Table 1
Framework on Integrated People-Centred Health Services: current status in 9 CEE countries.
| POLICY OPTIONS AND INTERVENTIONS | COUNTRY 0 – DOES NOT EXIST; 1 – DEVELOPMENT PLANS; 2 – JUST BEING IMPLEMENTED; 3 – IMPLEMENTED | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| BELARUS | CZECH REPUBLIC | HUNGARY | LITHUANIA | POLAND | ROMANIA | RUSSIA | SLOVAKIA | UKRAINE | |
| Strategy 1: Engaging and empowering people & communities (individuals and families, communities, informal carers, underserved and marginalized) | |||||||||
| Health education | 1 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 2 |
| Shared clinical decision making | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 0 | 2 |
| Self-management | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 2 |
| Community delivered care | 3 | 1 | 2 | 3 | 3 | 3 | 3 | 0 | 2 |
| Community health workers | 1 | 2 | 1 | 1 | 0 | 3 | 1 | 0 | 1 |
| Civil society, user and patient groups | 1 | 3 | 2 | 2 | 2 | 3 | 2 | 2 | 2 |
| Social participation in health | 2 | 2 | 3 | 2 | 2 | 1 | 2 | 0 | 2 |
| Training for informal carers | 1 | 1 | 0 | 2 | 1 | 0 | 1 | 0 | 2 |
| Peer support | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 |
| Care for the carers | 0 | 0 | 1 | 1 | 0 | 0 | 1 | 0 | 1 |
| Equity goals into health sector objectives | 0 | 1 | 1 | 1 | 1 | 2 | 0 | 0 | 2 |
| Outreach programmes and services | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 2 |
| Contracting out | 1 | 2 | 1 | 2 | 2 | 0 | 2 | 0 | 2 |
| Expansion of primary care | 2 | 3 | 2 | 2 | 2 | 1 | 2 | 1 | 2 |
| Strategy 2: Strengthening governance & accountability (bolstering participatory governance, Enhancing mutual accountability) | |||||||||
| Community participation in policy formulation and evaluation | 1 | 2 | 0 | 1 | 1 | 1 | 1 | 0 | 1 |
| National health plans promoting integrated people-centred health services | 1 | 2 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
| Donor harmonization and alignment with national health plans | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 |
| Decentralization | 0 | 1 | 1 | 1 | 1 | 2 | 1 | 0 | 2 |
| Clinical governance | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ? | 1 |
| Health rights and entitlement | 1 | 1 | 2 | 1 | 1 | 0 | 1 | 1 | |
| Provider report cards | 0 | 0 | 1 | 0 | 0 | 0 | 0 | ? | 0 |
| Patient satisfaction surveys | 2 | 3 | 2 | 3 | 3 | 3 | 2 | 3 | 3 |
| Patient reported outcomes | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 0 | 1 |
| Performance evaluation | 0 | 1 | 1 | 2 | 1 | 1 | 1 | 3 | 1 |
| Performance based financing and contracting | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 3 | 1 |
| Population registration with accountable care providers | 1 | 3 | 3 | 3 | 3 | 1 | 2 | 3 | 3 |
| Strategy 3: Reorienting the model of care (Defining service priorities based on life-course needs, respecting social preferences; Revaluing promotion, prevention and public health; Building strong primary care-based systems; Shifting towards more outpatient and ambulatory care; Innovating and incorporating new technologies) | |||||||||
| Local health needs assessment | 0 | 0 | 0 | 2 | 0 | 0 | 1 | 0 | 1 |
| Comprehensive package of services | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 | 1 |
| Strategic purchasing | 1 | 2 | 1 | 2 | 2 | 1 | 2 | ? | 1 |
| Gender and cultural sensitivity | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
| Health technology assessment | 2 | 3 | 2 | 3 | 3 | 0 | 2 | 3 | 1 |
| Population risk stratification | 1 | 2 | 2 | 1 | 1 | 1 | 1 | 3 | 2 |
