The Future of Public Health
Content
The future of public health:
Integrating prevention and
curative health services
Prof. Peter P. Groenewegen PhD
NIVEL – Netherlands Institute for Health Services
Research
Why integrate prevention and
curative health services?
• Decreasing returns to investments in health
• Changing patterns of disease
- increased prevalence of chronic disease
- genetics, life style and environment
• Changing insights in effective prevention
strategies
- targetting
- risk communication
- trust
- multiple strategies
Changing disease patterns (left)
Need for targetting and integration (right)
100
80
60
40
20
0
55-64 65-74 75-84 85-94
% with multimorbidity
Prevention and curative health
service provision
Prevention:
Universal
• Whole population
Selective
• Population at risk
Indicated
• Early symptoms
Curative health service:
‘Repair medicine’
• Diagnosis
• Treatment
‘Maintenance care’
• After care,
rehabilitation
• Chronic disease
management
Who’s currently responsible?
Universal
Municipal/
regional public
health
organisations
Selective
Symptom based
?
Curative health
services
Variation in
organization and
responsibility
What is needed to fill the gap
between prevention and
curative services?
•
•
•
•
•
Population-based approach
Adequate information systems
Incentives for providers
Organisation and task delegation
Attitudes, professional norms, regulation
Who’s able to fill the gap?
• Integration of public health and curative
health services is probably best possible in
modern primary care
• But ….traditional primary care (read GP)
attitude: my patients are healthy unless
proved differently
• Needed: shift from reactive to pro-active
and out-reaching
Conditions: population-based
approach
• Responsibility for the health of a welldefined population
• List system for primary care
• Close cooperation of primary care
disciplines
Conditions:
Information systems for integrated
preventive and curative services
• Integrated or shared electronic medical
record
• Identification of high risk patients
• Decision Support Systems
• E.g. cardiovascular risk management
Conditions:
Incentives and payment systems
• Inviting and reminders for screening work
best when done from GP paractice
• Extra work in prevention needs to be
remunerated
• Prevention as part of the insurance basket
• Targets
Organisation of primary care:
Transformation from cottage
industry to modern community
health service
www.nivel,nl
www.euprimarycare.org
www.healthservicesresearch.eu
Integrating prevention and
curative health services
Prof. Peter P. Groenewegen PhD
NIVEL – Netherlands Institute for Health Services
Research
Why integrate prevention and
curative health services?
• Decreasing returns to investments in health
• Changing patterns of disease
- increased prevalence of chronic disease
- genetics, life style and environment
• Changing insights in effective prevention
strategies
- targetting
- risk communication
- trust
- multiple strategies
Changing disease patterns (left)
Need for targetting and integration (right)
100
80
60
40
20
0
55-64 65-74 75-84 85-94
% with multimorbidity
Prevention and curative health
service provision
Prevention:
Universal
• Whole population
Selective
• Population at risk
Indicated
• Early symptoms
Curative health service:
‘Repair medicine’
• Diagnosis
• Treatment
‘Maintenance care’
• After care,
rehabilitation
• Chronic disease
management
Who’s currently responsible?
Universal
Municipal/
regional public
health
organisations
Selective
Symptom based
?
Curative health
services
Variation in
organization and
responsibility
What is needed to fill the gap
between prevention and
curative services?
•
•
•
•
•
Population-based approach
Adequate information systems
Incentives for providers
Organisation and task delegation
Attitudes, professional norms, regulation
Who’s able to fill the gap?
• Integration of public health and curative
health services is probably best possible in
modern primary care
• But ….traditional primary care (read GP)
attitude: my patients are healthy unless
proved differently
• Needed: shift from reactive to pro-active
and out-reaching
Conditions: population-based
approach
• Responsibility for the health of a welldefined population
• List system for primary care
• Close cooperation of primary care
disciplines
Conditions:
Information systems for integrated
preventive and curative services
• Integrated or shared electronic medical
record
• Identification of high risk patients
• Decision Support Systems
• E.g. cardiovascular risk management
Conditions:
Incentives and payment systems
• Inviting and reminders for screening work
best when done from GP paractice
• Extra work in prevention needs to be
remunerated
• Prevention as part of the insurance basket
• Targets
Organisation of primary care:
Transformation from cottage
industry to modern community
health service
www.nivel,nl
www.euprimarycare.org
www.healthservicesresearch.eu
