Health is considered to be a key factor in the development of any nation around the world. Resilient, effective and integrated healthcare systems (hereinafter referred to as HC) ensure high life expectancy and the work capacity of the population, thus contributing to the sustainable social and economic development of the country. In the present-day realities of Ukraine, the defence and restoration of the country is literally of central importance. However, recovery should not and cannot be solely focused on infrastructure and technological aspects. The fact that human capital is an integral part of economic development must be considered. In addition, health promotion and recovery reduce the burden on the healthcare system, which is extremely important in the context of critically limited human and financial resources.
In this article, we substantiate the necessity of introducing an integrated HC system at the municipal level as one of the key aspects of preserving and restoring municipalities in the current Ukrainian reality. In addition, we reveal the basic principles and guidelines that the international community currently relies on when implementing integrated healthcare, as well as propose specific steps to adopt these practices.
The name "Integrated Medical Care" (hereinafter referred to as IMC) comes from the Latin word "integer", i.e. "whole". The main goal of IMC is to improve the patient experience by establishing connections, a shared vision and approaches in an integrated network of HC facilities to act in a coordinated and cohesive manner. Patients expect to be treated holistically, and therefore integrated services, i.e. human-centred services, focus on people rather than diseases. This system contributes to the fight against fragmentation in the HC system and ensures better coordination between service providers. As a result, it makes medical care more responsive to the patient's needs and provides them with a holistic treatment experience, tailored to their specific requirements at different stages of medical care - from the first aid to the specialised and highly specialised levels.
Each HC facility, regardless of its ownership or funding source, is an integral part of the holistic system, as it is in the holistic HC system that residents of municipalities receive healthcare services. The quality and accessibility (both financial and logistical) of the services provided in this system directly affect the state of health of municipality residents. But human well-being is not only affected by medicine. According to US scientists, the state of health depends on lifestyle (mental health, nutrition, working conditions, living conditions, education, etc.) by 50%, on the environment by 20%, on genetics by 20%, and only by 10% on the HC system.1 At the same time, 15% of all deaths are caused by environmental risks, 22% are nutrition-related, 3% are due to lack of physical activity, and 3% result from childhood malnutrition.2
If we take into consideration the above-mentioned fact that the HC system in its classic sense has only a 10% impact on human health, we can draw a reasonable conclusion: the state of health largely depends on other, additional factors, not just the medical system. It is no coincidence that back in 2006 The Council of the European Union adopted a resolution urging to consider the impact of all legislative initiatives on health in its holistic context. This initiative was aptly named: "Health in All Policies and One Health".3
Based on this approach, in 2020, a number of countries began implementing IMC to improve the health and life quality of their citizens. For example, the United Kingdom, although no longer a member of the EU, has implemented a number of changes in the principles of procurement and interaction of the HC system with other systems since late 2022.4,5 This experience may be of additional interest to Ukrainian municipalities, as the British model of financing and managing the HC system was adopted as the basis for medical system reform in Ukraine.
So what are the objectives of the new UK healthcare policy?
- improving the health of children and young people;
- supporting older people to prolong their physical health and independence;
- a faster response to help those with preventable conditions;
- supporting people with chronic illnesses or mental health problems;
- caring for those with multiple needs associated with an ageing population;
- efficient use of shared resources to ensure the fastest possible access to care services.
Since these goals cannot be achieved solely through the HC sector, local self-governments, patient organisations and the Commission for the Quality of Medical Services were empowered to engage a wider range of stakeholders to achieve them.
How is this relevant to the present-day Ukrainian realities?
One of the most urgent tasks for our country is resource conservation, rational use and restoration. Accordingly, in order to preserve and restore human resources, supporting patients on their way to receive quality and free medical services should become one of the regular practices in municipalities. Who can provide such medical navigation? Based on the example of countries implementing this approach, we understand that this is a task for social service workers or healthcare facilities, rather than doctors or highly qualified nurses. Such "medical coordinators" take care of the patient's pathway both within municipal healthcare facilities and the HC system in general, as well as beyond, linking the patient with the required speciality physicians, treatments, NGOs, and social services. Medical coordinators are the ones who maintain communication between the primary healthcare team and the patient, understanding the patient's path as a holistic process.
Cooperating with partners within the hospital cluster may also significantly contribute to resource conservation, but only if the focus is on preventing chronic conditions from exacerbating and promptly responding to acute health deterioration. Services outside of the HC sector and the analysis of their impact reveal the potential for improving the health of municipality residents through integrated actions. For example, working with pre-school children to improve their mental and physical health. Apart from the medical sphere, such processes are likely to involve social, educational, infrastructure, cultural and sports sectors, and various non-governmental organisations.
The involvement of neighbouring municipalities, NGOs, and international support projects can contribute to the restoration of human capital and facilitate the processes of health recovery and maintenance for every resident of our municipalities. And it is not just a promising investment, but also an important strategic move towards strengthening the country's economic stability and social well-being.
As always, we are the ones to make the first step on this path.
References:
- Hood, C. M., K. P. Gennuso, G. R. Swain, and B. B. Catlin. 2016. County health rankings: Relationships between determinant factors and health outcomes. American Journal of Preventive Medicine 50(2):129-135.
- Prüss-Ustün, Annette & Wolf, Jennyfer & Corvalan, Carlos & Bos, Robert & Neira, María. (2016). Preventing Disease through Healthy Environments, a global assessment of the burden of disease from environmental risks.
- The Health in All Policies (HIAP) approach, codified in the TFEU and the Charter of Fundamental Rights of the European Union (the Charter), responds to the cross-sectoral nature of public health issues and aims at integrating health aspects in all relevant policies (Articles 9 and 168(1) of the TFEU; Article 35 of the Charter).
- UK Public General Act 28.04.2022 c.31 Chapter 31 “Health and Care Act 2022.”
- https://www.gov.uk/government/publications/guidance-on-the-preparation-of-integrated-care-strategies/guidance-on-the-preparation-of-integrated-care-strategies#fn:1
