Exam 1

Question 1

Health needs are:

Answer 1

the subset of health conditions that require a health
system response
Health needs are a “social construct”
Our collective decision on whether an issue
is a health need largely determines the
societal response

Question 2

What are some examples of health
conditions that are not always considered to
be health needs?

Question 3

Health systems

Answer 3

All organizations, people and actions whose primary intent is to promote, restore, or maintain health
ex: Biomedical Science, Health Care System, Public Health System, Global Health Governance

Question 4

Key Health System Actors

Answer 4

Providers
Government
Population
Academic Institutions
Private Companies
International Orgs
Nonprofit Non-Governmental Organizations

Question 5

what is policy?

Answer 5

Authoritative decisions that are intended to direct or influence the actions, behaviors, or
decisions of others.
“Authoritative” and “others” being the main key elements

Question 6

Who makes health policy?

Answer 6

 Government
 Private Companies
 Nonprofit Organizations
 Universities
 International Organizations
 Churches
 ???

Question 7

Who makes public policy related to health?

Answer 7

three branches of government federal and state
and?

Question 8

Public Policy Formulation - Chief Executive Powers

Answer 8

Policy Mechanisms that make or influence health policy
Formal authority
 Sign or veto legislation
 Issue executive orders
 Prepare budgets for approval
 Appoint federal/state officials and judges
Not policy mechanisms:
Informal authority
 Propose a legislative agenda
 Engage in political bargaining
 Influence public opinion

Question 9

Executive Orders

Answer 9

 Official documents through which the President of the United
States manages the operations of the Federal Government
 “Secondary legislation”
 Article II of the U.S. Constitution
 Vests executive powers in the President
 Requires that the President “shall take Care that the Laws
be faithfully executed”
 Historically related to internal operations of federal agencies
but more recently used to carry out policies and programs
 Examples:
 Emancipation Proclamation (Lincoln, 1863)
 Desegregation of Armed Forces (Truman, 1948)
 DACA (Obama, 2012)

Question 10

Under the executive branch is the

Answer 10

Department of Health and Human Services

Question 11

In the US, is health care generally considered a
right (that must be universally provided) or a
privilege/luxury (that only some people deserve)?

Answer 11

Priviledge

Question 12

Is healthcare a right or priviledge What about in the rest of the world?

Answer 12

• Universal Declaration of Human Rights, 1948
“Everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical
care and necessary social services, and the right to security in the event of
unemployment, sickness, disability, widowhood, old age or other lack of livelihood in
circumstances beyond his control.”
• Constitution of the WHO, 1946
“The enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race, religion,
political belief, economic or social condition.”
• Every other developed country has decided that health is a right
• At least 1/3 of countries mention the right to health in their constitution

Question 13

Public Health Core Values

Answer 13

A. Professionalism and Trust
B. Health and Safety
C. Health Justice and Equity
D. Interdependence and Solidarity
E. Human Rights and Civil Liberties
F. Inclusivity and Engagement

Question 14

What do values have to do with health policy and
systems?

Answer 14

“Each nation’s health care system is a reflection of its history, politics,
economy, and national values.” – T.R. Reid
So…underlying societal values determine (through policy) who’s
“deserving” of health benefits and who isn’t
Our health policy preferences are determined by our priority values”

Question 15

Intrinsic vs Instrumental Goals

Answer 15

Intrinsic Goals
1. Valued in and of themselves
2. It’s possible to raise the level of
attainment of the goal while holding the
level of all other intrinsic goals constant
3. Raising the level of attainment of the
goal is desirable
 Goals
 Health
 Responsiveness
 Fair Financing
Instrumental Goals
 “Means to another end”
 Goals
 Quality
 Access
 Efficiency
 Sustainability
 Innovation
 Etc.

Question 16

Background: Intrinsic Goals of a Health System

Answer 16

1. Health
2. Responsiveness: to “legitimate” expectations of the population.
   Respect for persons
   • Dignity
   • Autonomy
   • Confidentiality
   Client orientation/satisfaction
   • Prompt attention
   • Basic amenities
   • Choice of provider
3. Fair Financing: Households should not pay excessive share of income

Question 17

5 Intrinsic Goals of a Health System

Answer 17

Goal: Health
1. Overall level of health
2. Distribution of health in the population
Goal: Responsiveness
3. Overall level of responsiveness
4. Distribution of responsiveness in the population
Goal: Fair Financing
5. Distribution of financial contribution

Question 18

What’s the difference between goal
attainment and performance?

