gestion en salud

Planning Health workforce in OECD
countries: a review of 25 proyection
models from 17 countries
CHILE
Septiembre 2012
Summary
1.
Health Profesionals
-Skill studies
-National Examination of Medical Competence
(Quality)
2.-Medical and dental specialists
Extension of Undergraduate Studies
Extension of Postgraduate Studies
National Medical Examination
National distribution of physicians
Specialists breach closing
Specialists National Concourse (CONE)
Gobierno de Chile / Ministerio de Salud
“QUALITY AND EQUITY
IN HEALTH”
A NEW HUMAN RESOURCES
POLICY TO FACE THE BREACH OF
MEDICAL SPECIALISTS
2010 - 2015
The Problems
North desert
METROPOLITAN
temperate
South rain
Gobierno de Chile / Ministerio de Salud
1. Primary health care physicians
required all the country.
2. Physicians required by 29
Regional Health Services.
3. Medical and Dental Specialists
required by the Public Health
Sector.
4. Medical and Dental specialists
distribution is inequitable.
Overview of the distribution and
availability
of Chilean Medical
Gobierno de Chile / Ministerio de Salud
Overview of the distribution and availability of medical
specialists in the Public and Private System
S. Privado
(exclusivo)
5,843
Servicios de
Salud
8,669
Number of Medical Specialists
Gobierno de Chile / Ministerio de Salud
Health Services
Private Sector
(exclusive)
TOTAL
8.669
5.843
14.512
Sources: Physicians Health Services: HRIS April 2010 - Base APS 20092010 - SII December 2007.
Private medical estimate based on information from SII
Country average
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Overview of the geographical distribution
(Weekly Hours Rate, per 100,00 beneficiaries.
Year 2007)
Total 23 Especialidades (Horas)
5.000
4.500
4.000
3.500
3.000
2.500
2.000
1.500
1.000
500
-
Gobierno de Chile / Ministerio de Salud * c / 100.000 habitantes
Promedio País
Country mean
Mediana País
Availability of specialists hired by HS Hrs per
100,000 beneficiaries
5,000
Number of hours of medical specialists per 100,000
beneficiaries PUBLIC
2009-2010
4,000
3,000
2,000
1,000
0
305,317 hours per month of April 2010
Gobierno de Chile / Ministerio de Salud
13 Health Services in 2400 hrs./100.000
New Specialists with a new Human
Resources Policy stated in 2011
•
Incentives for an equitable
distribution
– Territorial special
alllowances.
– Variable allowances by
production
– Optimization of medical law
•
Incentives to development
– Training, courses and
continuos education
– Professional development
•
Incentives to retention
associated to regional social
development
– Housing, schools, private
exercise of medicine, etc.
Gobierno de Chile / Ministerio de Salud
•
•
•
To reduce under graduate
medical studies to 6 years
Current 7 year will be the
first postgraduate year
National Medical
Examination to be
applicated at the end of 6th.
year
9
Health Services availability 0f Medical Specialists
Contracted hours by 100,000 beneficiaries
Lesser
availability
Less availability per
100,000
beneficiaries
Mayor
availability
Increased
availability per
100,000
beneficiaries
Metrop. Oriente
Aysén
Valparaíso
Magallanes
Gobierno de Chile / Ministerio de Salud
“QUALITY AND
EQUITY
IN HEALTH”
A NEW HUMAN
RESOURCES POLICY TO
FACE THE BREACH OF
MEDICAL SPECIALISTS
2010 - 2015
Gobierno de Chile / Ministerio de Salud
New HR Policy for Specialized
Proposals:
Policy
2 components
Studies
Gobierno de Chile / Ministerio de Salud
Management
12
Three categories group to problem enfrentation
• It has an effective gap with little or no training capacity and N º of physicians is
less than the national average., same to specialists, Dont have school medicine .
And have poor atractive the young profesional.etc. (11)
Critical Zone
• The lack of specialists in the public sector is due to a combination of factors not attributable
solely to lack of supply in the area. (5) have a school medicine but production phisycian and
Intermediate specialist is poor, great rural population. Extrem zone. (5)
Zone
Retention
area
• There maldistribution of specialists, with good private offering. The recruitment of specialists,
is conditioned by competition with the private sector, being the critical working conditions. (13)
• Is possible buy a halth private service and have a big medicine school university and80 %
prduction the specialists.
Gobierno de Chile / Ministerio de Salud
Gaps Specialties *
*Horas médicas
Gobierno de Chile / Ministerio de Salud Fuentes: Estudio Dpto. de Formación, Capacitación y Estudios, 2011. SIRH Mayo 2011
Medicina Interna
Anestesiología
Cirugía General
Pediatría
Radiología
Psiquiatría
Traumatología
Oftalmología
Obstetricia y Ginecología
Otorrinolaringología
Neurología
Neurocirugía
Dermatología
Medicina Urgencia
Urología
Cirugía Infantil
Fisiatría
Anatomía Patológica
Medicina Familiar
Laboratorio Clínico
Medicina Nuclear
Salud Pública
Radioterapia
Inmunología
20,561 hrs
7,136 hrs
6,072 hrs
6,008 hrs
3,745 hrs
3,349 hrs
Total
62,626 hrs
0
Gobierno de Chile / Ministerio de Salud
5000
10000
15000
20000
25000
15
Background
Universities form
specialists in Chile
by law
The training
hospitals are 90%
public.
