socialdepartementet primary care and the care for the elderly
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Socialdepartementet
Primary care and the care for the elderly
Ministry of Health and Social Affairs Sweden
Coordination of healthcare and welfare for the elderly
• Improving healthcare and welfare for the most fragile elderly
• 500 million Euros 2011-2014
• Strengthening incentives and conditions for the county councils and the municipalities
• National coordinator
Ministry of Health and Social Affairs Sweden
Regional levelCounty Councils- Providing health and medical care
Local AuthoritiesMunicipalities-Social services, housing and home-based elderly care
National levelParliament and Government- Policy goals- Legislation, Supervision, Financial control measures
18 County Councils2 Regions 290 Municipalities
Ministry of Health and Social Affairs Sweden
Funding of healthcare
• County council taxes
• Supplemented by government grants
• Small user fees
• Long-term care for the elderly is financed and organized by the municipalities.
Ministry of Health and Social Affairs Sweden
Increased life expectancy
Percentage change in number of people per age group 2010–2050. Source: Statistics Sweden 2010
Socialdepartementet
Kostnad per person år 2004 i primärvård, öppenvård och slutenvård
0
5 000
10 000
15 000
20 000
25 000
30 000
35 000
40 000
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100+
Primårvård Specialiserad öppenvård Slutenvård
Health care cost per year of age (SEK), 2004
Primary care
Outpatient visits Inpatient care
Ministry of Health and Social Affairs Sweden
Current situation
• High quality healthcare and social care
• Ageing population
• Living longer with multiple health problems
• Limited knowledge on multimorbidity
• No uniform definition of multimorbidity
Ministry of Health and Social Affairs Sweden
“Those of us that are old and sick are not suited for the healthcare system”
Ministry of Health and Social Affairs Sweden
How do we meet the needs of the elderly?
• Ask them!
• Healthcare systems that suit persons with multimorbidity
• System of free choise
• Open comparisons
Ministry of Health and Social Affairs Sweden
System of free choice
• Opportunity to choose provider of social services and primary care
• Move power from politicians to citizens
• Promote a diversity of providers
• Voluntary tool for municipalities
• Mandatory for Primary care
Ministry of Health and Social Affairs Sweden
Open comparisons
• Open presentation of results each year
• Health care and social care
• Promote discussions on quality and efficiency
• Peer pressure
• Transparency
• Political accountability
Ministry of Health and Social Affairs Sweden
Challenges
• Continuity and coordination
• Funding
• Competence
• Organisation of healthcare
• Improved use of medication
• Research in elderly care
Ministry of Health and Social Affairs Sweden
The role of primary care
• Homebased care
• Coordination of specialised care
• Pallliative care
• Care of persons with dementia
• Multipharmacy
• ??
Ministry of Health and Social Affairs Sweden
Palliative care
• All dying persons, regardless of diagnoses
• Homebased care
• Institutional care
• National guidelines
• Swedish Palliative register
Ministry of Health and Social Affairs Sweden
The Swedish palliative register
• Improve the care of terminally ill
• Support care units
• Continuous update
• Evaluation of pain, nausea and anxiety
• Information to patient and family
Ministry of Health and Social Affairs Sweden
One municipality
Ministry of Health and Social Affairs Sweden
Best municipality
Ministry of Health and Social Affairs Sweden
Care for persons with dementia
• Importance of early diagnose
• Structured treatment and care
• National guidelines
• Swedish Dementia register
• Dementia ABC primary care
• BPSD register
Ministry of Health and Social Affairs Sweden
Good use of medicines
• Unsuitable medicines for the elderly
• Unsuitable combinations of medicines
• Inadequate use of neuroleptics
Ministry of Health and Social Affairs Sweden
Coordinated and Integrated care
• Homebased care
• Prevention
• Avoidable hospital care
• Readmissions in 30 days
Ministry of Health and Social Affairs Sweden
Thanks for your attention!