The increase in the care demanded by people in a situation of dependency has given rise, in recent decades, to the need to organize and coordinate health and social resources in order to provide comprehensive and effective care to the dependent population.
The idea that underlies the concept of socio-health coordination is, therefore, to enable accessibility to the different services and guarantee or facilitate the continuity of care between both types of services, it must be the link between the health and social systems to determine the needs. in these user areas and integrate the most appropriate resources that address these needs, contemplating the planning and implementation of common intervention protocols.
The increase in demand for professional social and health care to address the care needs of people in a situation of dependency has generated, for years, the need to reformulate the financing, management and distribution systems of resources destined for this collective.
In this context, the different formulas for addressing socio-health responses occupy a priority place and highlight the importance of the applications of concepts such as coordination, integration, collaboration and perhaps the most precise, complementarity, which appear at multiple levels of intervention: between professionals, social and health institutions, social, public and private initiative, different categories of resources, etc.
The concept of socio-health coordination aims to facilitate accessibility to the different services and guarantee or facilitate the continuity of care between services.
Improving the coordination of health services, as an intermediate step for continuity of care, has become one of the priorities to respond to emerging challenges in the health sector.
Does such socio-health coordination exist in Spain?
The beginnings of the debate and initiatives to respond to situations of lack of coordination between the different service provision systems date back to the Analysis and Evaluation Commission of the SNS (Commission “Abril”) in 1991, which already made proposals to correct the structural deficiencies and lack of coordination between health services and social services.
A few years later, in December 1993, an Interministerial Framework Agreement was signed (Ministry of Social Affairs and Ministry of Health) which promoted and developed, within the scope of their respective powers, coordinated action programs for the care of older people and people with disabilities, among other groups.
In this period, a line of collaboration was opened between both ministries, through the creation of a group of experts and the implementation of socio-health coordination experiences in various health areas of three autonomous communities (Madrid, Valladolid and Murcia).
Both initiatives gave rise to the preparation of two documents that have been a reference in the construction of the socio-health discourse: “Bases for the Organization of Services for Health Care for the Elderly” (1993) and “Criteria for the organization of health services for care of the elderly” (1995). From the beginning, the aim was to offer a community-based model that guaranteed continuity between the different levels of care, in accordance with the principles of comprehensiveness, interdisciplinarity and rehabilitation.
Another advance in this area of action occurred through the Agreement of the Congress of Deputies for the consolidation and modernization of the National Health System of 1997. Out of a total of thirteen recommendations, the third urges the Government to “Implement alternatives to social and health care.
In view of the great diversity of experiences and projects that the Autonomous Communities were promoting in this area, the Undersecretary of Health and Consumer Affairs, in close collaboration with the General Secretariat of Social Affairs through IMSERSO, decided in 1998 to give a impulse to the task of advancing in the configuration of a model of social and health care that had common bases, without prejudice to the powers that the Autonomous Communities have been granted in this matter. To this end, a group of experts was established with the task of preparing a report on the subject, and advancing compliance with the parliamentary agreement.
This group tackled a study on:
- Socio-health users.
- Socio-health benefits.
- Information systems and user classification.
- Socio-health coordination.
- Financing of social and health care.
Regulatory development of the General State Administration
In the field of regulatory development of the General Administration of the State, it is essential to highlight the importance of Law 63/2003, on Cohesion and Quality of the National Health System, in whose article 14 the socio-health benefit is defined as:
“The care that includes the set of care intended for those patients, generally chronic, who, due to their special characteristics, can benefit from the simultaneous and synergistic action of health and social services to increase their autonomy, alleviate their limitations or suffering and facilitate their reintegration. social".
This Law establishes the actions that must be taken from the health field:
- Long-term health care.
- Convalescent healthcare.
- Rehabilitation in patients with recoverable functional deficit.
With the promulgation of Law 39/2006, greater progress was sought in the interconnection of health and social resources to offer social health care. The content of this regulation does not regulate any relevant advance in this regard by leaving – in a diffuse manner – said responsibility in the hands of the Autonomous Communities. The mentions on this topic are included in the Law as follows:
- In article 3, by pointing out as its inspiring principle the collaboration of social and health services in the provision of services to SAAD users that are established in the standard itself and in the regulations of the Autonomous Communities and Local Entities.
- In article 11.1.c), which indicates as the competence of the Autonomous Communities the establishment of “socio-health coordination procedures, creating, where appropriate, the coordination bodies that are appropriate to guarantee effective care.”
- Article 21, on the prevention of dependency situations through services to promote personal autonomy and care, indicates the need to “prevent the appearance or worsening of diseases or disabilities and their consequences.” , through the coordinated development, between social and health services, of actions to promote healthy living conditions (…)”.
For their part, the different autonomous communities have carried out, to a greater or lesser extent, different initiatives aimed at improving socio-health coordination.
It should be noted that in a joint meeting of the counselors that make up the Territorial Council of the Dependency Care System (SAAD) and the Interterritorial Health Council, on February 24, 2010, it was agreed to prepare a White Paper on social and health coordination that describes your current situation and proposes lines of action for its improvement. With this decision, a fundamental step is taken to promote the coordination of health and social protection systems that, within the framework of European convergence, activate mechanisms of effectiveness and efficiency in the care and attention required by citizens.
Coordination must be carried out at several levels:
a) Between health services and social services.
b) Between the various services of the same system.
c) Between professional, social and health services, and the informal support system.
d) Between the different Public Administrations: General of the State, Autonomous and Local.
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