Lecture 11: Health systems Flashcards
Alma-Ata Declaration
emerged as a major milestone of the twentieth century in the field of public health, and it identified primary health care as they key to the attainment of the goal of health for all
Highlighted multiple stakeholders need to make a commitment in order to make this work
First international declaration underlining the importance of primary healthcare
International Conference of Primary Health Care
When it comes to primary health care they highlight that essential health care should be based on practical, scientifically sound and socially acceptable methods of care
Also highlight:
o Bring healthcare as close as possible to the people
o Governments have a primary responsibility for the health of their people
o People have both the right and duty to participate individually and collectively to participate in the planning and implementation of healthcare
Health for All
Strong relationship between health systems, health, wealth and social well being
o Healthy people are more likely to be employed, and less likely to take sick days, more likely to be more productive, and less likely to retire early
Generally speaking lower income countries will see great benefit from investing in very basic interventions, such as hygiene sanitation issues, immunization, bug nets
How we share advanced knowledge
How we share health information online
Primary care
Generally speaking, we are speaking about first contact care
Primary healthcare is the level of healthcare the provides entry into the health system for all other needs and problems that might arise
Primary healthcare: first contact care as well as health promotion and prevention seen in public health initiative
o More basic level of healthcare
o Deals with the majority of healthcare related issues
o If you don’t feel well do you have access to a doctor?
Strong primary healthcare includes
Diagnosis and treatment
Management of healthcare problems
Providing ongoing support
Includes things such as health prevention and promotion
Characteristics of Primary healthcare
Based on evidence based medicine
Are universally available
Should be affordable
Should address the actual needs of the community
Provide preventative care, curative care as well as retaliatory services
Should be linked to more advanced levels of healthcare through a referral system
Secondary care
Medical care provided by a specialised or facility upon referral by a primary care physician
Tertiary care
Specialized consultative care, usually on referral from primary or secondary medical care personnel, by specialists working in a center that has personnel and facilities for special investigation and treatment
o Example: cancer care centers
WHO 5 elements to provide primary care for all
Reducing exclusion and social disparities in health
Organizing health services around people’s needs and expectations
Integrating health into all sectors
Pursuing collaborative models of policy dialogue
Increasing stakeholder participation
Cuba’s life expectancy
79
Why is Cuba doing so well
They do make a lot of investments, its prioritized
Healthcare system is based on a term called Poly-clinics
o A place where a range of healthcare services are administered
o Diagnostic centers
o Family care
o Internal medicine
o Pediatrics
o Gynecology is apart of it
o X-rays and ultra sounds
o Emergency services
o Family planning
Health Systems
All activities whose primary purpose is to promote, restore or maintain health
Agencies that plan, fund and regulate health care
The money that finances healthcare
Those who provide preventative health services
Those who provide clinical services
Those who provide specialized inputs, such as the education of the healthcare professionals
Production of drugs and medical devices
Vertical Approach
Public health initiatives targeted at addressing a single disease/health condition at a time
Ultimate goal to eradicate or reduce the prevalence of the disease
Vertical approaches are not as beneficial as if a specific thing is included in a horizontal approach
When is vertical approach used
Vertical programs are necessary if primary health care is not sufficient and it’s a temporary solution
o If you want to address the needs a specific target group that is hard to reach
o If it needs to be a quick fix
o When you need very high skilled people to do a couple of things
Horizontal approach
Public health initiatives focused on integrated delivery of general health services and tackling overall health problems
Aim is to develop health networks that cater to people’s day-to-day health issues
Changing nature of healthcare globally
Development of pharmaceuticals
Technological advancements
Surgical advances
Treatment of non-communicable diseases
Global Health System
The group of actors whose primary intent is to improve health, along with the rules and norms governing their interactions
Organized social response to health conditions at the global level
WHO is the only real actor in global health systems, because of its universal memberships
Other global health system organizations
UNICEF
World bank
Global governance for health
The way in which the global health system is managed; no government at the global level
Example: formal decision-making processes of the UN; voluntary codes of conduct or organizations
Key stakeholders for global health
UN systems US is a key player in a lot of things National governments Philanthropic organizations Academic organizations
4 essential functions of the global health system
- Production of global public goods
o Referring a lot to knowledge related goods
o Any tools that your using to standardize the language when talking about health and disease (international classifications) - Management of externalities across countries
o Trying to prevent negative effects of ill health
o Surveillance systems to monitor progression of disease
o What response mechanisms are set in place
o Coordination mechanisms with other countries - Mobilization of global solidarity
o Mostly provided through the provision of aid
o Donor aid
o Technical cooperation and capacity is also involved here
o Humanitarian assistance during disasters - Stewardship
o Ontario ministry of health and long-term care: provide overall strategic direction
Importance of health systems
Improving the health status of individuals, families and communities
Defending the population against what threatens its health
Protecting people against the financial consequences of ill health
Providing equitable access to people-centred care
Making it possible for people to participate in decisions affecting their health and health system
