Chapter 11 State healthcare provision Flashcards
Explain likely role of the State in the provision of alternative or complementary health and care protection.
1
Q
Overall objectives of government’s provision of healthcare might be considered under four headings.
A
- protecting the nation’s health
- subsidising the poor
- balancing the budget
- following social culture and/or political promises
2
Q
Protecting the nation’s health
A
- the extent of protecting the nation’s health depends on the nation’s wealth.
- starts through availability of food, water , hygiene, etx.
- provision of medical services and education.
- keeping a productive workforce thats healthy grows GDP and this gives government money to sustain the healthcare provision.
- politics will have an influence on the gov providing healthcare.
- education about general healthy lifestyle should be part of State’s approach.
3
Q
Subsidising the poor
A
- Even where healthcare is heavily commercialised the State will have a role in providing healthcare(primary medical assistance & hospitals) to the poorest.
- provision of healthcare in this manner is seen as state’s wellfare package (redistribute wealth)
4
Q
Balancing the budget
A
- provision of healthcare is part of the state’s budget.
- whether services are provided to everyone or just those that cannot afford private care.
- cost of provision can be funded by health charges or general taxation or both.
- gov should be aware that using more advance medical treatment & tech will increase cost of healthcare by more than CPI. This may be exacerbated by increasing longevity and morbidity.
5
Q
Following social culture and/or political promises
A
- state’s healthcare approach may be determined by a political party’s ethics. This may change with changin parties.
- state healthcare may be part of national culture and so radical changes may be hard to introduce especially in the short-term.
6
Q
Role of commercial insurance in the provision of health will depend on nature of state provision: Possible models of co-existence include:
A
- Insurance can be optional.State provide comprehensive but insurance higher quality of service.
- Insurance can be optional complement. Here State provides limited range of medical services.
- Insurance a compulsory alternative. State provides everything for members up to a certain salary.
- Insurance can be a compulsory complement. State provides certain procedures and the rest insurance is mandatory for.
7
Q
Challenges allocating limited resources
A
- Demographic challenge - increasing/aging population has increased costs of healthcare.
- technological - increased demand for healthcare increased due to technological medical advances.
- sysyphus - life expectancy gains in older age groups and tech innovation leads to constant budget pressure.
- burden of disease - general health of the population may increase the cost of healthcare.
- access to skilled medical professionals and insfrastructure. - cost and duration of medical training is extensive. professionals may leave for other countries after training.
- competition or regulation in healthcare - market failure in healthcare market leads to the need for regulation.
8
Q
Resource allocation: Cost analysis
A
- simplest method of economic evaluation of a healthcare system.
- assess if a particular healthcare system is sustainable overtime & estimate required budget.
- can provide breakdown of future & current costs
- doesn’t consider the quality and effectiveness of the healthcare system.
9
Q
Cost-effective analysis (CEA)
A
- assess the costs of a healthcare system relative to the non-monetary benefits of the healthcare system.
- CEA = cost of healthcare system in monetary units / measure of effectiveness (measure in a scale)
10
Q
Benefits of CEA
A
-benefits relative to the costs can be easy to
understand.
-benefits do not have to be converted to monetary terms
11
Q
Weaknesses of CEA
A
- need for all healthcare systems assessed to have same measure of effectiveness.
- inability to account for multi-dimensional effects
- possibility that CEA will under-estimate the value of various healthcare interventions.
- does not reflect utility of healthcare servivces to population covered.
12
Q
Cost-utility analysis (CUA)
A
- assesses the costs of healthcare relative to the changes in quality of life as well as in mortality.
- emphasis on healthy years of life saved rather than number of lives saved.
CUA = Costs in monetary terms/ (Benefits in QALYs)
QALYs - quality adjusted life years.
13
Q
Cost-benefit analysis (CBA)
A
- CBA puts a monetary value on the cost of the healthcare system.
- 1 advantage is that a healthcare system can be analysed on its own merit wihtout comparing it to other systems.
CBA = costs in monetary terms / benefits in monetary terms
CBA < 1 for a project to be recommended.
-it is challenging to put amonetary value to changes in a person’s life.
14
Q
Willingness to pay (WTP)
A
-can be used to measure the value that an individual places on a health system.
- There are two ways to determine WTP
1. direct method - done through questionnaires
2. indirect method - by observing an individual’s behaviour and identifying how much he/she is willing to pay for medical treatment.
15
Q
Methods of State healthcare support
A
- Provided to all or means-tested
- provided directly by its own medical establishments or by commercial establishments
- lump sum or regular income (if regular payments are required eg LTC)
- flat-rated or earnings-related
- linked to some form of CPI
- different for different stages of disability
- different for different lifestages/circumstances
