Lecture 7- Healthcare systems Flashcards
what is a system
Systems- interconnected elements within a defined whole
- A defined boundary
- Has to have a purpose, which must be well defined
Complicated vs complex systems
complicated- elements and connections equally important
complex- connections are most important
systems can be
- Simple or
- Complex or
- Complex adaptive
systems- predicatibility of behaviour
systems- number of interactions
systems- locus of decision making
systems- strength of interactions
systems- causal loop diagram
- vicious cycle
vs
- virtuous cycle
A virtuous circle has favorable results, while a vicious circle has detrimental results. Both circles are complex chains of events with no tendency toward equilibrium (social, economic, ecological, etc.) —at least in the short run
Balancing elements = most important
- Reinforcing (Resilient) loop= vicious cycle (red)
- Reinforcing loop as a virtuous cycle (green)
Models of healthcare provision (4)
- Out-of-Pocket Model
- Bismarck Model
- National Health Insurance
- Beveridge Model
Out-of-Pocket Model (‘Individual Liability’)
- Most countries in the world do not have universal healthcare provision for their citizens.
- In those countries, only those rich enough receive healthcare, the others do not.
- Some have public hospitals that provide free emergency care, but only emergency care. Thereafter, all costs are borne by the patient.
- Those who can afford to do so, pay for healthcare insurance so that they do not have to go to public hospitals.
countries which use out-of-pocket model
poorer countries e.g.
Africa, India, China and South America
Bismarck Model (‘Multi-Payer’ Insurance)
- Named after Otto von Bismarck, Chancellor of Prussia, who invented the welfare state in 1883 as part of the unification of Germany.
- Healthcare is:
- provided by private healthcare providers and doctors
- financed by an insurance system (not-for-profit ‘sickness funds’ that are strictly regulated) that is funded jointly by employers and employees through payroll deduction.
countries which use bismark model
Examples include Germany, France, Belgium, Netherlands, Switzerland, Japan and in Latin America.
Beveridge Model (‘Single Payer and Provider’)
*
- Named after William Beveridge, author of the “Social Insurance and Allied Services” report (1942) that formed the basis of the post-WWII welfare state in the UK including the NHS.
- Healthcare is:
- provided mostly by state controlled healthcare providers and doctors
- financed by the government funded by general taxation.
countries which use beveridge model
- Examples include UK, Spain, most Scandinavian countries, New Zealand and Cuba.
National Health Insurance (‘Single Payer’)
- Named after Lloyd George’s National Insurance Act (1911) in the UK in which employers and employees pay National Insurance contributions.
- Healthcare is:
- provided by private healthcare providers and doctors
- financed by a government run insurance scheme that is funded by citizens’ contributions.
countries which use national health insurance model
Examples include Canada, Taiwan and South Korea.
in the UK we have
devolved healthcare
type of healthcare in england
internal makret healthcare
internal market -england
improve performance
control costs
type of healthcare in scotland
integrated
integrated healthcare- scotland
collaboration
co-ordination
type of healthcare in wales
planned
planned healthcare (wales)
- common goals
- optimal system
type of healthcare in NI
health and social care
health and social care- NI
pooled resources
funding differences throughout the UK
