101 Revision Flashcards
What three factors define health?
- The absence of illness
- The capacity to function
- Complete wellbeing
What is WHO’s definition of health?
Health is a state of complete physical, mental and social well-being, and not merely the absence of dis-ease.
What is a health system?
Any activity whose primary purpose is to promote, restore and maintain health
What is the issue with health systems?
They do not involve some factors which have the biggest impact on health- like the environment. Therefore the health system plays a role in public health, but is not the sole factor determining the health of a population
What are the factors which impact health but are not included in the health system?
The environment Nutrition Housing Education The social environment Sport and leisure Transport
How do health systems improve population health? (2 expanded points)
- Financial protection against the cost of ill health
- Rich & Poor treated equally- now poverty not a disadvantage and wealth not an advantage - Respond to peoples’ expectations
- Implement new technology
- Have reasonable wait times
- Respect their patients
What is amenable mortality?
Deaths that could have been prevented if people got the right treatment at the right time.
How can we judge whether a health system makes a difference?
Look at amenable mortality rates.
What are the three key standards of health systems?
Quality, Access and Efficiency
What is quality?
It is defined by different people differently.
Doctors judge it by whether they have technology, drugs, whether they diagnose correctly.
Patients judge it by wait times, how comfortable they are, whether they’re cured and the convenience of it.
What is access?
People being able to make use of a service if they need it. It includes transport and geography.
What is efficiency?
The ratio of resource allocation to outcome- getting max output of minimum cost, and assuring the right amount of each service is provided to meet the healthcare goals.
What happens if one of these aspects fails?
The health system is less likely to make a difference to the health of their population.
What is primary care?
It is medical care provided by a healthcare professional, usually located in the community rather than a hospital setting. Other than in emergencies, primary care is the first point of contact between a patient and the healthcare system. (their location can be described as ‘ambulatory’ as people can just walk up)
What is secondary care?
This involves more specialized medical or surgical services, and uncomplicated hospital care, for both inpatients and outpatients. Often they are accessed by referral from a primary health carer and are provided mainly in a hospital setting.
What is tertiary care?
Hospital based, highly complex and expensive services
What is public health?
All organized measures to prevent dis-ease, promote health and prolong life among the population as a whole. It involves providing conditions in which people can be healthy. It focusses on groups rather than individuals.
What does public health involve?
Prevention (such as immunisation/screening), Health promotion and education (sex-ed), environmental health and communicable disease control (water quality, food safety etc).
How are disability and aged care services related?
Both provide support, rehab and accommodation while caring for health and non-health needs.
How are disability and aged care services different?
The MoH funds disability services, but only monitors aged care services.
What are some examples of regulated professions?
GPs Specialists Dentists Nurses Midwives Allied Professionals
What are some examples of non-regulated professions?
Care workers
Patient navigators
Community health workers
Health promoters
How does primary health care contribute to health outcomes?
It prevents avoidable hospitalization, manages health issues before they become too acute, and is patient-focussed.
How does a GP contribute to the organization of a health system?
They keep track of the patients’ movements and receive information from the treatment providers to keep a holistic view.
What is gatekeeping?
Patients can only access secondary/tertiary care through referrals from a primary care specialist. They manage the entry to more specialized services.
When does gatekeeping become an issue?
When different specialists can’t diagnose an issue, so a patient has to travel back and forth between the primary and secondary carers all the time.
Which is broader: Primary care or primary health care?
Primary health care
What is ‘user pays’?
Care is available to those willing and able to pay for it.
What is ‘universal access’?
All citizens have healthcare regardless of whether they can pay
What is the paradox in payment for New Zealand?
The govt. pays almost all hospital costs, but less than half the cost of primary care. As a result, people use hospitals for primary care, or don’t get primary care at all.
What created the system with both govt and user paying in New Zealand?
Specialists are paid by hospitals, but primary care physicians were originally small businesses- therefore, they only get part funding.
From a healthcare perspective, what are organisations?
A social unit of people systematically structured and managed to meet a need or to pursue collective goals on a continuing basis. All organisations have a management structure that determines relationships between functions and position, and delegates roles, responsibility and authority to carry out tasks. They are open systems as they affect and are affected by the environment beyond their boundaries.
How do we make the distinction between public & private organisations?
Ownership and accountability
What are the three key questions to ask when determining public/private fp/private np?
- Who is in charge?
- Where does the money come from?
- What kind of things do they do in the system?
What are the qualities of Publicly funded Health Care?
- Accountable to government, and therefore the electorate and voters
- Run by ministries or a board
- Funded by the government via taxes and levies
- Provides health services, such as hospitals
- Funds health service providers and activities
- Formulates health policy nationally and locally, and oversees its implementation
What are the pros of publicly funded health care?
