Session 4: Health And Healthcare Systems

Question 1

Define the term systems.

Answer 1

A set of connected things or devices that operate together for a common goal.

Question 2

Define the term health systems.

Answer 2

All activities whose primary purpose is to promote, restore and maintain health.

Question 3

What are the 4 different types of healthcare financing?

Answer 3

Out-of-pocket payments.
Private health insurance.
Social health insurance.
Tax-based financing.

Question 4

What are out-of-pocket payments?
Give some examples.

Answer 4

Direct payments by patients for medical care, who get no reimbursement from insurers or the government.

Medication.
Consultation with a doctor.

Question 5

What are the advantages and disadvantages of out-of-pocket payments?

Answer 5

Advantages:
- Contains health service demand.

Disadvantages:
- Exacerbates health inequalities.
- Serious illness could result in catastrophic health expenditures.
- Underuse of health services.
- Cost those of lower incomes proportionately more.

Question 6

What is private health insurance?

Answer 6

Individuals contribute to a fund by paying voluntary premiums in advance to an insurance company, so that the costs of their healthcare are covered when required.
Some employers may contribute to schemes for their employees.

Question 7

What are the advantages of private health insurance?

Answer 7

Protection against catastrophic expenditure.

Patients have options for their insurance which can drive up standards of care.

Reduces burden on public finances.

Question 8

What are some disadvantages of private health insurance?

Answer 8

Can lead to overuse of healthcare provisions.

Costs people with a lower income proportionately more than those with a higher income.

It can exacerbate health inequalities.

Adverse selection - lower risk will not purchase, meaning the average level of risk is high.

Question 9

What is social health insurance?

Answer 9

Insurance system where employers and employees contribute a proportion of their salary to a fund. For those who are jobless, the government pays contributions.

Healthcare is given by private healthcare providers.

Question 10

What are the advantages of social health insurance?

Answer 10

Protection against catastrophic expenditure - pools the risk.

Universal coverage through government contributions.

Access based on need.

Social insurance funds can be kept separate from other government funds, so the allocation on health spending is more certain.

Question 11

What are the disadvantages of social health insurance?

Answer 11

High administration costs and delayed reimbursements can occur (due to the fragmentation of funds).

May be opt-out for higher earners.

Question 12

What is tax-based financing healthcare?

Answer 12

Healthcare, that is funded through general taxation, is provided mostly by state-controlled providers and doctors.

Question 13

What are the advantages of tax-based financing healthcare?

Answer 13

Fewer inequalities.
Lower administration costs.
Universal coverage.
Controls on spending leads to prioritisation.
Access is based on need.

Question 14

What are the disadvantages of tax-based financing healthcare?

Answer 14

Healthcare budgets are variable and depend on government funding.
Can lead to overuse of healthcare.
Less choice of providers.

Question 15

What are the 4 structural levels of healthcare in England?

Answer 15

National bodies - department of health and social care, and NHS England.

Regional levels - integrated care boards and care partnerships.

Local level - primary care networks and local authorities.

Service providers - primary care, hospitals, private, social care.

Question 16

What are the functions of the 14 NHS boards in Scotland?

Answer 16

They are all purpose; planning, commissioning and delivering NHS services, taking overall responsibility for the health of their populations.

They also have some specialist and health improvement services.

Question 17

What are the functions of the 7 local health boards in Wales?

Answer 17

Commission and provide services to their local populations.

They are hospital-based, mental health, community and GP services.
They also have the ambulance service and specialist cancer care.

Question 18

What are the functions of the 5 health and social care trusts in Northern Ireland?

Answer 18

Integrated health and social care systems, managing hospitals; health centres; residential homes; day centres.
They also have a public health agency and ambulance trust.

Question 19

What are integrated care systems?

Answer 19

Partnerships that bring together providers and commissioners of NHS services across a geographical area.

Question 20

What are the functions of integrated care systems?

Answer 20

They help to plan health and care services to meet the needs of their population.

They integrate care across different organisations - joining up hospital and community-based services, physical and mental health, and health and social care.

Question 21

What are the advantages of integrated care systems?

Answer 21

Focus on collaboration, not competition.

They help to improve care for people with long-term conditions, community and home-based.

They have the potential to tackle inequalities, addressing social and economic determinants of health.

Question 22

What are the roles of local authorities in public health England?

