1. EU SECTION???
The best of health
Maria Jesus Montero, Minister of Health for the Government of Andalucía, champions the
actions and initiatives of the region’s dynamic public healthcare system…
A
ndalucía, the southernmost region in Spain, is the acknowledgement of high performance. This strategy
well-known across Europe due to its colourful enables teamwork based on multidisciplinary and multi-
landscapes and cultural heritage, as well as the professional approaches, providing more autonomy and
beauty of its beaches and golf courses. That is why we responsibility to achieve objectives.
‘ …new rights include a second
welcome more than 21 million tourists every year. However,
the region is also home to 8.4 million inhabitants, who are
supported by an exceptionally dynamic, proactive and medical opinion for severe
modern public healthcare system.
diseases, pre-implantatory
Excellent healthcare as a citizen’s right genetic diagnostic (PGD) tests
The regional healthcare service of Andalucía fulfils all the
basic features of the Spanish National Health System: for couples with severe inherited
universal coverage that is tax-funded and consequently diseases, and some specific
without direct charges for patients, except for a small rights for hospitalised children
’
copayment for drugs on ambulatory care, which account
for, on average, less than 4%. In addition, the regional and end-of-life patients…
government – which has been in charge of healthcare since Each healthcare worker can certify the quality of their
1984 – has deployed a wide set of new rights on quality activity through a programme from the Agency for
aspects of care. Based on the principle that citizens must be Healthcare Quality Certification. All the programmes are
at the centre of the system, the role of the public healthcare based on professional performance. A certification of
network has evolved from being merely a provider of excellence is earned through demonstrated improvements
services, to a guarantor of the quality of healthcare. in the usual clinical practice, and this certificate is a
In this way, in 2002 Andalucía was the first region in Europe prerequisite to career progression and increased salary. So
to set a maximum waiting time for elective surgery: far, more than 13,000 professionals in Andalucía, mainly
120 days for more than 700 procedures, such as cataract doctors and nurses, are enrolled in this programme.
surgery. When a surgeon indicates an intervention, the Accessible, efficient and extended care
patient is registered in a database and receives a report to Accessibility in primary care is a main feature of our system,
check their waiting time with, or alteratively they can also and an enormous effort to improve it has been made in
find out this information via the telephone or through a the past 25 years. Currently, there are 1,136 primary care
special webpage. If the time of planned surgery exceeds the centres and 360 auxiliary offices, whereas there were only 33
limit, the patient has the right to undergo the procedure in in 1986. More than 6,000 family physicians act as gatekeepers,
a private clinic and charge the costs to the public service. and each one has 1,400 people assigned to them on
Currently, the average time for elective surgery is 43 days. In average. The physicians work in multiprofessional teams,
the same way, there is a limited waiting time for diagnostic together with community nurses, paediatricians, dentists,
tests (30 days) or specialised consultation (60 days). physiotherapists, midwives, epidemiologists, veterinarians,
Furthermore, new rights include a second medical and auxiliary and administrative personal. An extended
opinion for severe diseases, pre-implantatory genetic network of services is provided at this level, including
diagnostic (PGD) tests for couples with severe inherited dental care, rehabilitation, home care, minor surgery and
diseases, and some specific rights for hospitalised children many others.
and end-of-life patients – such as an individual room,
E-health
amongst others.
One of the most striking achievements in Andalucía is the
Professionals’ commitment to the system massive use of ICT for healthcare. A single electronic
Achieving excellence is a main objective, and professional health record for each citizen is available, anywhere and at
development is promoted through personal continuous anytime. A centralised physician appointment system,
training, providing incentives and motivation through meanwhile, is available by internet, phone or SMS. Using
1 Public Service Review: European Union: issue 22

2. SECTION???
their individual health smart card, patients can receive Furthermore, there is a specific professional – the liaison
their medication directly at any pharmacy in the region nurse – who is in charge of home-based highly complex
during the ordered treatment period. Moreover, pharmacists patients. This nurse visits the patient at home, plans their
are able to network with physicians for drugs interactions, care needs and assures them when objectives are achieved
contraindications, compliance or warnings. For example, in coordination with the corresponding primary care
doctors can share all clinical information, as well as the centre team.