- Serves the public interest
- Provides services with no easy profit (no market)
- Public controls their actions
- Equal access (universal)
- Won’t go bankrupt
What are the cons of publicly funded healthcare?
- Often inflexible
- Inefficient
- Difficult to measure performance as no profit figures
What are the qualities of private for-profit care?
- Accountable to the company owner(s)
- Have boards of directors
- Income from investment and revenue
- Cannot out-spend revenue
- Some govt. contracts
- Provide insurance, drugs and aged care
- Large groups lobby govt. over policy (influence)
What are the pros of private for-profit care?
- Respond to market demand
- Efficient
- Flexible and innovative
- Profits are a clear measure of success
What are the cons of private for-profit care?
- The interests of the private company may oppose those of the public
- Cost is a barrier to access
- Prone to ‘cream skimming’- only accepting the easiest, low risk patients
What are the qualities of private non-profit care?
- Accountable to board of organisational members
- Funded by membership fees, govt. contracts and donations
- Provide services which other systems don’t/won’t- ie community mental health facilities
- Primary care, hospitals and insurance can be n-p
- They represent professionals and industries (eg. doctors’ interests)
- They can lobby the govt. over policy
What are the pros of private non-profit care?
- Respond to needs without necessitating a large amount of demand
- Responsive to local groups and communities
- Give groups a voice
- Give the govt. ideas
What are the cons of private non-profit care?
- Difficult to control effectively
- Dependent on voluntary commitment
- Difficult to assess performance
- Often struggle to get funding
What does publicly funded healthcare mean for doctors?
Wide variety of cases- chance to increase their skills
Their work is linked to ‘bigger picture’ objectives
What does publicly funded healthcare mean for patients?
Gives them equal treatment, regardless of their ability to pay
What does private for profit healthcare mean for doctors?
Their work is linked to profitability
What does private for profit healthcare mean for patients?
Services of quality and high quantity are available if they can pay
What does private non profit healthcare mean for doctors?
Their work is linked to the goals of their organisation
What does private non profit healthcare mean for patients?
They may be provided specialist treatment as organisations choose whom they serve.
What are DHBs?
They are publicly funded organisations accountable to the government. The MoH receives advice from the DHBs and tells them their regional health goals.
There are 20 DHBs, each in charge of a different region. They provide hospitals, community and public health services, and assessment, treatment and rehab facilities
They have contracts with the government, private and NGO providers.
What are the three main functions which an organisation can perform in the health system, and what is special about the overlaps between them?
Policy, payer or provider. (NB these aren’t mutually exclusive)
Overlaps provide the ‘glue’ holding the health system together- contracts and agreements which allow the health system to work efficiently.
What does the policy function involve?
- Decisions made on behalf of the taxpayer
- Setting priorities and incentives
- Advising stakeholders (including the MoH)
- Eg. ACC and PHARMAC
What is involved in the payer function?
- Looks after those who pay (inc. taxpayers)
- Determines what will be paid for
- Looks after interests of taxpayers and contributors
- Eg. DHBs, PHOs, PHARMAC, ACC
What does the provider function involve?
- Gives out services
- Eg. Student health, hospitals
What organisation carries out all 3 healthcare functions?
DHBs
What are PHOs?
They are NGOs which liaise with GPs and DHBs. The DHB contracts a PHO to provide primary care. The PHO’s group of GPs actually provides the care. They monitor and channel funding from DHBs to the GPs. They can have some policymaking function.
What are the three ways in which we can experience the health system?
As a taxpayer, citizen or patient
What do taxpayers want?
- Best value for money
- Pay as little as possible
- Increases in costs and copayments minimized
What do citizens want?
- Health services provided in accordance with rights
- Access guaranteed
- Make sure that those who aren’t supposed to access these rights (eg. health tourists) don’t get access
What do patients want?
- High quality treatment
- Short wait times
- Safe treatment
What are some organisations which act in the interests of taxpayers?
PHARMAC ACC MoH Treasury Souther Cross
What are some organisations which act in the interests of citizens?
MoH
DHBs
Commissioners (childrens, health and disability)
Researched medicines industry
What are some key issues for users?
- How to get access to health services
- How to get specialist attention or into hospital
- Availability of services
- Cost
- Results and outcomes
How did NZ come to have a dual system?
Originally GPs were run by private owners and individuals. The govt. wanted to introduce free health to all, so tried to buy all care facilities- but got strong opposition from the GPs. Now, most are paid for by the govt, but there is capitation in GPs- govt. pays for some, the GPs charge extra directly.
