Increasing healthcare expenditure is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation that include ageing, medical innovation, and changes in the burden of disease, such as the growing prevalence of chronic diseases. Most healthcare systems in developed countries have been designed to 'cure' acute episodes, rather than to 'manage' chronic conditions, and therefore they are not suitably or efficiently organized to respond to the changing needs and preferences of users. New models of chronic care provision have been developed to respond to the changing burden of disease and there is already considerable practical experience in several different countries showing their advantages but also the difficulties associated with their implementation. In this paper, we focus on the Spanish experience in terms of policy changes and pilot studies focused on testing the feasibility of moving towards chronic care models. In particular, we discuss a framework that identifies and analyses ten key prerequisites to achieving high performing chronic care-based healthcare systems and apply it to the current Spanish National Health System (NHS). We find that the design of the Spanish NHS already meets some of these pre-requisites. However, other features are still in their early stages of development or are being applied only in limited geographical and clinical contexts. We outline the policies that are being implemented and the pathway that the Spanish NHS is taking to address the crucial challenge of the transition towards an optimal health system focused on chronic care. Given the current evidence and trends, we expect that the pathway for developing a chronicity strategy being followed by the Spanish NHS will significantly transform its current healthcare delivery model in the next few years.

译文

在许多国家,医疗保健支出的增加是一个令人关注的问题,特别是在这种升级的潜在驱动因素方面,包括老龄化、医疗创新和疾病负担的变化,例如慢性病的日益流行。发达国家的大多数医疗保健系统旨在 “治愈” 急性发作,而不是 “管理” 慢性病,因此它们没有适当或有效地组织起来以应对用户不断变化的需求和偏好。已经开发了新的长期护理模式,以应对不断变化的疾病负担,几个不同国家已经有相当多的实践经验,显示了它们的优势,但也显示了与实施相关的困难。在本文中,我们着重于西班牙在政策变化方面的经验,并着重于测试转向慢性病模式的可行性的试点研究。特别是,我们讨论了一个框架,该框架确定并分析了实现高性能的基于慢性护理的医疗保健系统的十个关键先决条件,并将其应用于当前的西班牙国家卫生系统 (NHS)。我们发现西班牙NHS的设计已经满足了其中一些先决条件。但是,其他功能仍处于开发的早期阶段,或者仅在有限的地理和临床环境中应用。我们概述了正在实施的政策以及西班牙NHS为应对向以长期护理为重点的最佳卫生系统过渡的关键挑战而采取的途径。鉴于目前的证据和趋势,我们预计西班牙NHS遵循的制定慢性病策略的途径将在未来几年内显着改变其当前的医疗保健模式。

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