Week 7 (Health systems) Flashcards
Health system
-consists of all organizations, people, and actions whose primary intent is to promote, restore, or maintain health
-Includes efforts to influence determinants of health as well as more direct health-improving activities
Primary objectives of health system
-Improved health (level and equity)
-Responsiveness and patient-centered care
-Social and financial risk protection
-Efficiency
Improved health (level and equity)
-highest attainable average level of health across the population (overall health outcomes)
-smallest possible differences in health between and among individuals and groups
Responsiveness and patient-centered care
-meets the legitimate needs and expectations of the population
Social and financial risk protection
-minimize financial and social burdens caused by ill health
-reduce out-of-pocket expenditures that can lead to medical debt, inhibit access and lead to poverty
Efficiency
-maximize output per expenditure (bang for buck)
-appropriate allocation of health goods, services, resources
Measuring “Improved health”
-Level health of individuals throughout life, premature mortality/life expectancy, and non-fatal health outcomes/morbidity
-Differences that exist between the population served by a health system:
–Health opportunities, access, resources, treatment, outcomes
Measuring responsiveness
-Respect for dignity, individual autonomy, and confidentiality
-Client orientation:
–Prompt attention to health needs, basic amenities, access to social support networks for individuals receiving care, choice of institution and care provider
Measuring social and financial risk protection
decreases:
-People who live in poverty are more likely to experience ill health
-Ill health leads to a variety of social ills as well, including decreased productivity, job loss, family insecurity, homelessness, stigma, and so forth
-Out of pocket (OOP) payments that create financial barriers to care/access issues
-Catastrophic health expenditures (OOP so high that household is required to forego the consumption of other necessary goods and services)
-Impoverishment (OOP payments so high that they can push households below or further below the poverty line)
Measuring efficiency
-Technical efficiency:
–Using resources to achieve maximum health outcomes
–Focuses on how well inputs are converted to outputs
-Allocative efficiency:
–Assesses whether resources are directed toward the most cost-effective interventions for the greatest population health benefit
–This may change as the burden of disease changes or other exigencies arise
System building blocks
-Service delivery
-health workforce
-health information systems
-access to essential medicines
-financing
-leadership and governance
Overall goals/outcomes of health system
-Improved health
-responsiveness
-social and financial risk protection
-improved efficiency
Service delivery
-good health services are those which deliver effective, safe, good quality personal and non-personal care to those that need it, when needed, with minimum waste.
-Services (prevention, treatment, rehabilitation) may be delivered in the home, the community, the workplace, or health facilities
Health workforce
-a country’s health workforce consists broadly of health service providers and health management and support workers
-these include private and public sector health workers and unpaid and paid workers
-Countries have enormous variation in the level, skill, and gender-mix in their health workforce
-there is a strong positive correlation between health workforce density and service coverage and health outcomes
Health information systems
-the generation and strategic use of information, intelligence, and research on health and health systems is an integral part of the leadership and governance
-there is a significant body of work to support development of health information and surveillance systems, the development of standardized tools and instruments, and the coalition and publication of international health statistics
Access to essential medicines and technologies
equitable access to essential medical products, vaccines, and technologies of assured quality, safety, efficacy, and cost-effectiveness
Financing
-mobilization, accumulation, and allocation of money to cover the health needs of the population, individually and collectively
-Involves making funding available for purchase of goods and services, set right financial incentives for providers, ensure access of all individuals to effective public health and personal health care
Leadership and governance
-ensuring that strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system design and accountability.
-management of relationships with stakeholders in health and overall monitoring of other functions of health system
4 types of health system models
Beveridge, Bismarck, NIH, OOP
Beveridge model
-a government-funded healthcare system, often referred to as a “single-payer” system, revenues are collected through taxes, everyone is covered automatically regardless of employment status or income
-named after sir William Beveridge, who designed the system in the UK in the 1940s
-“Socialized medicine”
-Used in the UK, Spain, Italy, Norway, Denmark, and New Zealand
Pros and Cons of Beveridge model
-Pros: universal access to healthcare, lower overall costs, no medical bankruptcy, more equity in access
-Cons: higher taxes, longer wait times, less provider choice, potential for underfunding
Bismarck model
-a form of social health insurance that is mandatory for all citizens, people are insured through nonprofit “sickness funds” generally financed through joint contributions of employers and employees through payroll deductions, contribution is income based
-Named after Otto von Bismarck, who introduced system in Germany in 1880s
-Used in Germany, France, Belgium, Japan, Switzerland, and others
Pros and cons of Bismarck model
-Pros: high-quality care, choice of doctors and hospitals, lower out of pocket costs, regulated insurance ensures fair pricing and competition
-Cons: payroll taxes can be high, complex administration, may still have some gaps
National Health Insurance (NIH) model
-hybrid system: largely private sector providers (like Bismarck) but with a government single payer (like Beveridge)
-Healthcare is publicly funded but privately delivered
Government runs a national health insurance program that covers everyone, citizens contribute to a public insurance fund
-Used in Canada, Taiwan, South Korea
