Healthcare systems Flashcards
Murray and Frenk (2000) 4 main healthcare functions?
stewardship, resource generation, financing and provision
what is stewardship?
- performance assessment and regulation of other functions i.e. safety checks, regulate safety standards of drugs
- ensuring correct provision e.g. doctors and nurses and enough drug supplies?
- interectoral advocacy: help to achieve health goals with other sectors e.g. social determinants of health
- Consumer protection due to the asymmetry of info e.g. ensure safe information given, patient protection
- Feedback loops to improve
Who does stewardship in the healthcare system?
Depends, hundreds of organisations can be involved in a decentralised system, in NHS its the department of health and the district comissioning groups.
What is resource generation?
- Generate human resources e.g. staff numbers- and future planning with degree entry.
- Facilities- plan resources where there is need
- Knowledge generation- research
- Products- manufacting of pharmaceuticals
What is finacing?
- Revenue collection- e.g. General taxation, insurance compulsary or voluntary, out of pocket payments, donations
- Fund pooling- the money is no longer tied to the contributor- the risk is shared like in an insurance scheme to account for uncertainity and unequal need.
Not all is pooled- out of pocket for dentist, opticians, prescriptions - prioritise the money for different streams (Purchasing, prioritisation and contraction)
What is provision?
- Combination of personal financed resources into a production.
- Process within an organisational setting causing service delivery- can be personal (directly consumed) e.g. doctors visit, or non personal (indirect) consumed collectively through say health promotion.
What is the ‘Beveridge’ model of healthcare?
Developed for the UK NHS in 1948. A fully integrated system with all functions controlled by the state. It supplies universal health coverage which is free at the point of delivery.
Financing is by compulsary general taxation and is all highly centralised.
Advantages of the beverage/ integrated system?
(+) Universal health care coverage- equitable as progressive funding.
(+) Single purchaser of healthcare inputs e.g. staff and drugs so can get for cheaper as they have nowhere else to sell to
(+) Low transaction costs due to simplicity of stewardship and contracting
(+) integrated care, better information sharing
(+) Easier to manage public health initiatives e.g. pandemic
disadvantages of the beverage/ integrated system?
(-) No competition and theoretical associated advantages of improved efficiency, choice and quality
(-)There can be large costs associated with building these systems and potential dis-economies of scale
(-)Non-price rationing (to avoid consumer moral hazard)
Low wages
(-)Subject to reform depending on election results
Health care budget can vary with wider government finances
Social health insurance model?
‘Bismarck Model’ created in the 19th century in Germany
Funded by compulsory payroll deductions
Government stewardship and resource generation
Variations
May be public or private insurance schemes (pooling)
May be public or private providers, purchasing and revenue collection
Less integrated than Beveridge Model
Advantages of the Social health insurance model?
(+)Government stewardship and resource generation provides some element of price control and avoidance of adverse selection
(+)Direct relationship between payment and benefits can act as incentive to consumers to pay into the system(?)
(+)Can also build in choice of insurer and provider
Independence from government – separate funds earmarked for health care
(+)Equity can be reflected based on progressive contributions
Disadvantages of the Social health insurance model?
(-) Universal coverage not possible without government intervention, which is especially problematic in contexts where there is a large informal sector
(-)There may be no competition and associated benefits
(-) Efficiency may not be achieved - high transaction costs if there is more than one sickness fund and multiple providers
(-) Can lead to distortions in the labour market…price of labour changes which changes incentives for manufacturers across the whole economy
What is private health insurance?
Revenue collection, pooling and purchasing is through multiple, competing private organisations
Contributions are voluntary, or with some element of choice, but generally through payroll
Provision is private through multiple organisations that may, or may not, be linked to the insurers
Stewardship and resource generation provided by government and private sectors
Highly segmented
Advantages of private health insurance?
(+) Efficiency (in the presence of perfect competition)
(+) More choice - health care providers may be more responsive to consumers
(+) Improved quality in response to consumers
(+) Higher wages may be able to attract better staff who deliver better quality
(+)Funding for innovation more readily available
(+)Less impact caused by government changes (in theory)
Disadvantags of private health insurance?
(-)Poorer and less healthy are left uninsured
(-)High transaction costs associated with advertising, contracting, multiple providers and insurers
(-)Monopolies can develop which are no longer responsive to consumers
(-)Competition may lead to fragmentation and poor care
(-)Non-independent stewardship can lead to poor quality and cost inflation as firms seek to increase profits
(-)Large scale public health interventions difficult to fund and manage