Gobierno de Chile / Ministerio de Salud
Residential
programs usually
last three years to
five years for
specialist and
subspecialists.
We have
accreditation and
certification
programs highly
structured
16
Breaches are very uneven distributed by Regions, Health Services and
Specialties.
Causes of breaches are multifactorials.
In spite of previous affirmation we have identified common focuses of
intervention at the local level managment.
The aim is to end the breaches by the year 2015.
“QUALITY AND EQUITY IN
HEALTH”
A NEW HUMAN RESOURCES
POLICY TO FACE THE BREACH
OF PHYSICIAN SPECIALISTS
Gobierno de Chile / Ministerio de Salud
Interventions
• The state decided to buy 90% of specialist training
programs. INVESTMENT
• Seeking partnerships with younger Universiades to create
new programs and open new fields of training, especially in
intermediate areas. INNOVATION.
• Created a national contest to enter these residences, paid
by the state, a salary of approx. U $ 2,500 dollars, and
payment of duty University. MANAGEMENT AND TRAINING.
– To apply you must collect points, and these are obtained
working in primary care, emergency room
– More points are given depending on the area of work
the more critical more points.
– Maximum is achieved between three and four years.
– The financing requires the physician or specalist to
return after six years, double the training time in an
area agreed. Notarized contract.
Gobierno de Chile / Ministerio de Salud
18
Interventions
Example: rehabilitation/ U of Chile / Arica.
Exchanged mixed programs are created with the primary care
of nine years, three of training and six of payment, which
are half the time in primary care and in hospital half
formed, which is achieved by operating the network.
These intervention brings specialized human resources to
primary care, 400 in training today
We are creating training programs strongly with e-learning for
primary care focused on improving family health and
resoluteness.
Gobierno de Chile / Ministerio de Salud
19
OUTCOMES
Gobierno de Chile / Ministerio de Salud
20
Availability Specialist for Health Services
Evolución de Horas Disponibles de Especialistas 2010 2013
Availability of hours variation rate
over 2012:
2010: 32%
2011: 27%
500.000
450.000
400.000
350.000
300.000
250.000
200.000
150.000
Variation rate projected by 2013,
relative to the start of the period:
43.5%
100.000
50.000
-
Horas Disponibles
Especialistas
2010
Especialistas
2011
Especialistas
2012
Proyección
2013
305.000
316.000
401.178
437.698
Evolución de Horas Disponibles de Especialistas 2010 –
2013 x 100.000 Beneficiarios
3500
3000
2500
According to the projected growth of
hours, by 2013 all Health Services slated
to be on the average standard hours:
2,500.
2000
1500
1000
500
0
Gobierno de Chile / Ministerio de Salud
Especialistas 2010 Especialistas 2011 Especialistas 2012
Proyección 2013
Horas x 100,000 Beneficiaria
2400
2448
2468
3301
Horas Promedio Estándar
2500
2500
2500
2500
Availability Specialist for Health Services
HOURS PER 100,000 beneficiaries
6.000
5.000
4.000
3.000
2.000
1.000
Promedio 2010
Promedio 2012
Promedio Estándar
325,000 hours available as of May 2012
According to the increase of hours recorded, only 3 Health Services are under the averages
Average 2010: 2400 hours.
Average 2012: 2468 hours.
Gobierno de Chile / Ministerio de Salud
Standard Rate: 2,500 hours.
Availability of specialists by Health Service contracted hours and
training for 100,000 beneficiaries
Horas Formación por 100 mil habitantes 2012
Horas Por 100 mil habitantes 2012
Promedio 2010
Promedio 2012
Promedio Estándar
6.000
5.000
4.000
3.000
2.000
1.000
401,178 hours available in May 2012.
325,000 hours + 75,528 hours contracted training
3 Health Services are under the average hours
Gobierno de Chile / Ministerio de Salud
SPECIALISTS PROGRAMS
STATE FOUNDS
EVOLUTION
2012
2009
700
S.Programs
150
PAO
Gobierno de Chile / Ministerio de Salud
2500
S. Programs
1800
PAO
24
MEDICAL SPECIALISTS INVESTMENT 2006-2012
In respect to the year 2006, the budget has been increased in 42% at the
year 2011 and in 2,550% at the year 2012.
Training budget growth
Period 2007 - 2012
50,000,000
45,000,000
40,000,000
35,000,000
30,000,000
25,000,000
2012
20,000,000
15,000,000
10,000,000
5,000,000
2.210
physicians
25
Gobierno de Chile / Ministerio deSeries1
Salud
0
2007 (M$)
2007 (M$)
1,321,300
2008 (M$)
2008 (M$)
3,563,342
2009(M$)
2009(M$)
7,917,103
2010(M$)
2011(M$)
2010(M$)
15,898,633
2012(M$)
2011(M$)
30,711,622
2012(M$)
45,493,089
Investment in training Primary
Health Care Physicians
In comparisson with the budget at the year 2008, the budget in 2012 has
been increased in 538%.
Years
2008
2012
Budget
M$ 2.553.742
M$ 16.315.959
26
Gobierno de Chile / Ministerio de Salud
Evolution Training Programme Budget
Direct primary care 3 and 6 years
Period 2008 - 2012
BREACH REDUCTION
96%
The current breach will be reduced in 96%
in 25 medical specialities by the year 2014
* In accordance with the current
physicians and dentists been trained.
Gobierno de Chile / Ministerio de Salud
number
of
THANKS !!!!