HEALTH SYSTEMS.pptx

7/29/2019 HEALTH SYSTEMS.pptx

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HEALTH SYSTEMS

By

Dr Ekiria Kikule

Bachelor of Community HealthUganda Christian University 2013


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Definition

A health system also sometimes referred toas health care system orhealthcaresystem

Is the organization of people, institutions and

resources to deliver health care services to

meet the health needs of target populations.

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1. Health needs/problems

determined by demographic & environmental

(cultural, economic, political, etc)

characteristics

2. Health services

3. Health management & support systems

4. Community participation

5. Health outcomes

Elements of a Health System

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WHO Definition

"A health system consists of all organizations, people

and actions whose primary intent is to promote,

restore or maintain health. This includes efforts to

influence determinants of health as well as more

direct health-improving activities

A health system is therefore more than the pyramid of

publicly owned facilities that deliver personal health

services4


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WHO Definition (Cont)It includes:

A mother caring for a sick child at home

Private providers

Behaviour change programmes

Vector-control campaigns

Health insurance organizations

Occupational health and safety legislations Inter-sectoral action by health staff e.g.

encouraging the ministry of education to promotefemale education, a well known determinant of

better health 5


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History Variety of health systems around the world

In some countries, health system planning isdistributed among market participants.

In others, there is a concerted effort amonggovernments, trade unions, charities,religious bodies, etc to deliver planned healthcare services targeted to the populations

they serve. However, health care planning has been

described as often evolutionary rather thanrevolutionary.

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Goals of a Health System

According The World Health Organisation(WHO):

Good health Responsiveness to the expectations of

the population

Fair financial contribution.

Continuity of health care provision7


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Functions of Health Systems

1. Provision of Health care services

2. Resource generation

3. Financing

4. Stewardship

a) Qualityb) Efficiency

c) Acceptability

d) Equity8


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HS evaluation dimensions have also beendescribed in the United States as "the

five C's":

1. Cost

2. Coverage

3. Consistency

4. Complexity

5. Chronic Illness

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Health Care Providers

Health care providers are institutions ORindividuals providing health care services.

Individuals include

health professionals

allied health professionals

Individuals can be self-employed or workingas an employee in a hospital, Clinic or otherhealth care institutions

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Other health care institution include:

Government operated

Private for-profit

Private not-for-profit (e.g. NGOs)

Health care Institutions may also work

outside of direct patient care such as:

Government health department or agency

Medical Laboratory

health training institution

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Doctors

Nurses

Midwives

Dietitians

Paramedics

Dentists

Psychologists

Lab Technologists

Pharmacists

Optometrists

Community Health

Workers (CHW)

Trad. Medicine

Practitioners

Examples of health workers:

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Financial Resources

Generally five 1ry methods of funding healthsystems:

1. General taxation to the state, county or municipality

2. Social health Insurance

3. Voluntary or private Health Insurance

4. Out-of-pocket payments

5. Donations to Charities

Most countries' systems feature a mix of all fivemodels.

all types of health care finance "are compatible

with" an efficient health system.13


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Health Insurance

The term generally used to describe a form of

insurance that pays for medical expenses.

Used more broadly to include insurance coveringdisability or long term nursing care needs.

May be provided through a social insuranceprogram or from private insurance companies.

It may be obtained on a group basis (e.g., a firm

covering its employees) or purchased by individualconsumers.

In each case premiums or taxes protect the insuredfrom high or unexpected health care expenses.

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Payment Models 1.

65% - 80% renewable health systemexpenditures spent on wages in most

countries.

Three ways to pay medical practitioners:

Fee for service

Capitation

Salary.

These systems can be blended

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Payment Models 2.

1. Fee-for-servicearrangements paygeneral practitioners (GPs) or

private practitioners based on the

service

Such arrangements are even morewidely used for specialists working in

ambulatory care e.g. consultations

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Payment Models 3.

2. In capitationpayment system GPs arepaid for each patient on their "list", usuallywith adjustments for factors such as ageand gender.

