keys to family health
Culturally appropriate services
Community based health promotion
Slide9Evaluation of impact
Slide10Lessons LearnedRapid implementation driven by political momentum enabled broad-based reform across the country;DHBs and general practitioners do not have as much ownership of strategy because of rapid implementation;Fee reductions limited by soft regulatory approach and GP resistance;
Tensions between universal and targeted approaches;
Not enough attention to planning and evaluating service delivery innovations aimed at reducing inequalities;
Impact of service delivery innovations dependent on capacity and expertise of local practitioners.
Slide11Primary Health Care Funding Path
Rapid Implementation
Slide12Implications for the United StatesSeveral versions of area deprivation indeces available – strong correlation with health outcomes; use readily available Census data
Existing and promising programs to address health inequalities through focus on social risk factors:
Community health centers – 1200 centers, 25 million served
Patient Centered Medical Home – comprehensive, coordinated, team approach
Accountable Health Communities – 44 communities
IMPACT Act – possible adjustments to Medicare payments based on social risk factors
Scaling up depends on:
Clearer understanding of what works
Local capacity and expertise to undertake new models of careAppropriate funding
Ongoing accountability mechanisms, evaluation and feedback
Political will