Answer 18

Performance = goal attainment relative
to the resources available

Question 19

Key Assumptions for Competitive, Efficient Markets

Answer 19

Do these assumptions hold for health services?
Buyers:
 Informed-no
 Rational-maybe
 Have time to shop-no
Suppliers:
 Free entry-depends
 Free exit-depends
Product
 Homogenous-no
 Price known in advance-not currently

Question 20

Market Failures in Health Service Delivery

Answer 20

 Almost all health care services are subject to some kind of market failure
 Occurs when markets cannot perform their functions of resource allocation and
efficiently improve human welfare, as expressed by demand and preferences
 Examples
 Monopolistic power of providers due to asymmetry of information and barriers to
entry
 Absence of advance price information due to uncertainty and technical complexity
 Consequences
 Induced demand
 High prices
 Excess profit
 Expansion of expensive technology
 Poor quality

Question 21

Building Blocks vs. Control Knobs Frameworks

Answer 21

Control Knobs Frameworks:
• Mechanisms and processes that affect system
performance
• Purpose was to provide governments with policy
options to deliberately change system outcomes
• Highlights interconnectedness between health
system components
Building Blocks:
• Essential components of a health system
• Purpose was to create shared definition for
what a health system is
• Helps WHO and others identify gaps and
priorities for strengthening health systems

Question 22

Control Knob 1: Financing

Answer 22

1. Mechanisms for raising money
   (revenue collection)
   • Taxes
   • Insurance premiums
   • Direct payment
2. Design of institutions that collect money
   (fund pooling)
   • Government
   • Private insurance companies

Question 23

Risk Pooling

Answer 23

Practice of sharing uncertain risks of financing
health interventions among all members of a “pool”
 Illness and healthcare costs do not fall evenly throughout the population
 e.g., old vs young, disabilities, chronic conditions, environmental hazards
 Pooling risk across the population helps protect individuals from extreme health care costs
 A larger risk pool is more protective than a smaller risk pool
 Often, low-risk people prefer not to join risk pools with high-risk people
 Risk can be pooled through public or private institutions

Question 24

5 Types of Health Financing

Answer 24

1. General Revenue-source: Taxes, User fees
2. Social Insurance-source: Earmarked taxes, Mandatory premiums, User fees
3. Voluntary Private Insurance-sources: Premiums from
   individuals and employers
4. Community Financing-sources: Contributions from
   community members
5. Direct Payment-sources: Patients

Question 25

What type of health financing do we
have in the US?

Question 26

Criteria on which to weigh the different types of health financing
give examples for each

Answer 26

Fiscal Capacity?
Equity?
Economic effects?
Implementable?

Question 27

Control Knob 2: Payment

Answer 27

How the money is paid out
• Who pays
• Who to pay
• What to pay them for
• How much to pay them

Question 28

Value-Based Care

Answer 28

Healthcare delivery model in which providers, including hospitals and physicians, are
paid based on patient health outcomes rather than volume

Question 29

Payment Models

Answer 29

1. Fee for service
    Payment based on # of services
2. Capitation
    Payment based on # of people
   enrolled
3. Salary
    Payment is annual salary
4. Per diem
    Payment is based on # of days
   patient is in hospital
5. Per admission
    Payment is based on # of patients
   admitted to hospital

Question 30

how do payment models create different incentives
that influence how providers behave

Answer 30

Imagine you’re a heart surgeon
working under one of these payment
models…
What are some ways the payment
model may influence how you care
for your patients?
Think of non-healthcare analogy and
representative photo to explain your
answer

Question 31

Universal Health Coverage (UHC)

Answer 31

“To ensure that all people obtain the health services they need without suffering financial
hardship when paying for them” (WHO)

Question 32

Access

Answer 32

The opportunity or ability to obtain needed health services and benefit from financial risk
protection
1. Physical accessibility – Availability within reasonable reach and with hours that
allow people to obtain services
2. Financial affordability – Reflects people’s ability to pay (e.g., includes
transportation costs)
3. Acceptability – Captures people’s willingness to seek services (e.g., cultural
factors, perceived effectiveness)

Question 33

Among the 15.6 million global deaths that could be averted annually…

Answer 33

• 7 million could be prevented
• 8.6 million are amenable to care
• 3.6 million from lack of access
• 5 million are due to poor quality among people using care

Question 34

As countries expand health care to UHC, services must be accompanied by a minimum guarantee of quality

Answer 34

• do no harm
• be respectful and people centered
• provide health benefit

Question 35

Measuring Quality

Answer 35

Effective Coverage = the extent to which people receive the care they
need at a high enough quality to deliver the desired results