The Future Hospital: What Have We Learned

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The Future Hospital What Have We Learned?

• Gur Ofer
• Workshops Summary
• December 2004

2
Thanks

• Our Guests
• The NI team Ziva, Hana, Nurit (and Bianka)
• Kineret and Adi
• The participants

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The Future Role of the Hospital

• Factors contributing to
• Less hospitalizations
• Shorter LOS
• More hospitalizations
• The balance
• Integrated systems and the role of hospitals

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Less Hospitalizations

• Due to
• Better prevention (smoking, obesity)
• Better primary care (see Integrated Systems
  below)
• More ambulatory procedures
• Drugs replacing interventions
• More post-hospitalization home care
• Better homes
• IT tests, telemedicine and self-care

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Less Hospitalizations cont

• Better services to the elderly and the
  chronically ill
• Sub-acute care (in the hospital or outside)
• Smoother transfer to rehab and nursing
• All the above as in the previous slide
• Safer hospitals (fewer errors, infections)

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Shorter LOS

• Faster and better diagnoses and tests
• Minimally invasive surgery
• Faster recovery
• Final recovery at home
• More efficient flow of patient care (see more
  below)
• Special wards for sub-acute and chronically ill

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Longer LOS

• Increased ambulatory procedures leave hospitals
  with the more complex cases.

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More Hospitalizations

• New treatments requiring hospitalization
• Biotech
• Genetic engineering
• New materials
• Increase in the proportion of the elderly in the
  population

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Organizational Changes Inside Hospitals

• Safer hospitals Less errors, infections
• More efficient and simplified care process
• More friendly architecture
• Division by illness rather than procedure
• Division into short (routine) and long
  (complex) LOS cases
• Improved Emergency Ward and procedures (New
  specialty)

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Hospitalization and LOS on balance

• My hunch
• Less of both, but indeed not clear.
• However
• Depends on improvements in public health,
  ambulatory care and integration.
• (see below)

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Integrated Systems and Treatment

• The main goal better and continuous treatment
• Organizational or contract based (virtual)
  integration?
• Advantages of the latter
• Availability of better contracts, including
  provisions for proper risk sharing
• Much better IT integrative systems
• More flexible and allows for multiple arrangements

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Who Should Lead?

• Partnership rather than leadership in virtual
  integration
• The importance of case management
• Primary physician leads most cases throughout.
• Specialists (based in hospitals) lead severe and
  chronic disease.
• But What is the proper location of specialists
  in hospitals or outside? The resulting bias in
  rates of utilization and dominance

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Lessons for Israel

• Planning for the future
• Take into account the above when planning for new
  beds
• Consider structural changes inside the hospital
  Emergency wards, different internal divisions,
  clinical processes, sub-acute wards.
• Must improve safety and reduce errors
• Essential to improve the availability and
  transparency of information throughout to
  operators, regulators, policy makers, the public

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Integration

• Transfer the government hospitals to independent
  (non-profit) trusts
• To where?
• The small size of Israel and the limited markets
  at the periphery seem to call for independent
  hospitals with a system of contracts with the
  sick funds.
• Joining the sick funds is an option, provided the
  rights of the other SFs are protected.
• Allow limited horizontal mergers of hospitals
  into functional networks?

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Integration (2)

• Continuity of care under any organization
• Case management according to severity of case
• Most cases handled by the primary care physician
• Severe cases by the specialist hospital
• Primary care follows through into the hospital
  and beyond (using both IT and personal
  continuity)
• Use of Electronic Medical Record (EMR)
• A consistent system of prices, reimbursement and
  risk sharing of the above

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• THANK YOU!