Health policy questions Flashcards
Main public health problems in the Central and Eastern Europe coutry
high mortality rate
high rate of noncommunicable disease morbidity
unfavourable health behaviors
insufficient public health training
low level of interaction between public health professionals and health policy maker
Communication between public health professionals and health policy maker
decision making based on solid epidemiology data like planning and organizing health care service
evidence based public health action/intervention
positively discriminative resource allocation
continous health monitoring system
Health care financing in Hungary
Dual financing
informal payment
DRG system (inpatient care)
Per capitat (General practician)
Meaning of quality in healthcare service
Quality is when the product and services characteristics that meet costumer expectations Doing the right thing For the right person At the right time And do them right at the first time
Quality focus on
Process of care
Aprropriateness of care
Clinical effectiveness
Medical errors
Inappropriate or incomplete diagnosis and treatment Injury Behaviour Syndrome Infection and other ailment
Cause of medical errors
Underuse, overuse of variation in services
Communication problems
Lack of using evidence (EBM)
Dissatified patients
Evidence based medicine
is the process of systemically finding, appraising and using contemporaneous research finding as basic for clinical decisions
Fundamental principle of EBM
- EBM posits a hierarchy of evidences to guide clinical decision making
- Evidence alone is never sufficient to make a clinical decision
Steps of EBM
1, Patient
- Question
- Resource
- Evaluation
- Patient
- Self-evaluation
Possible sources of evidence
Result of primer research, clinical epidemiology study
Systemically review of literature
Result of HTA (health technology assessment)
Guideline recommendations
Potential benefits of clinical practice guidelines
Improve the quality of clinical decisions
Support the quality improvement activites
Medical researcher benefits from the spotlight that evidence based guideline shine on gaps in the evidence
Widen the boundary between benefits and harms
Classification of evidence
Grade A: Very strong evidence
(from randomized control trials)
Grade B: Fairly strong evidence
(from non-randomized control trial, good observable studies)
Grade C: More limited evidence
(Poor method observable studies, case report)
Clinical/Medical Audit
Systemic, critical analysis of the quality of healthcare, including the procedures used for diagnosis and treatment to improve patient outcomes
Effects: decrease the variation of services
Increase the likelihood of desired health outcome
Building block of clinical audit
1, Time and resoucres
2, Confidential, link to management
3, Educational, multidisciplinary
4, Standards, Objective measurement, willingness to change
Driving force of change
New people New technology Competition Incentives Managerial pressure Quality approach
Resisting force of change
unwilling for quality thinking job insecurity complacency skill decifits established work pattern
Level of quality
Adequacy to standard
Adequacy to efficient usability
Adequacy to the explicit expectations of the customer
Adequacy to the latent expectations of the customers
Quality management
include all the activites (planning, assurance, improvement) that organization use to control, direct, coordinate quality
Quality assurance
refers to the planned and systematic activities implemented in a quality system so that quality requirements of a product or service will be fullfilled
Total quality management
include all the employees and objectives of continual increase of customer’s satisfaction
Components of quality care
Technical quality
Risk management
Economical efficient
Patient/customer satisfaction
Why do we need quality management in health care
Ageing population
increasing prevalence of chronic degenerative disease
Increase demands of the patient
Quality problems in healthcare
Development of new technologies
Increase in health expenditures
Patients mobility across borders increases
Tools of quality management
Standard (protocol, guideline)
Criteria
Quality indicator
Clinical indicators in health care
Preventive care Access care Clinical care Appropriate care Safety care Effectiveness care Continuity care Satisfaction care Organizational management
Health policy
Cover course of actions (and inaction) that affect the set of institutions, organization, services and funding arrangements of the healthcare system
Steps of policy process
Identify problems, recognize issues
Policy formulation
policy implementation
Policy evaluation
Policy instruments
Legislation and regulations
Taxation and financial incentives
Information and coordination
Provision of direct services
Values in health policy
Quality Choice Solidarity Equity Efficiency
Main functions of health system
Service provision
Financing
Resource generation
Stewardship
Main goal of healthcare system according to WHO
Good health
Responsiveness to the expectation of the population
Fair financial contribution
Measuring of health needs
Biomedical measures of health status
Health status indicators
Self-report
Geographic variations
Demand
The quantity of a good/service per unit time that an individual will purchase and consumpt
Needs
The health services level which good medical opinion necessary to meet
Utilization
the actual uses of health service and facilities
Measuring of healthcare utilization
Inpatient days
Outpatient visits
Prescription
Percentage immunized
Individual (behavioral) determinants of health in adults are
BMI
smoking
physical activity
sun exposure
Main types of health systems
Tax based systems Social health insurance Private health insurance Out of pocket payment Donations
Gatekeeper in health care
A primary-care provider, often in the setting of a managed-care organization, who coordinates patient care and provides referrals to specialists, hospitals, laboratories, and other medical services
Players of medicine
Consumer
Healthcare provider
Health insurance
Health policy
HTA
Health Technological Assessment, multidisciplinary activity that
systematically examines performance, safety, efficacy, cost, legal and
ethical aspects of application of health technology
Indicator
tool allowing to assess the performance of the organization
and its functional features
quality assessment
assess two similar treatment options in
regard of the better outcome, disregarding price
Basic types of health care system
Primary (GP), Secondary
specialist), Tertiary (specialist in a special center
Horizontal and vertical equity
Horizontal is allocation of equal or
equivalent resources for equal health need; Vertical is allocation of
different resources for different levels of health need
Regarding needs, demands and price elasticity
rate of elasticity -0.17
What are the tools of health policy?
Evidence based health care, health
technology assessment
Clinical Effectiveness
the extent to which specific clinical
interventions maintain and improve health, and secure the greatest
possible health gain from the available resources
Medicare
Federal social insurance program for elderly and non-elderly with
disabilities (hospital insurance, supplemental insurance, managed care,
prescription drugs)
