global health

Health Systems Chapter 5 Key Ideas ○ Health systems focus on ways to improve population health by preventing disease ○ Health care delivery systems focus on medical services and curative care ○ In high-income countries, health care systems focus mostly on chronic disease while in low-and middle-income countries they focus on selective primary care ○ As development increases the distribution of health care becomes more important than money spent on health care Defining Health Systems ○ Health system: collections of organizations, people, and policies that work to improve population health ○ Inclusion is broadening to nonmedical determinants of health, like built environment and education systems ○ Health care delivery system: focuses on curative services delivered by clinicians ○ Primary, secondary, tertiary care Levels of Prevention ○ Primary: preventing disease before it appears ○ Taxation, vaccination, education ○ Secondary: detecting disease early in its course ○ Screening tests ○ Tertiary: providing clinical care to prevent the spread of disease or added health effects ○ Medical treatment, management programs Health Care System Features ○ Universality: coverage for everyone in a population ○ Accessibility: the degree to which people can receive needed health care services ○ Variation by income, race/ethnicity, geography ○ Comprehensiveness: reasonable costs ○ Portability: ability to move within system ○ Transparency and accountability Health Care Payments ○ Wide variation across nations ○ Capitated: lump sum for each covered patient ○ Tends to decrease services provided ○ Fixed salary for clinicians ○ Fee-for service: provider bills for specific services (tests, visits) provided ○ Tends to increase services provided ○ Free market Health Care Markets ○ Central problem with market-based health care delivery systems: health care is not a perfect market ○ Difficult to comparison shop ○ Difficult to identify good services ○ Information asymmetry ○ Without downward pressure on prices, prices will rise for a given level of quality ○ Governments generally do better than private companies at controlling costs in inefficient markets Health Care Delivery: US vs. Other High Income Countries ○ US is only industrialized nation without universal health insurance ○ Problems tend to be identified later than in systems with high primary care coverage ○ More administrative costs for billing ○ US citizens have access to most innovative technology and treatment but no better outcomes and at higher cost than other countries ○ Spends twice as much on health care as next country ○ Ranked 38 in life expectancy Example: Canadian Health System ○ Funding from federal and provincial governments ○ Payroll, sales, and corporate taxes; premiums; lottery ○ Care delivered by private clinicians who negotiate payments ○ Coverage throughout Canada for all citizens ○ Some limitations on dental, vision care ○ No private insurance option ○ Little change in health expenditures since 1980s Health Care Delivery: Middle & Low Income Countries ○ In 1980s UNICEF shifted focus from disease-specific care to selective primary health care ○ Female education, feeding programs, family planning ○ Many countries could not fund programs ○ Private FFS systems are most common ○ Can create disparities for the poor within countries ○ Smoking, poor nutrition, inactivity are major issues in middle income countries Global Health Expenditures