Public Health Flashcards
What is a necessary cause?
A factor that must be present before a disease
- TB bacillus - TB
Definition of cause
The effect produced when comparing one value of risk factor or exposure to another in groups of people.
What are component causes?
Individual causes that work together with the necessary cause to produce disease
- risk factors for TB (smoking)
What is a sufficient cause?
A combo of factors that is sufficient to produce disease in at least some people
Levels of causation
- social factors (gender)
- population factors (housing)
- physiological factors
- behavioral factors
Ecological model of risk factors
- biological
- behavioral
- societal
- structural
Problem based approach to evidence based practice
- assess you patient
- ask the right question
- access the evidence
- appraise the evidence
- apply the evidence
- audit clinical practice
Things to ask when appraising evidence
- selection bias
- measurement bias
- confounding
- due to chance?
How to check if an association is causal
- does the cause precede the effect? (Temporality)
- what is the strength of the effect?
- is the effect dose-dependent?
- is there a plausible biological explanation of the effect?
- has the effect shown similar results in different populations (consistency)
How to appraise the validity of a case-control study
- did they select incident (new) cases
- did they accurately diagnose the cases
- ‘did they select representative controls
- did they control potential confounding
- did they accurately assess exposure
What is the economic problem?
- unlimited wants
- limited resources
Sources of funds for health care in South Africa
- companies and individuals
- little donor funding
- general tax revenue (43%)
- private voluntary health insurance (44%)
- out of pocket payment (13%)
How is the money for health services collected?
- South African revenue services
- health insurance contributions collected directly from members
How does a medical aid work?
- pools members money to cover future health care costs
- there are rules for benefit
- the risk is pooled (healthy subsidize the ill)
Who regulates medical aids?
Council of medical schemes
Outline concept of prescribed minimum benefits–
- prevent dumping patients on public hospitals
- 270 conditions covered by all schemes
- ## cannot refuse condition but need not pay all treatment
What are the biggest costs for medical schemes?
Hospitals, specialists, medicines and non-health care expenses
Costs to think about for service provision
- capital costs (don’t vary per patient, training etc)
- recurrent costs (supplies)
Describe the A frame for access to health care
- availability (physical access)
- acceptability (cultural access)
- affordability (financial access) e
Things to consider for availability of health care
- location
- willingness to provide mobile services
- opening and closing hours
- relationship between services offered and community needs
Things to think about for acceptability of health care
- how service is perceived
- attitude of providers
- May vary in response to illness nature and cultural beliefs
- providers expectations
- patient expectations
Things to think of in affordability of health care
- consultation fees
- transportation and food
- loss of income
Factors that influence affordability
- income
- exemptions
- access to social grants
- assists that can be turned into income
- access to savings and credit
- sick leave
Direct costs of health care
- cost of transport
- cost of special foods
- cost of any pre-admission deposits
- costs of going to pharmacy
