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Summary ICAHS 2020! Endgrade 8,0!
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Lecture 1 Introduction (6th Januari)Information about assignment 1:
Primary care > Germany & country of choice.
Choose a country among OECD-members who are high-income countries.
Which country did we choose?
Why?
What to do after informing?
Formulate an objective to your analysis (Collect before Wednesday)
Describe theoretical background
Identify units of analysis
Deduct indicators (quantitative and qualitative)
Gather data and do the analysis (based on indicators and context)
As you collect data, modify the theoretical background, revise units of analysis and
indicators (iterative process)
Make a comparative table (with references)
Always assess the comparability
Lecture 2: Introduction to health systems (6th Januari)
Pre-modern states (before 19th century) Not health systems
- Hospitals run as religious charity
- Epidemics
- State intervention: quarantine for infectious diseases
Beginning 18th-19th century
- French revolution (right to health)
- Industrial revolution (money)
19th century and later
- Emergence of welfare state
o responsibility of the state for population health measures and healthcare
services
- Scientific developments
o Sanitation and hygiene, control and epidemics
o Vaccination and antibiotics
o Biomedical paradigm
o Focus on health care rather than health
80s / 90s (welfare states are crumbling)
- Population growth
- Population ageing
, - Higher levels of chronic diseases and disability
- Increased availability of technology
- Rising expectations of the public
- Increasing health care costs
- Unable to cope with the cost of care for ageing population
- Solution: Health reform
Varying context in which health systems function.
Countries responded differently:
- Political, social, economic and technological context
- Historical developments, national and global
- Scope of the responsibility (individual or Mondial)
- Different actors, structures and processes.
Two typologies:
- Germany (Bismarck): Social health insurance with income based contribution from
wages. BUT taxes are already drawn away.
- UK (Beveridge): Tax-based financing, equitable access, National Health System.
Efforts to define health systems and what they do came after they were formed and
functioning. The complexity and challenge:
Why trying to define what health care system is and
what it does?
1. Measure the performance:
You cannot manage what you don’t measure
Not a universal law
A production system perspective:
Outputs and outcomes are different in health!
2. Define concepts, draw borders and assign responsibilities.
In order to strength and reform it
Health care frameworks for different purposes.
Murray and Frank is THE LITTERATURE for this course. We need to know it by hard.
• We need to know:
– Performance assessment and benchmarking
• >WHO Framework, Murray & Frenk, 2000
– Programme development for health systems strengthening
• > WHO, Building Blocks, 2007
– Intervention development
• > Complex adaptive systems (2008)
– Guide health reforms
• > Roberts, 2004
– Analyze investments for health system strengthening
• > Shakarishvili et al, 2011
,Different perspectives and frameworks to health, health policy, public health and health
systems doesn’t necessarily match coherently.
Mid 20th century:
- Biomedical paradigm for health (more on disease than on how)
- Focus on diseases rather than health
- WHO, vertical programmes to combat diseases
Things started to change in 1970s
- Alma-Ata international Conference is looking at health in a global way for the first
time.
- 1981: WHO – Health for All. (Not Disease-free for all – different way of phrasing) ALL
does mean Equity. Health is the responsibility of all sectors, not only the health
sector.
- WHO definition of health did develop.
- Governance of health did develop.
Ottawa Charter for Health promotion > 1986
- Health is not merely a product of health services
- Recognition of prerequisites (safety / piece / education) and the role of non-health
sectors on health (food / transport / sport)
Public health and health care systems:
What is public health:
- The science and art of preventing disease, prolonging life and promoting health
through the organized efforts of
society.
Three ways of phrasing
Public’s health > Health of the public (this
way will be used)
Public health services > not private
Public health services > population based
services
What is a health system:
- All organizations, people and actions whose primary intent is to promote, restore or
maintain health. (WHO )
It has boundaries:
Personal medical > inside health care system (hospital care)
Non-personal health services > inside health care system (health promotion
campaigns)
Intersectoral action > health care system needs to work with other sectors (using
seatbelts in cars / air pollution / tobacco tax) Leadership is ministry of health, others
need to work with it
, Other factors > outside the scope of health care system, but has influence on health
(ex. Education)
Public health: Health for all
- Everything that relates to society’s health is a part of public
health
o Medical / non-medical interventions (personal /
population-based health services)
o Governmental decision and practices
o Activities of the public sector, private sector and
NGO’s
o Health system is a component of it
Health system pyramid:
Objectives (4):
- Health gain (increase in the measured health of
an individual or population, including length and
quality of life)
- Equity - Equity = need is important; equality =
same (Everyone should have access to health
services in accordance with their needs, and
should contribute to the financing of these
services in accordance with their needs.)
- Responsiveness (Legitimate expectations of the
population, how are they feeling with the health
level and services, etc.)
- Effectiveness and efficiency Economic objective:
Efficiency is more about the process and
effectiveness is more about the goal. In terms of resources it’s mostly time and
money.
Effectiveness: Doing the right thing
Efficiency: Doing it the right way.
Indicators
Health gain: Life expectancy / QALY / DALY
Equity: Life expectancy at birth by race and sex / uninsured rates
o Rich funds the poor / Young funds the old / Healthy funds the sick
Responsiveness: Patient or population satisfaction
o Decisions depend on society
Effectiveness and efficiency: Average costs of treatment in hospitals / comparison
between countries in lower extremity amputation in adults with diabetes
Indicators are mostly developed in high income countries.
Four functions of the health care systems:
1. Stewardship
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