3 measures of health system performance
attainment of good health
looking at both at how the health system can improve or protect peoples health
concerned with how long you could live in good health (disability and disease free)
Responsiveness to the expectations of the population
Referring to goals of the health system to reduce inequalities in a way that improves the situation for the people who are the worst off
Client oriented? Is it responsive to their expectations
Fairness of financing
Ways in which you pay for health care
Does the healthcare system do anything for reducing the burden of out of pocket expensive for health care
4 functions of health systems
Providing health services
Generating human/physical resources for service delivery
Raising/pooling resources to pay for health services
Stewardship (govern and regulate the health system)
Responsibility of health care
Performance of the country’s health system lies with the government
- Need a responsible government to oversee the healthcare of people
- Continuous, sustainable involvement of the government
- Looking at primary healthcare
Not always just about how much money governments are investing in healthcare
- Rather efficiency
- Wasteful of resources
Canada’s Health System
Will vary from province to province
Provide overall strategic direction
30% coming from private sector 70% from public sector
hospital drugs and physicians is where most of our money is going
spending into these areas has been slowed
prescription drugs
o generally speaking people support with covering drug costs in taxation
Ontario Ministry of Health and Long-term Care
Local health integration networks: have a better way of plan, fund and implement more efficient healthcare services
Local authorities are more capable of knowing what’s going on in a region or sub region
Make sure healthcare is patient focused,
Investing in things you need in a specific region
Local Health Integration Networks
LHIN
Ontario created 14 LHINs in 2006 with the mandate to plan, fund, and integrate health services for more efficient care in their regions
Authority of governance of health care has been moved to regional authorities, based in the belief that local authorities can better integrate and coordinate services and contain costs
Non-profit organizations funded by the Ministry of Health and Long-Term care
Problem with US healthcare
The US has the most expensive healthcare system
US spends the most on healthcare,
US has the highest technology of healthcare services however millions of people don’t have access
Using taxation is not the only way to pay for public health
People who are better off need to subsidize costs for those less off
Health System Building Blocks
Service delivery Health workforce Information Medical products, vaccines and technologies Financing Leadership/governance
What is public sector responsible for
stewardship of the system
raising funds
making decisions on how to allocate those funds
establishing approaches to health insurance
Private sector responsibilities (for profit)
provision of services including non-licensed medical practitioners
operation of health clinics, hospitals, services and laboratories
can partner with public sector or work under contract to the public sector
involved in all countries
Private sector responsibilities (not for profit)
involved in community-based efforts to promote better health through education improved water sanitation
often carry out health services
can partner with the public sector or work under contract to the public sector
Allopathic or Conventional medicine
western medicine physician to population ratio: • low income: 2.8/ 10 000 • lower middle: 10.1/10 000 • upper middle: 22.4/10 000 • higher: 28.6/10 000
Complementary and Alternative Medicine (CAM)
complementary and alternative or traditional medicine is very common in many developing countries
a group of desperate methods of healing and healthcare, which incorporate herbal medicines, spiritual practices, use of animal parts and manual treatments
80% of the population in Africa and India will use CAM, 40% of the population will rely on CAM (complimentary and alternative medicine)
in lower income countries both high and low income populations are likely to use CAM
in higher income countries women are more likely to use it
Health services organization: low income countries
fragmented health system that include both public and private providers
Health services organization: middle-income countries
system organized around a national insurance scheme
Health services organization: high-income countries
national health insurance
Universal health coverage
ensures that all people obtain the health services they need without suffering financial hardship when paying for them
Universal health coverage requires…
strong, efficient health system
system for financing health services
access to essential medicines and technologies
sufficient capacity of well-trained motivated health workers
User fees
are bad, should not have people who are already in a compromised situation paying for services. Drop service fees
o if you cant eliminate them: reduce them to a point where it is not a huge burden on the people using the service
Sliding scale arrangements
pay based on SES
o however, healthcare providers would need to know something about peoples SES
Out of pocket payments
you should try and keep them to a minimal level
are regressive in nature
may be considered neutral or progressive if they don’t pose a huge burden on people
Free of Charge Services
free of charge services wont translate into unjustified and over utilized services
in lower income countries: there will still be barriers
• transportation
• gender
• cultural barriers
• lack of awareness of services
• health literacy
Triple burden of disease
triple burden of disease: communicable, non-communicable and injuries
Health sector concerns
demographic and epidemiologic change: high cost of treated NCDs
inaccessible/Inequitable care: inefficient care, lack of coverage
Quality of care/Unsafe care: unsanitary conditions, medical errors
Misdirected care: emphasis on secondary and tertiary care
Fragmented care: excessive specialisation threaten routine care
Inverse care: richest consume greatest amount of healthcare
Stewardship: lack of clear rules and regulations
Human Resources: weak management of HR, absenteeism
Health Sector Reform
Improving performance of civil services Decentralization Improving function of health ministries Building the health financing options Introducing managed competition Working with the private sector