Capitation payments used in Italy, UKAustria Denmark, Ireland (since 1989), theNetherlands and Sweden (from 1994)

Capitation payments have become morefrequent in managed care environments inthe United States.

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Capitation (cont) Capitation systems allow funders to control the

overall level of primary health expenditures, andthe allocation of funding among GPs is determinedby patient registrations.

BUT under this approach, GPs may register too

many patients and under-serve them, select thebetter risks and refer patients who could have beentreated by the GP directly.

Freedom of consumer choice over doctors, coupled

with the principle of "money following the patient"may moderate some of these risks.

Aside from selection, these problems are likely tobe less marked than under salary-typearrangements.

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Payment Models 4.

3. Salary Arrangements- In some countriesgeneral practitioners (GPs) are employed onsalaries for the govt.

Salary arrangements allow funders to control primarycare costs directly

Salaries they may lead to:

under-provision of services (to ease workloads)

excessive referrals to secondary providers

lack of attention to the preferences of patients

Some countries are moving away from thissystem.

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Health System Management 1.

Management of any health system istypically directed through policies & plansadopted by govt, private sector businessand other groups

Policies encompass:

Personal health care delivery

Financing

Pharmaceuticals

Health human resources

Public health

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The rapid emergence of many chronicdiseases that require costly long term care &

treatment affecting health care delivery

practices.

Many health managers & policy makers now

re-examine their health care delivery

approaches

Examples of emerging health issues of PH

concern; HIV/AIDS, Diabetes, HT, etc 21


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PH facing controversies, e.g. the control oftobacco smoking linked to cancer and otherchronic illnesses

Antibiotic resistance is another majorconcern, leading to the reemergence ofdiseases such as Tuberculosis

A WHO campaign is calling for intensifiedglobal commitment to safeguard antibioticsand other microbial medicines for futuregenerations.

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Public Health 1. Public health is concerned with threats to the

overall health of a community based on the

analysis of the health of a population The population can be as small as a handful of

people, or as large as all the inhabitants of severalcontinents (e.g. in a pandemic)

Public health divided into:

Epidemiology

Biostatistics

Health Services Other important PH subfields include:

Environmental management

Social & Behavioural health

Occupational Health. 23


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Public Health 2. Today, most govts recognize importance of

PH programs in reducing the incidence ofdisease, disability, the effects of ageing and

health inequities

BUT PH still receives less govt funding

compared with curative medicine.

Vaccinations are voluntary in some countriesand some govts pay all or part of the costs

for vaccines in a national vaccination

schedule24


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Health Information 1.

Sound information critical in the delivery of

modern health care and efficiency of healthsystems.

Health informatics - the intersection ofinformationscience, medicine& health caredeals with:

the resources

Devices

Methods

required to optimize the acquisition and use ofinfo in health and biomedicine.

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Necessary tools for proper health information

coding and management include: Clinical guidelines

Formal medical terminologies

Computers & other info & communicationtechnologies

The kinds of data processed may include

Pts medical records Hosp admin & clinical functions

HR information

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The use of health information enables evidence-

based policy & evidence-based mgt in healthcare.

Increasingly, information and communication

technologies are being utilized as tools toimprove health systems in developing countries

through:

The standardization of health info

Computer-aided Dx & Rx

Monitoring of health services delivery

Info dissemination to population groups on health and

treatment 27


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Health Systems Strengthening 1.

Since 2000 - more initiatives have beentaken at the international and nationallevels to strengthen national healthsystems as the core components of theglobal health system.

Having this scope in mind, it is essentialto have a clear, and unrestricted, vision ofnational health systems that mightgenerate further progresses in globalhealth.

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Health Systems Strengthening 2.

Selection of performance indicators heavily

dependent on the conceptual frameworkadopted for the evaluation of the healthsystems performance

Tools & Guidelines are being developed byinternational agencies and developmentpartners to assist health system decision-makers to monitor and assess health

systems strengthening. These include: HR development

Use of standard definitions, indicators andmeasures

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Documents

HEALTH SYSTEMS.pptx