The search for low-cost integrated healthcare: The Alzira model – from the region of Valencia
The challenges facing the Spanish healthcare system mirror those currently concerning the English NHS: an ageing population, rising costs, and increasing demand. Such challenges have propelled managers, clinicians and policy-makers to look further afield for innovative models that deliver efficient and effective healthcare.
The Alzira model, from the Valencia region of Spain, is a pioneering approach to the provision of healthcare through public-private partnership and was subject to an NHS Confederation study visit in March 2011, designed by leading UK and European policy experts.
Under this model, the private contractor receives a fixed annual sum per local inhabitant (capitation) from the regional government for the duration of the contract and in return must offer free, universal access to its range of health services. Implemented in 1999, the Alzira model was originally designed for secondary care only, but the model was extended to cover primary care in 2003. Full integration of healthcare provision hinged on aligning clinical and business directorates and the use of technology across all services. A shared patient record between GPs and specialists is a key ingredient of the model, which relies on a rigorous management culture that expects compliance with procedures and guidelines, uses staff incentives and has a strong performance management system.
This paper reviews the model, in particular from the UK perspective. While many aspects of the model do look attractive, participants on the study visit felt there were some obstacles and issues to be taken into account when considering its replicability into the local NHS context. These obstacles are discussed later in the paper.
It was clear that without the inclusion and clinical integration of primary care into the wider system, this model is unlikely to operate successfully. The importance of clinical integration, supported by incentives, information systems, clear goals and effective management, is key. However, would it be worth adapting some of its underpinning principles and applying them to the UK context?