lab tests and diagnostic images, between hospitals and
primary care. Healthy ageing
16% of the Andalucían population are older than 65 years
Last year, we had 105 million e-prescriptions and 95 million of age, and this percentage is growing due to the increase
appointments. Consequently, when a patient wants to in life expectancy. Moreover, Northern Europeans are
obtain an appointment, they can simply visit the Health choosing Andalucía as a place for their retirement. We are
Department webpag, where following an identification therefore promoting many initiatives to improve elderly
procedure, they can select the most convenient option in people’s health and wellbeing. Under the motto of ‘healthy
their physician’s agenda. One million appointments are ageing’, many programmes support physical activity, self-
made using this easy and free procedure every month. management and active lives. Furthermore, a number of
‘ One of the most striking initiatives support disabled or dependent people, such as
the family carer supporting programme.
achievements in Andalucía is
Health in all policies
the massive use of ICT for Currently, one of the most relevant governmental strategies
healthcare. A single electronic is addressed to broaden the field of health promotion,
health record for each citizen prevention and protection following the ‘Health In All
is available, anywhere and Policies’ approach. We work together with other regional
’
government departments and agencies to promote a healthy
at anytime. view of other policies and initiatives, such as transport,
Home care and citizen services housing, education, economic activities, and others. Currently,
A complementary strategy has been oriented to provide we are passing a law on this issue at the Regional Parliament,
more information directly to citizens and several tools to which I think will constitute a milestone.
improve self-care. A call centre, ‘Salud Responde’ (Health Results, costs and challenges
Responds), provides phone appointments; information on
Andalucían results in terms of life expectancy or avoidable
services and centres; personal counselling on specific
mortality for amenable care are good given our per capita
health conditions; activation of second medical opinion
income. The regional public health expenditure is relatively
procedure; and information on living wills and many
low (€9,390m; 6.67% of the Region GDP) in comparison to
other topics, such as waiting times; a tobacco cessation
the OECD average, with a very broad network of services
programme line; AIDS information; and a translation
and the cutting-edge technologies available: transplantation,
service for foreigners. Within this latter specification, if an
human assisted reproduction, robotic surgery, genetic
individual needs clinical care and does not speak Spanish,
we use the phone-translation service. Using a regular counselling, etc. Moreover, patients’ satisfaction is very
phone (landline or mobile phone) and ordinary earphones high (90%) at both hospital level and primary care level.
(one for the doctor and the other one for the patient), a As Minister of Health, it is my opinion that we have to face
call to ‘Salud Responde’ activates a procedure that enables a number of challenges in the coming future. First of all,
a direct translation for patient and doctor, under safe and management of chronic patients should be improved,
confidential conditions. The service is available at any reinforcing their autonomy with organisational measures
point of care, 24/7 for 11 languages and from 08:00 to 18:00 and telemedicine services and devices. Secondly, we need
for a further 40 languages, including all the European to facilitate professional excellence, supporting high-
ones. The most used so far have been English, Arabic, quality training and promoting a friendly and professional
German, Chinese, French, Romanian and Russian. environment. Thirdly, sustainability is an unavoidable
There is also ‘www.informarseessalud.org’ (‘to be informed task for all health systems. Finally, we need to increase our
is healthy’), which contains many videos, documents and research to foster new treatments for diseases, as well as
applications containing information on diseases, healthy increase our social and economic development.
habits, recommended physical activities, and diets,
amongst others. This is coordinated with a ‘Patient’s Maria Jesus Montero
School’ for people with chronic conditions. This initiative Regional Minister of Health of Andalucía
is intended to improve self-management for some Government of Andalucía
common chronic diseases (for instance, diabetes and Tel: +34 955 006300
cardiac insufficiency) and provides skills and evidence- www.juntadeandalucia.es/salud
based knowledge.
Public Service Review: European Union: issue 22 2