Documentos de Académico
Documentos de Profesional
Documentos de Cultura
+ cancer care
Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries
Facets
272,000 mg
India
2,300 mg
6,600 mg
Source: Based on data from: Treat the pain (http://www.treatthepain.com )
Applies a diagonal approach to avoid the false dilemmas between disease silos -CD vs NCD- that continue to plague global health
Outline
1.The Diagonal Approach
2. Effective Universal Coverage and the challenge of chronic conditions 3. Effective Universal Coverage: Mexico
Diagonalizing:
Integrate pain control and palliative care into national health reform, insurance and social security programs
For decades, energy has been spent in disputes opposing disease-specific vertical service delivery models to integrated horizontal models. Delivery science is consolidating evidence on how some countries have solved this dilemma by creating a diagonal approach: deliberately crafting priority disease-specific programs to drive improvement in the wider health system. Weve seen diagonal models succeed in countries as different as Mexico and Rwanda.
Jim Yong Kim, World Bank President, World Health Assembly, 2013
Outline
1. The Diagonal Approach
Population (Horizontal)
Source: Modified from the WHO, World Health Report, 2013 andSchreyogg, et al., 2005.
Financial protection Integrated across the life cycle: diseases and people
Huge steps in the transition thru reform in the quest for UHC in many countries
Examples:
Brazil China Colombia Chile EEUU (Affordable Care Act) El Salvador Peru South Africa Taiwan Mexico: Seguro Popular de Salud
Yetoften in the
context of rapid, profound, polarized and complex epidemiological transition or battling fragmented health systems
66%
70%
Communicable
NonCommunicable
25%
9%
Injuries
18% 12%
1980
2010
Source: Cepal, 2012. The epidemiologic profile of Latin America and teh Caribbean: challenges, limits, and actions.
NCD
Breast cancer
HIV/AIDs (KS)
Chronic Cervical Cancer (HPV) Long term disability post infection (polio) Chronic w acute episodes: Asma, mental
Acute
An effectiveUHC response to chronic illness must integrate interventions along the Continuum of disease:
1. 2. 3. 4. 5. 6. Primary prevention Early detection Diagnosis Treatment Survivorship Palliative care
eUHC requires an integrated response along the continuum of care and within each core health system function
Health System Functions
Stewardship Financing Delivery Resource Generation Components of the continuum of disease and life cycle
Primary Prevention Secondary prevention
Diagnosis
Treatment
Survivorship/ Rehabilitation
Not associated with a specific illnesses Most patients lose their lives making advocary especially challenging advocacy People who are alive are afraid of death and would rather not discuss it Measurement based on Burden of Disease and Cost-efectiveness misses the point and skews priority setting
Why have pain control and palliative care been forgotten in the quest for UHC?
Outline
1. The Diagonal Approach 2. Effective Universal Coverage and the challenge of chronic conditions
Protection of patients
Example: CONAMED
(National Commission of Medical Arbitration)
Financial protection
Affiliation:
2012: 54.6 m
Benefit package:
2004: 113
2012: 284+57
Benefits Package
Horizontal Coverage:
Beneficiaries
MING FPCHE EPHS EPI CBP # Int. Causes + FPCHE # Int. MING + SP + FPCHE
17 108 110 49 20 49 49 57 57 116 128 128 131
CAUSES FPCHE
284 59
131
MING + SP
No. Interventions
59
FPCHE 59 interventions
CAUSES 91 FPCHE 6
6 83 6 22 6 6 65 2005 8 65 2006 6 65 2007 176 184
189
189
198
198
206
12 65 2008
12 65 2009
12 65 2010
12 65 2011
13 65 2012
13 65 2013
SP = Seguro Popular MING = Medical Insurance for a New Generation (Children born after December 1, 2006 and until they are 5 years of age) now XXI Century Medical Insurance FPCHE = Fung for Protection against Catastrophic Health Expenditure EPHS =Essential Personal Health Services EPI = Expanded Programme of Immunisations CBP= Community-based package
In Mexico
Legislative innovative benchmark at a global level:
2009: modification of the General Health Law and Law on Palliative Care 2013: Expansion of the General Health Law on palliative care matter However..
Out of the 83,771 deaths from cancer or HIV/AIDS in 2010, 65,447 patients died in
Stewardship
Financing
CAUSES and FPCHE: theres no explicit coverage; In Social Security, a whole Lacking service units Supply and distribution chains incomplete geographically Scarcity of qualified personnel Fear in the prescription Incorporation of relevant classes in university curricula is missing Absence of published investigations
Delivery
Resource Generation
Source: Adapted from Knaul, F. M., Gralow, J. R., Atun, R., & Bhadelia, A. (Eds.). Closing the Cancer Divide. Harvard University Press, 2012.
Funds
Level
Fund-C
Fund CAUSES
1y2
1y2
Catastrophic 3 fund
Communication between funds and levels is problematic, yet the population struggles to moves across and between funds
* Since Dec 2006. ** Since 2013 Source: Adapted from: Frenk J, Gonzlez-Pier E, Gmez-Dants O, Lezana MA, Knaul FM. Comprehensive reform to improve health system performance in Mexico. Lancet 2006; 368: 1524-34.
Poor Beneficiaries
Rich