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

:增加医疗保健支出是许多国家关注的问题,尤其是与此类疾病升级的潜在驱动因素有关,包括老龄化,医疗创新以及疾病负担的变化,例如慢性病的流行。发达国家的大多数医疗保健系统都旨在“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以应对用户不断变化的需求和偏好。为了应对不断变化的疾病负担,已经开发出了新的慢性护理模式,在几个不同的国家已经有相当多的实践经验,显示出它们的优势,以及与实施相关的困难。在本文中,我们将重点关注西班牙在政策变更方面的经验,而试点研究则侧重于测试向慢性护理模式转变的可行性。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长期护理的医疗系统的十个关键前提条件,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,或仅在有限的地理和临床环境中使用。我们概述了正在实施的政策以及西班牙NHS正在采取的途径,以应对向着重于慢性护理的最佳卫生系统过渡的重大挑战。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极大地改变其当前的医疗保健提供模式。

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