1. PUBLIC SERVICES IN DEMOGRAPHICALLY CHALLENGED AREAS: HEALTH CARE SYSTEM IN CASTILLA Y LEÓN (SPAIN)

2. SPAIN: 505,990 Km 2 CYL: 94,225 Km 2 (18.6%) SPAIN: 46,7 M CYL: 2,5 M (5.3%) SPAIN: 92.4 inhabs./Km 2 CYL: 26.5 inhabs./Km 2 (2014) DEPOPULATION CYL = CASTILLA Y LEÓN

3. < 100 inhabs.100 to 1,000 inhabs.1,000 to 10,000 inhabs.> 10,000 inhabs. 6381,35323423 [+2,233 minor villages] 37,844424,707641,6981,390,541 2,494,790 INHABITANTS DISPERSION MUNICIPALITIES * *

4. LIFE EXPECTANCY AGEING INDEXES GROWTH BY AGE GROUPS POPULATION PYRAMID AGEING 80,6 82,0 83,6

5. HEALTH CARE SYSTEM 3,267 M€ (32.9%) % REGIONAL GOVERNMENT BUDGET PRIMARY HEALTH CARE CYLSPAIN % Primary Care/Health Budget17.813.8 Inhabitants / Family Doctor9261,356 Inhabitants / Nurse1,1491,557

6. CHALLENGES ACCESSIBILITY -PEOPLE TO SERVICES: -SERVICES TO PEOPLE: TELEMEDICINE ADEQUACY -NEW APPROACH: DEPOPULATION & DISPERSION AGEING ON DEMAND TRANSPORT CHRONIC PATIENTS PLAN

7. PEOPLE SERVICES ON DEMAND TRANSPORT PURPOSE OF TRAVEL Leisure Buying Health Administrative Others Winter Summer 810 routes 3,493 population spots 380,000 inhabitants User Platform Vehicle Information board

8. SERVICES PEOPLE TELEMEDICINE ANTICOAGULANT THERAPY CONTROL CARDIOLOGY PSYCHIATRY OPHTHALMOLOGY

9. A NEW APROACH: CHRONIC PATIENTS PLAN CHRONIC PATIENTS PLAN “Improve health outcomes and quality of life of people with chronic diseases, through a comprehensive quality care, adjusted to the level of care needs and in coordination with social services, in a context of sustainability” Resources consumption80% Health system activity70% Primary care visits60% Hospital admissions60% Complex Chronic Patients Stabilized Chronic Patients Initial Chronic Patients Healthy / No chronic diseases

10. A NEW APROACH: CHRONIC PATIENTS PLAN CHRONIC PATIENTS PLAN 2. Enhance patient autonomy and responsibility 3. Innovation and knowledge management 1. Ensure continuity of health and social care

11. THANK YOU PUBLIC SERVICES IN DEMOGRAPHICALLY CHALLENGED AREAS HEALTH CARE SYSTEM IN CASTILLA Y LEÓN (SPAIN)