| Surveillance, research and control of risks and threats to public health | 1 | 2 | 2 | 2 | 2 | 1 | 2 | 3 | 2 |
| Public health regulation and enforcement | 1 | 2 | 3 | 2 | 1 | 1 | 1 | 3 | 2 |
| Primary care with family and community-based approach | 1 | 2 | 2 | 2 | 2 | 0 | 2 | 1 | 2 |
| Multidisciplinary teams | 1 | 2 | 1 | 2 | 1 | 2 | 1 | 1 | 1 |
| Home and nursing care | 2 | 3 | 3 | 3 | 3 | 1 | 3 | 3 | 2 |
| Repurposing secondary and tertiary hospitals for acute complex care only | 1 | 2 | 0 | 1 | 1 | 0 | 1 | 1 | 2 |
| Outpatient surgery and day hospital | 1 | 1 | 3 | 2 | 1 | 1 | 1 | 3 | 1 |
| Shared electronic medical record | 0 | 1 | 2 | 2 | 1 | 3 | 1 | 2 | 1 |
| eHealth | 0 | 1 | 2 | 2 | 1 | 3 | 1 | 2 | 2 |
| Strategy 4: Coordinating services within and across sectors (Coordinating care for individuals; Coordinating health programmes and providers; Coordinating across sectors) | |||||||||
| Care pathways | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 2 |
| Referral and counter-referral systems | 2 | 3 | 3 | 3 | 3 | 3 | 2 | 3 | 2 |
| Case management | 0 | 0 | 0 | 2 | 0 | 2 | 0 | 0 | 1 |
| Care transition | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | |
| Team-based care | 1 | 2 | 1 | 2 | 1 | 1 | 1 | 0 | 1 |
| Regional/district-based health service delivery networks | 1 | 2 | 1 | 2 | 2 | 0 | 2 | 0 | 2 |
| Integration of vertical programmes into national health system | 1 | 1 | 2 | 1 | 1 | 0 | 1 | 1 | 1 |
| Incentives for care coordination | 1 | 1 | 1 | 2 | 1 | 0 | 1 | 0 | 0 |
| Health in all policies | 1 | 1 | 1 | 2 | 1 | 0 | 1 | 1 | 1 |
| Intersectoral partnerships | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
| Merging of health sector and social services | 1 | 1 | 1 | 2 | 1 | 0 | 1 | 1 | 1 |
| Integration of traditional medicine into health services | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 0 |
| Coordinating preparedness and response to health crises | 1 | 1 | 1 | 1 | 1 | 2 | 1 | 0 | 0 |
| Strategy 5: Creating an enabling environment (Strengthening leadership and management for change; Strengthening information systems and knowledge; Striving for quality improvement and safety; Reorienting the health workforce; Aligning regulatory frameworks; Improving funding and reforming payment systems) | |||||||||
| Transformational and distributed leadership | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 0 | 1 |
| Change management strategies | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 0 | 1 |
| Information systems | 1 | 1 | 2 | 2 | 1 | 1 | 1 | 0 | 1 |
| Systems research and knowledge management | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 0 | 1 |
| Quality assurance | 1 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 2 |
| Culture of safety | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 2 | 1 |
| Continuous quality improvement | 1 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 2 |
| Workforce training | 1 | 1 | 1 | 2 | 1 | 3 | 1 | 3 | 3 |
| Multi-disciplinary teams | 1 | 2 | 1 | 2 | 1 | 2 | 1 | 0 | 1 |
| Improvement of working conditions and compensation | 1 | 1 | 1 | 2 | 1 | 2 | 1 | 1 | 1 |
| Provider support groups | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 |
| Alignment of regulatory framework | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Sufficient health system financing | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Mixed payment models based on capitation | 1 | 2 | 1 | 1 | 1 | 1 | 1 | 3 | 2 |
| Bundled payments | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ? | 2 |