Exam 1 Flashcards
Health needs are:
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
What are some examples of health
conditions that are not always considered to
be health needs?
Health systems
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
Key Health System Actors
Providers
Government
Population
Academic Institutions
Private Companies
International Orgs
Nonprofit Non-Governmental Organizations
what is policy?
Authoritative decisions that are intended to direct or influence the actions, behaviors, or
decisions of others.
“Authoritative” and “others” being the main key elements
Who makes health policy?
Government
Private Companies
Nonprofit Organizations
Universities
International Organizations
Churches
???
Who makes public policy related to health?
three branches of government federal and state
and?
Public Policy Formulation - Chief Executive Powers
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
Executive Orders
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)
Under the executive branch is the
Department of Health and Human Services
In the US, is health care generally considered a
right (that must be universally provided) or a
privilege/luxury (that only some people deserve)?
Priviledge
Is healthcare a right or priviledge What about in the rest of the world?
• 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
Public Health Core Values
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
What do values have to do with health policy and
systems?
“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”
Intrinsic vs Instrumental Goals
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.
Background: Intrinsic Goals of a Health System
- Health
- Responsiveness: to “legitimate” expectations of the population.
Respect for persons
• Dignity
• Autonomy
• Confidentiality
Client orientation/satisfaction
• Prompt attention
• Basic amenities
• Choice of provider - Fair Financing: Households should not pay excessive share of income
5 Intrinsic Goals of a Health System
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
What’s the difference between goal
attainment and performance?
Performance = goal attainment relative
to the resources available
Key Assumptions for Competitive, Efficient Markets
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
Market Failures in Health Service Delivery
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
Building Blocks vs. Control Knobs Frameworks
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
Control Knob 1: Financing
- Mechanisms for raising money
(revenue collection)
• Taxes
• Insurance premiums
• Direct payment - Design of institutions that collect money
(fund pooling)
• Government
• Private insurance companies
Risk Pooling
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
5 Types of Health Financing
- General Revenue-source: Taxes, User fees
- Social Insurance-source: Earmarked taxes, Mandatory premiums, User fees
- Voluntary Private Insurance-sources: Premiums from
individuals and employers - Community Financing-sources: Contributions from
community members - Direct Payment-sources: Patients
What type of health financing do we
have in the US?
Criteria on which to weigh the different types of health financing
give examples for each
Fiscal Capacity?
Equity?
Economic effects?
Implementable?
Control Knob 2: Payment
How the money is paid out
• Who pays
• Who to pay
• What to pay them for
• How much to pay them
Value-Based Care
Healthcare delivery model in which providers, including hospitals and physicians, are
paid based on patient health outcomes rather than volume
Payment Models
- Fee for service
Payment based on # of services - Capitation
Payment based on # of people
enrolled - Salary
Payment is annual salary - Per diem
Payment is based on # of days
patient is in hospital - Per admission
Payment is based on # of patients
admitted to hospital
how do payment models create different incentives
that influence how providers behave
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
Universal Health Coverage (UHC)
“To ensure that all people obtain the health services they need without suffering financial
hardship when paying for them” (WHO)
Access
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)
Among the 15.6 million global deaths that could be averted annually…
• 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
As countries expand health care to UHC, services must be accompanied by a minimum guarantee of quality
- do no harm
- be respectful and people centered
- provide health benefit
Measuring Quality
Effective Coverage = the extent to which people receive the care they
need at a high enough quality to deliver the desired results
