Behaviorálny a experimentálny ekonomický tím MZSR

Integrated Health Care

At beet, we are actively involved in shaping the concept of Centres of Integrated Care (CIS). These are partnerships that bring together health and social care in one common space, with the aim of improvement and access health and social care.

Several reasons motivate the implementation of the Integrated Care Centres project. Among the most important ones are:

  • lack of outpatient health and social care in the regions of Slovakia
  • excessive administrative burden on doctors and other medical staff
  • inadequate patient management in the healthcare system
  • Lack of links between health and social care.

From the successful implementation of the CIS project we promise:

  • Strengthening outpatient health care in the regions,
  • reducing the administrative burden on healthcare staff; and
  • Effective patient management in the healthcare system through virtual and physical integration of services.

We are currently working on the design of a strategy for a network of Regional Centres for Integrated Health Care (RCIS) and Centres for Integrated Health Care (CIZS), with calls for the creation of these centres expected to be published in the second half of 2023.

Integrated care refers to partnerships that bring together health and social care in one shared space (physical or virtual). The project aims to both improve and simplify access to health and social care and improve the quality of care provision for different types of patients (long-term ill, acute, chronic and those with special needs). This care is provided in Integrated Care Centres (hereafter also referred to as 'CIS').

CIS can be simplistically seen as a conceptual successor to the former health centres/clinics that aimed to provide the necessary outpatient and social services in a given region. They are characterized by several features, the most important of which are that CIS:

  • constitutes a single common area, including its staff and material equipment
  • serves to integrate the provision of general and specialised outpatient health care, selected social services and other services in the form of compulsory or optional components
  • is not a new type of healthcare facility
  • is not a new type of social/health care provider
  • does not change the legal personality of individual service providers operating in the CIS
  • is divided into two types according to the scope of services provided - smaller local ones ("CIZS") and regional ones with a wider scope of services ("RCIS")

In the current primary health care system, there is no effective referral of patients within the different types of health care provided. Within this inefficient patient routing, there is a lot of duplication in the provision of healthcare, with primary care physicians playing a key role in capturing and directing the patient for a particular health problem. At the same time, the continuity and interconnectedness of general practitioners and specialists is important for better access to care and, ultimately, patient adherence to the system. The link between health and social care is also essential.

The creation of integrated centres with a multidisciplinary portfolio of health and social services also reflects and follows the announced changes in the optimisation of the hospital network (support for the outpatient sector and patient management in the primary sphere will enable regulated referral of patients within inpatient health care).

The intention to create a network of integrated health care centres was also defined in the Strategic Framework for Health Care 2014-2030. Among the priority activities proposed for the defined period were:

  • Implement the concept of an integrated health care model with a priority focus on the positions of general practitioner for adults, general practitioner for children and adolescents, gynaecologist and dentist as first contact doctors (gatekeeping) and nursing on the basis of concentration of activities by creating new procedures in the field of treatment and prevention, strengthening and expanding general outpatient and nursing care. Ensure that the health system is supplemented by general practitioners and specialists through a residency programme (targeted, financially supported specialisation studies), with subsequent deployment in those regions where there is a shortage or a high average age.
  • Implement medical prevention programs in the prevention of communicable and non-communicable diseases through collaboration with other components of health care delivery.

CIZS (IROP 2014 – 2020)

In creating a network of integrated care centres, the MoH has started the creation of Integrated Health Care Centres (hereinafter referred to as "IHCCs")

41

22

52 346 627

Completed projects

Projects in process

Contracted eligible expenses

The primary objective of establishing the CIZS was to strengthen primary health care in unattractive regions. This will secondarily be reflected in lower pressure on the hospital sector. It will also ensure greater efficiency and the provision of health services that are cost-effective and efficient with long-term sustainable financing. At the same time, the elimination of duplication and overuse of specialised and inpatient care is a priority.

Basic parameters of the CIZS project

  • Structure of CIZS components
    • Mandatory
      • general outpatient health care for adults;
      • general outpatient health care for children and adolescents;
      • specialised gynaecological outpatient health care.
    • Optional
      • other than mandatory general and specialized health care
      • other health care provision activities (ADOS, collection workplace, stationary and others)
      • social services (e.g. specialized social counseling)
    • eligible applicants
      • public administration entities (municipalities and VÚC)
      • non-profit organizations

The funding source was allocated funds from the Integrated Regional Operational Program for the period 2014-2020 (IROP) within priority axis 2, specific objective 2.1.2 - Modernize the health infrastructure for the purpose of integrating primary health care.

A comprehensive methodological guide for project preparation and successful operation of CIZS is summarized in the document Methodology for the implementation and operation of the Center for Integrated Health Care - as part of Annex V04 to calls for CIZS (https://www.mpsr.sk/vyzvy/376).

Out of 72 approved applications for NFA, 25 projects have been successfully finalised, another 40 are in the process of implementation with an estimated completion date by the end of 2023. 7 projects will eventually not be implemented (contract not concluded/project did not contribute to the OP objectives). The final number of contracted CIZS projects is thus 65.

The total contracted amount represents the value of € 52 574 774, while the average amount of the total contracted amount per CIZS amounted to approximately € 809 thousand, including the applicant's co-financing of almost € 40 thousand.

