Health Care Systems & Policies. Source:

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1 Health Care Systems & Policies Source: 1

2 Health System What is a Health System? A health system consists of all the organizations, institutions, resources and people whose primary purpose is to improve health. A health system delivers preventive, promotive, curative and rehabilitative interventions through a combination of public health actions and the pyramid of health care. Actions of the health system should be responsive and financially fair, while treating people respectfully. A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction to function. Strengthening health systems means addressing key constraints in each of these areas. WHO, Monitoring the building blocks of health systems

3 Goals of Health Systems Good health Responsiveness to the expectations of the population Fairness of financial contribution Functions of Health Systems Provide health services WHO World Health Report 2000 WHO World Health Report 2000 (entirely focused on health systems) Raise money that can be spent on health, referred to as resource generation Pay for health services, referred to as financing Govern and regulate the health systems, referred to as stewardship 3

4 Health System All health systems should do. 1. Provide access to a comprehensive range of health services, including prevention, diagnosis, treatment, and rehabilitation 2. Protect the sick and their families against the financial costs of ill health and disability through the establishment and operation of some type of insurance scheme 3. Improve the health of populations through appropriate governance of the health system, regulation of that system, promotion of good health, and the carrying out of key public health functions, such as surveillance, the operation of public health laboratories and food and drug administration 4

5 WHO Health System Framework WHO Health Systems Framework Source: Everybody s business Strengthening health systems to improve health outcomes. WHO s framework for action. Geneva, WHO, 2007 ( 5

6 WHO Health System building blocks WHO definitions of health system building blocks Good health service deliver safe and effective health interventions to people where and when they need them, in an efficient manner. A health workforce performs well when it has the right number of trained staff, in the right fields, in the places they are needed, and they perform their work as effectively and efficiently as possible. 6

7 WHO Health System building blocks WHO definitions of health system building blocks A health information system functions well when it delivers the information needed for monitoring health status and health system performance in a reliable and timely manner. To function well, a health system has to ensure that it provides equitable access to medical products, vaccines, and technologies that are safe, of appropriate quality, have been procured at the best available prices, and can be used in cost-effective ways. 7

8 WHO Health System building blocks WHO definitions of health system building blocks An effective health financing system is one that raises enough money to fund an agreedupon health program and protect individuals from financial harm due to the costs of health services. Leadership and governance concern the management, oversight and regulation of health systems in open, participatory, and accountable ways, that week to maximize health for the money spent. 8

9 Health System Typology Roemer s Health System Typology Health System Types Insurance Funding Management Health systems/case Studies Comprehensive Universal, according to need Progressive taxation Public centralized Quebec England Welfareoriented/Mandated Mandated for those who contribute to insurance fund Insurance fund covering a part of health care costs (employers workers, state) Public decentralized France Netherlands Entrepreneurial Private for population, public for limited targeted population Private, out of pocket, collective insurance Private/public Massachusetts- USA Source: Roemer, M.I National Health Systems Through out the World, Annual Review of Public Health, 14:

Social Health Insurance Social Health Insurance Financed through governmentmandated contributions by employers and employees Health care delivered by

closely integrated Financing integrated with insurance and payment Government has overall control Carrin G & James C from WHO Geneva. (2005).

10 Social Health Insurance Social Health Insurance Financed through governmentmandated contributions by employers and employees Health care delivered by private providers Private, not-for-profit insurance companies: called sickness funds; collect and pay physicians and hospitals Insurance and payment are closely integrated Financing integrated with insurance and payment Government has overall control Carrin G & James C from WHO Geneva. (2005). Social health insurance: Key factors affecting the transition towards universal coverage. Pages

11 NHS & Market model National Health Service Government manages the infrastructure Medical institutions are operated by government Workers are government workers (e.g., physicians, nurses ) Tax-supported Great Britain, Cuba, previously Soviet system, Sweden Market Model of Health Care Health services are largely privatized and increasingly run on a for profit basis Health Insurance is segmented with private insurance for low risk and social insurance for high risk populations Health insurance linked to employment Insurance coverage is rarely universal Government plays minimal regulatory role 11

12 Graph of the Preston Curve for 2005, cross section data. Retrieved from Preston, S. H (2007). "The changing relation between mortality and level of economic development". International Journal of Epidemiology 36 (3):

13 Health Care System in Korea Korean Health Care System Data retrieved from Korean version of Health-care Reform in Korea (Economics Department Working Papers, No. 797, OECD/Korea Policy Centre, Health and Social Policy Programme, Page 10 13

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19 Questions Suggestions Comments Thoughts 19

20 Discussion Questions Discussion Questions 1. Define health system and identify its goals and functions. 2. Identify the key components of a health system (i.e., WHO health system building blocks). 3. Compare and contrast the models of health systems of the United Kingdom, Germany and the United States. 20

Universal Healthcare. Universal Healthcare. Universal Healthcare. Universal Healthcare

Universal Healthcare. Universal Healthcare. Universal Healthcare. Universal Healthcare Universal Healthcare Universal Healthcare In 2004, health care spending in the United States reached $1.9 trillion, and is projected to reach $2.9 trillion in 2009 The annual premium that a health insurer