ENQual questionnaire National Quality Policy in Spain Susana Lorenzo MD, MPH, PhD Quality Manager Fundación Hospital Alcorcón

Spanish Health Care System n 1855 Health Law n 1942 Illness' mandatory coverage n Management through Instituto Nacional de Previsión n general medicine, drug prescription and several ambulatory surgery n 1967 Health Care Services Ordination (S. S.). n Primary, secondary and tertiary levels n Clusters’ planning n 1977 Social Security White Book

Spanish Health Care System n 1978 National Health Service n 1981 Ministry of health and consumer affairs n 1986 Health Law n 2002 National health service desegregated Autonomous Communities n 2002 Patient rights law

1986 Health Law n Universal coverage (100%) n Financing through taxes, salary and special taxes n NHS model n Based on Health care areas for management purposes n Primary health Reform based in Alma-Ata n Health care level Reorganization n Private and public management (concerts are possible) n Patients’ rights n Community participation regulated (Consejos de Salud)

Objectives: 1. Improve managers’ responsibilities and system’s efficiency. 2. Patient satisfaction and choice capacity. 3. Promote costs consciousness. 4. Flexibility and autonomy to manage budgets. 5. Improve people participation and implication. Recommendations: ORGANIZATION: decentralization, Consejo Interterritorial payment derived form objectives. MANAGEMENT: to measure health product, to develop economic analysis, clinicians deployment, improve quality in health care FINANCIATION: from National General Budget besides SS. Abril Report

2002 National health service desegregated Autonomous Communities

EFQM Excellence Model in Spain n Asturias : Hospital Monte Naranco (2) n Aragón todos los hospitales y áreas de salud 2002 (1) n Baleares : Fundación Hospital Manacor (1) n Cantabria : Area Torrelavega n Cataluña : Hospital Creu Roja (1), ICO (1), Sagessa (1), Hospital del Piu 1, AP, otros en curso n Galicia : Hospital Arquitecto Marcide (2); Hospital Juan Canalejo (1) (unidad del corazón) n Madrid : todos los hospitales y areas de atención primaria 2003 n Murcia : en curso en varios hospitales n Osakidetza ( ): 3 autoevaluaciones (hospitales y áreas). 4 reconocimientos n Valencia : Hospital La Fé (1); Instituto de Oftalmología (1)