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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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Health System Management 2.
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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Health System Management 3.
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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Health Information 2.
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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Health Information 3.
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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