Health Services and Health Needs Assessment - Lecture Flashcards
What are the three different domains of action in public health?
Health protection - environmental, occupational, infective
Health improvement - global, psychosocial, health education, wider determinants of health
Health services - primary care, health economics, care groups etc - focus on the development and implementation
How is the NHS funded?
General Taxation (direct aka to individuals or households or indirect aka on items) - majority.
National Insurance Contributions
Some costs - prescriptions and dental charges
Enables mostly free at the point of use
This pools the risk, and enables all people to access healthcare
What are the drawbacks of a taxation system to pay for healthcare?
Healthcare spending tends to increase every year - so it must compromise with other public spending areas
Budgets are less predictable
What is the private model of paying for healthcare?
Example USA
Patients may for medical services through private insurance (employer, organisation etc) or out-of-pocket
High risk for the individual
What is the inverse care law?
Those with highest health needs are the least likely to be able to access healthcare.
For example -
Those with the greatest health needs tend to have higher health insurance costs, also tend to be from deprived backgrounds so struggle to pay these costs so can not access healthcare (barrier) or may be denied cover.
Vicious circle - increases health needs…
Leads to larger inequalities in health
How is social health insurance?
Individual contribute a portion of their salary to health costs
Employers typically match the contributions made by their employees
This forms insurance or sickness funds
What is meant by scarcity in health care funding?
How does this link to the purpose of economic analysis?
Not enough resources to do everything we need so we must choose which needs are met and which are not.
Limited availability of resources such as time, money and human resources but potential use has no upper limits.
Use economic analysis to help with decision on resource scarcity (compare CBA).
What is meant by opportunity costs in health care funding?
In a fixed budget where increases costs will displace the funding of some services already provider, the opportunity cost is measured as the health cost as a result of the displacement of the previous resources in order to allow funding for new things.
Aka the costs of choosing to deploy resources in one way rather than another.
What is the NHS budget like?
Highly variable with changes in government
In real terms slightly increased over time (additional during COVID-19 specific funding)
Planned to remain stable from 2022-23 to 24/25
Majority spent on staffing, prescription and primary care.
Where does the majority of spending on public health come from?
Local authority grants - majority
Public Health England - screening and routine immunisations - receives funding from gov through DHSC budget.
NHSE section 7A
UK health Secuirty Agency
Note public health spending like-for-like is decreasing.
How is public health spending changing?
70% increase in mental health services since 2016/17
Some increase in health protection, physical activity and health at work.
Largest cuts were seen in smoking/tobacco, sexual health services and substance misuse.
Define health
A state of complete physical, psychological and social wellbeing and not simply the absence of disease/illhealth.
How should we assess health needs?
Of the individual - history, exam, tests -> diagnosis
Of the community - engage, view records, complete surveys -> identity needs
Define Health Needs Assessment
A systematic assessment of the health issues facing a population leading to agreed priorities and resource allocation that will improve health and reduce inequalities.
What are the key elements of a Health Needs Assessment?
Equity, effectiveness and efficiency:
- identify unmet needs
- identifies ineffective activity (stop or change)
- identifies opportunities to improve efficiency
