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