Answer 22

Responsible for improving the health of their local population and for public health services including most sexual health services and services aimed at reducing drug and alcohol misuse.

Question 23

What are the criteria’s for priority-setting?

Answer 23

Burden of disease.
Clinical effectiveness of the interventions.
Cost effectiveness.
Equity.
Transparent, independent and consistent.
A clear framework.
Explicit processes for rationing.
Process for appeals, audits and evaluation.

Question 24

What are the roles and responsibilities for health Priorities Forums?

Answer 24

Produce guidelines to help integrated care boards to choose how to allocate their resources.

Advise commissioners as to the interventions and policies that should be ranked as high or low priority.

Develop an ethical framework to make fair and consistent decisions which treat patients equally.

Assess patients’ health needs according to their capacity to benefit from healthcare.

Question 25

What can cause variation in services provided in different regions?

Answer 25

Differences in NSH funding allocations.
Different eligibility criteria between integrated care boards.
Variation in funding priorities between integrated care boards.

Question 26

What are individual funding requests?

Answer 26

Requests for treatment that fall outside of the normally commissioned treatments for patients that have exceptional circumstances.

Question 27

What is the panel checklist for patients who have individual funding requests?

Answer 27

Anticipated clinical benefit over available options.
Valid reasons as to why the standard treatment is not appropriate.
The impact that not funding the treatment.
Possible precedents that funding of the treatment will set for future requests.
Exceptionality of the patient.

Question 28

What determines whether the patient has exceptional circumstances?

Answer 28

The patient has an atypical clinical presentation compared to the normal patient population with that same condition, requiring different treatment for their additional benefit.

Question 29

What is global health?

Answer 29

Health problems, issues and concerns that:
- Transcend national boundaries.
- Are influences by circumstances in other countries.
- Are best addressed by co-operative actions and solutions.

Question 30

What is international health?

Answer 30

Health problems that are concerned with diseases and conditions of middle and low income countries, where aid is provided to lower income countries from higher income countries.

Question 31

How does global health differ from international health?

Answer 31

It focuses on improving health equity across the world.
Targets are transnational health issues, determinant and solutions.
Progress is dependent on collaborative study, research and practice.
It requires intersectional and interdisciplinary thinking.
Involves the integration of population-based preventative systems and service-level action.

Question 32

What are some global health issues?

Answer 32

Issues that affect many counties:
- Climate change.
- Urbanisation.
- Malnutrition.
- Polio, avian influenza, and tobacco control.

Question 33

What are the 17 sustainable development goals?

Answer 33

Question 34

What are the 3 measurable determinants of health across a population?

Answer 34

Life expectancy.
Maternal mortality.
Infant mortality.

Question 35

What is maternal mortality?

Answer 35

A maternal death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management.

Question 36

What is the maternal mortality ratio?

Answer 36

The number of maternal deaths per 100,000 live births.

Question 37

What are the major causes of maternal deaths?

Answer 37

Severe bleeding.
Infections.
High blood pressure during pregnancy.
Complications from delivery.
Unsafe abortion.

Question 38

What is universal health coverage?

Answer 38

All people have access to the full range of quality health services they need, when and where they need them, without financial hardship.

Question 39

What does universal health coverage actually cover?

Answer 39

Health promotion and prevention.
Treatment.
Rehabilitation and palliative care.

Question 40

What are the social determinants of health?

Answer 40

Income and social protection.
Education.
Unemployment and job security.
Working life conditions.
Food insecurity.
Housing, basic amenities and the environment.
Early childhood development.
Social inclusion and non-discrimination.
Structural conflict.
Access to affordable health services of decent quality.

Question 41

Who influences global health?

Answer 41

United Nations.
World Health Organisation.
World Bank.
Charities and foundations.
Public-private partnerships.

Question 42

What are some current priority global public health priorities?

Answer 42

Infectious disease and control.
Antimicrobials resistance.
Non-communicable diseases.
Universal health coverage.
Improved provision of healthcare for maternal and child health.
Pandemic preparedness.
Climate change.
International movement of people and goods.
Aging population.

Question 43

What are some strategies for tackling global public health issues?

Answer 43

Development of political will and funding.
Improvement of the global early response capacities.
Improvements in global surveillance.

Question 44

What are the key principles for prioritisation?

Answer 44

Clinical effectiveness.
Fairness and equity.
Financial principles.