In the contracted CICUs (65), the dentist (in 89% of the CICUs), the internist (in 23% of the CICUs) and the FBLR (in 22% of the CICUs) have the largest share of representation, in addition to the mandatory components (VLD, VLDD and gynecologist). The widest range of health care specialties (not including ADOS) is offered by the CIZS Nováky in the Trenčín Region (12), the CIZS Žarnovica in the Banská Bystrica Region (10) and the CIZS Kolárovo in the Nitra Region (10). Social care is integrated in 29 CIZS.

CIZS (OP Slovensko 2021 – 2027)

Considering the success of the CIZS project implemented in the IROP 2014-2020 programming period The Ministry of Health of the Slovak Republic continues the CIZS project.

The primary objective of the continuation of the CIZS project is to Strengthening health and social care in the regions. Mandatory provision of health and social services will contribute to accessibility in prevention, diagnosis, treatment and care of patients at the local community level.

Unlike other health facilities such as polyclinics, the CIZS integrates not only the provision of outpatient health care but also the provision of social services on a daily basis. This means that the patient/client has everything under one roof and does not have to travel to another place, address or even another city for examination or service provision.

This integration leads to better communication between healthcare providers, patients, social service providers and clients

  • Mandatory components
    • Healthcare
      • general outpatient health care for adults;
      • general outpatient health care for children and adolescents;
    • Social care
      • basic social counselling
    • integration of eHealth modules

 

  • Optional components
    • Healthcare
      • specialised dental-medical outpatient health care
      • specialised gynaecological outpatient health care
      • other specialised outpatient healthcare
    • Other outpatient and pharmacy care facilities
      • Stationary
      • ADOS
      • public pharmacy
      • SVaLZ - Physiotherapy, balneology and medical rehabilitation
    • Social care
      • non-compulsory outpatient or outreach social services
    • Other services
      • Facilities for educational activities for health professionals and patients

The continuation of the CIZS project has allowed room for the introduction of innovations that were not included in the original CIZS project.

Compulsory social care

As health care creates the conditions for early identification of social disadvantage (there is often a correlation between ill health and social disadvantage), in all CIZS built from the new project period there will be compulsory basic social counselling.

In addition to this mandatory component, the CIZS will be able to support other social components, either on an outreach or outpatient basis.

Emphasis on digitalisation

Healthcare delivery should be responsive to current digital trends. Therefore, the CIZS needed to integrate relevant eHealth modules in accordance with Act No. 153/2013 Coll. on the National Health Information System.

The CIZS will also support software, applications and digital tools for remote patient management (telemedicine).

Innovative ambulance

In the context of the Slovak healthcare system, there is an assumption that fewer and fewer doctors will be caring for an increasing number of patients. This will result in capitation tribes with a higher number of patients, where there will be more patients per doctor than the norm.

The continuation of the CIZS project responds to this current as well as projected shortage of health personnel by building premises for junior medical and non-medical staffwho is expected to take over from the doctor or nurse in the future.

The source of funding is allocated funds from the Operational Programme Slovakia 2021 - 2027 under the specific objective RSO 4.5.

Comprehensive methodological guidance for project preparation and successful operation of the CIZS will be published in Q3 2023.

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RCIS (OP Slovakia 2021 - 2027)

The Integrated Care Centres project continues with the development of Regional Centres for Integrated Care (RCIS). These larger health facilities integrate the mandatory components of health and social care with innovative administrative and digital support.

 
  • Mandatory components
    • Healthcare
      • Ambulance
        • general outpatient health care for adults;
        • general outpatient health care for children and adolescents;
        • gynaecology and obstetrics,
        • Dental Medicine,
        • Internal medicine,
        • Neurology,
        • Surgery,
        • FBLR (Physiotherapy, balneology and medical rehabilitation)
        • Diabetology/endocrinology,
        • specialist's outpatient clinic according to regional specifics
        • specialist's outpatient clinic according to regional specifics
        • specialist's outpatient clinic according to regional specifics
      • Joint investigation and treatment units (JITUs)
        • medical rehabilitation
        • Radiology
      • Social care
        • basic social counselling
      • integration of eHealth modules
    • Optional components
        • Main components of health care - outpatient and pharmacy health care
          • Outpatient clinics (other than compulsory specialities)
          • Workplace
          • Stationary
          • Day Health Care Unit
          • SVaLZ unit
        • Supportive components of healthcare
          • Counselling Centre for Health Protection and Promotion
          • Education Centre
        • Social care
          • other types of social services on an outpatient, outreach or other form according to the community plan of the municipality
        • Administrative management of RCIS
          • RCIS Manager
          • RCIS Administrative Team
          • RCIS reception with client centre
        • Digitization
          •  Telemedicine software
          •  Other health and social software

Comprehensive guidance on project preparation and successful operation of the RCIS will be published in Q3 2023.

Finalisation of the methodology for the operation of the RCIS.

Communication with potential eligible applicants for non-repayable financial contribution (NFA).

Q3/2023
methodology for the implementation of RCIS
Q3/2023
launching an RCIS challenge
Q4/2023
closure of the RCIS call
TBD
evaluation of the RCIS call
12/2029
completion of project implementation

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