Week 2: Intro to health policy and health systems Flashcards
Health policy
- Many definitions
- Not always written down or codified
- Policy as a process in time and place
- Inevitably political
- What is and what could b
What is health policy?
Who: political actors, public sectors (government), private sector (industry)
What: decisions, plans, actions
non-decisions , no plans , inaction
Within the power of policy actors
Where: within society
Healthcare system, institutions, organizations, services, funders
External to health care system (food, transportation, tobacco
Why: achieve health and health care goals
(Non)Decisions Political actors Public and/or Private Sector Goals
Remember: health policy is always political – is always a question of values
Health systems
Set of institutions and rules to regulate, finance and pay for personal services called health care
Health policies vs Health systems
- Often aimed at particular gestures of health systems
- Health policy efforts need to be informed by the specifics of health systems
vs. - Make some health policy issues more relevant/visible
- Make some health policy efforts more possible
Policy objectives
- Trade-offs: often more than one objective
- Objective are not always compatible
Security: Minimum human needs (food, shelter, etc)
Liberty: Freedom to do what you want, without harming others
Equity: “treating likes alike”
Efficiency: Getting most for money spe
How can we accomplish our objectives
- Policy instruments
- Tools available to achieve selected policy goals
Do nothing
Status quo
Extortion
Encourages activities without forcing it
Using symbolic gestures like
Expenditure
Spending money
Promote something good that will benefit others
Taxation
Tax policy to encourage/discourage activities
Reducing the amount of tax an individual is required to pay
Regulation
Rules to encourage or penalize activities
Public ownership
Government-run activities
Lalone Report (1947)
Human biology: Biological causes of disease, genetic inheritance
Environment: Physical and social, not under individual control
Lifestyle: Personal decisions
Health care organizations: Availability and quality of clinical services, healthcare services are kept separate, environment and lifestyle services are not a concern in healthcare systems
Social determinant of health
Non-medical factors that affect a person’s health and well-being
Population health
- Stresses the importance of improving health for the entire population
- Acts on “broad range of factors and conditions that have a strong influence on health”
What is health care?
Relationship in which a group of individuals (“carers” or “providers” offer personal services to an “individual “patient”
- “personal” implies emphasis on due process rather than outcome
- relies on trust
Principle - agent relationship
patient = principle
health care provider (HCP) = agent
We (patient) must delegate decisions to agent (HCP)
Asymmetry of Information
Recipients of care cannot judge the effectiveness of care
Types of Services (the ‘silos’)
Levels of care
Minimal integration (coordination)
Primary, Secondary and Tertiary
Systems with good primary care are more…
Cost-effective, equitable, and deliver high quality care
Primary care
First point of entry in the health care system
Critical to ensure health system, sustainability and performance
Primary care does not just include clinical care
May include health promotion, disease prevention and rehabilitation
Primary care focuses on services..
to diagnose, treat and manage disease
Primary care focuses on…
Relationships
- not about “cheaper” providers, but those who “specialize in relationships” with patients, other parts of the healthcare system, broader population
Generalist
PC are specialists
Family medicine became a specialty in the 1990s
Trained in recognizing undifferentiated disease and managing uncertainty
Tools are the eyes, ears and brain
“Not just doctors”
other providers can be the first point of contact
Nursers, nurse practitioners, PA, midwives, pharmacists, dietitian etc
Primary care and chronic disease
The best way to manage chronic disease
people are living longer and developing more chronic diseases
Have to be treated by a different specialist is time consuming, expensive, and confusing for the patient
Specialized care
next level of care offered in multiple settings
secondary and tertiary care
Secondary care
Ambulatory care (outpatient services provided outside of the hospital
Hospitals
Involves specialized care from a specialist
cardiologist or oncologist
Tertiary care
Highly specialized and complex (cancer center)
May include research and teaching
Hospitals
Emergency services
Potentially life-threatening situations
Ambulance services
Transport to hospital
May treat directly in the community or on the route
Skilled staff (paramedics and emergency medical technicians)
Transfer between hospitals or other facilities
Long term care
Set of health, personal care and social services required on a sustained basis
LTC institutions
Specialized facility
Nursing home, home for the aged
Home and community care
Community based
In-home services, community support services, supportive housing
LTC Functions
Acute substitutions
Long term care substitutions
Prevention/maintenance
Acute substitutions
Allows discharge from acute care (hospitals) to community and still receive needed care
Long term care substitutions
Serves those who might otherwise have to be in an LTC institution
Prevention / maintenance
Keep people healthy enough to remain out of institution
LTC social supports
Goes beyond clinical services to other elements of determinants of health
Activities of daily living
Instrumental activities of daily living
Often informal (unpaid) caregivers (volunteers, family)
Activities of daily living (ADL)
Functional mobility
Personal care
Instrumental activities of daily living (IADL)
Independent living
shopping, housework, transportation
Other silos (types of services)
Rehabilitation, Pharmaceuticals, Diagnostic imaging, Dental care, Mental health care, vision care
Types of providers
Professions, Skilled trades, Informal caregivers
How is a profession defined?
Work relies on a systematic body of knowledge that must be learned and taught in a recognized educational institution
Mechanism for testing and assessing mastery of knowledge
Services provided can place recipients in harm if not done properly
Asymmetry of information
Regulated health professions
Professional body issues certification to members and oversees activities (ON=28)
Self-regulating
Governing grants authority via legislation
Protects the interests of the public
The College of Physicians And Surgeons of Ontario
Associations
Advocacy groups
represent the interests of their members
Ontario Medical Association
Skilled trades
It may or may not be designated as a profession, depending on the province
Personal Support Workers
Much healthcare is delivered by non-professionals
May be paid (PSW) or unpaid (trained volunteers)
Informal care givers
Often family members
Financial implication: Avoid LTC instututions, cheaper ofr the healthcare system, but not for the family
Consequences of professional regulation
Who will be registered to practice depends on jurisdiction (province/territory)
Issues when professions move from one jurisdiction to another (province to province or country to country)
Adds complexity to service delivery in a myriad of ways (digital health)
Human health resources
How many healthcare providers we need
Recruitment
how to get people to work a particular type of job
Retention
How to get people to stay in a particular job
Stickiness
The probability that someone working in a job will stay there the next year
What are (or should be) the limits if government?
Ideas how to balance different policy objectives
Libertarian & Egalitarian
Libertarian
Maximize individual autonomy and political freedom
Minimize state involvement
Egalitarian
Maximize social and economic equality
Minimize social and economic inequalities through state intervention
