Transcript Document
Globalization and Health Care Systems Reform
Bernardo Ramirez MD, MBA UCF Health Management and Informatics April 2013
Global Health Care Management Experience
•All countries in the Americas •Partnerships Europe, CEE and NIS (Hospitals, Managed Care, Health Systems, Health Reform, Education and training on health services management [human resources development, institutional strengthening]) •Managerial and Health Services Research Perspectives •Globalization impact in health and health care services and management •Health systems reform strategies with issues like competitiveness, state regulations, insurance companies, public private partnerships and patient empowerment •Quality, safety and performance improvement •Value and impact of heath care. Chronic Care
Percent
Physician Views of the Health System, 2009 and 2012: “System Works Well, Only Minor Changes Needed” Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Percent
Physician Satisfaction with Practicing Medicine Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Examples of global issues in healthcare include:
Outsourcing of medical services (e.g. medical transcribing, radiology, billing support – similar to other businesses) Acquisitions and consolidations in the pharmaceutical industry Movement of health professional labor across national borders Medical tourism; competition for international patients Immigration and global workforce Global health – pandemics (e.g. HIV/AIDS, Avian flu, SARS) Comparative Health Systems and Health Reforms
HEALTH AS A SYSTEM
STRUCTURE PROCESS OUTPUTS PRODUCTIVITY EFFICIENCY OUTCOMES RESOURCES HEALTH SERVICES HEALTH STATUS EFFECTIVENESS POPULAT ION UTILIZAT ION
Adapted from Donabedian A. (2005) Evaluating the Quality of Medical Care. Milbank Quarterly Vol 83-No4, Reprinted from Vol44No3, 1966. And From Bradbury R. (1992) Health Systems Analysis and Hospital Quality Improvement. ISQUA,9 th International Conference Mexico.
Health Services Elements
Population Access/utilization (Education, Health Promotion, Options for Care, Legal Aspects, Geographical and Cultural Barriers) Epidemiology (Transition, Mortality, Morbidity, Population, Life Expectancy) Life Styles and behaviors (Prevention and chronic health, Patient & Family Centered)
Health Services Elements
Resources Physical Resources, (hospitals, clinics, private public, Ambulatory services) Equipment/Technology, Medicines Human resources (Education, health manpower, Incentives, training, continuing education, Physicians, nurses, technicians and emerging professions) Financial Resources (Resource allocation, budgets, financial schemes, reimbursement, insurance mechanisms)
Health Services Elements
Health Services Primary/Secondary health care. Systems.
Management Information Systems Clinical Standards and Protocols. Safety Issues.
Quality Assurance and Quality Improvement Legal aspects (malpractice) Incentives, Performance management.
Cost or services Efficiency, clinical & Management efficiency Effectiveness, Health Impact and outcomes
Types of Health Care Services
Traditional, spiritual, empirical Charitable and altruistic organizations Entrepreneurial Private practice Welfare-oriented, social insurance Government and centrally planned Prepaid voluntary insurance Owned by industry for their workers
Origins of Health Care Systems England. Chadwick report on laboring conditions. Boards of Public Health (1850). Mandatory Insurance for workers (1911) Welfare State Beveridge Report (1942), NHS (1948) Germany. Bismarck, Mandatory insurance for injury and illness (1883) Central Planning Concept: Semashko. (1923) Mixed Systems from tax-free health care in Saudi Arabia to combination of public-private
Ward in a London Hospital 2003
Infant Mortality and Total Heath Spending (% GDP)
Total Health Spending (% GDP) & Body Mas Index
THE HEALTH TRIANGLE
ACCESS EQUITY COST QUALITY & PERFORMANCE MANAGEMENT
Adapted from Cost, access, quality triangle. Harvard Medical International, 2002 Retrieved from the Internet December 20, 2006 http://www.hmiworld.org/hmi/issues/Sept_Oct_2002/features_health_systems.html
Average Health Care Spending per Capita , 1980–2010 Adjusted for Differences in Cost of Living Dollars ($US) 16 * 2009 Source: OECD Health Data 2012.
THE COMMONWEALTH FUND
Health Care Spending as a Percentage of GDP, 1980–2010 Percent 17 * 2009 GDP refers to gross domestic product.
Source: OECD Health Data 2012.
THE COMMONWEALTH FUND
Health Care Spending per Capita by Source of Funding, 2010 Adjusted for Differences in Cost of Living 18 Dollars ($US) 8,233 5,269 4,463 4,445 4,338 3,974 3,758 3,670 3,433 3,035 3,022 * 2009.
Source: OECD Health Data 2012.
THE COMMONWEALTH FUND
Dollars ($US) Pharmaceutical Spending per Capita, 2010
Adjusted for Differences in Cost of Living
19 * 2009.
** 2008.
Source: OECD Health Data 2012.
THE COMMONWEALTH FUND
Relation of Health with Physicians
Will problems be solved in developing countries if there were more physicians?
More and other health professionals?
Different Health Personnel Ratios?
How about training, incentives, etc?
More hospitals and health centers?
More technology?
Number of Practicing Physicians per 1,000 Population, 2010 21 * 2009.
Source: OECD Health Data 2012.
THE COMMONWEALTH FUND
Average Annual Number of Physician Visits per Capita, 2010 22 * 2009.
** 2008.
Source: OECD Health Data 2012.
THE COMMONWEALTH FUND
Doctors’ Perception of Patient Access Barriers
Percent reporting their patients OFTEN have: Difficulty paying out-of-pocket costs AUS 25 CAN 26 Difficulty getting diagnostic tests 16 38 FR GER NETH NZ NOR SWE SWIZ UK 29 41 21 27 42 7 26 59 4 10 6 15 16 3 13 14 Long waits to see a specialist 60 73 59 68 21 75 60 49 10 28 US 59 23 28
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Practice Has Arrangement for Patients’ After-Hours Care to See Doctor or Nurse
Percent
* In Norway, respondents were asked whether there practice has arrangements or if there are regional arrangements.
Physicians.
24
Percent
Practice Uses Nurse Case Managers or Navigators for Patients with Serious Chronic Conditions Note: Question asked differently in France.
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Primary Care Doctors’ Receipt of Information from Specialists
Percent said after their patient visits a specialist they always receive: Report with all relevant health information Information about changes to patient’s drugs or care plan Information that is timely and available when needed AUS CAN 32 30 13 26 24 11 FR GER NETH NZ NOR SWE SWIZ UK 51 47 26 13 12 4 13 5 1 41 44 15 26 22 4 12 13 8 59 44 27 36 41 18 US 19 16 11
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Health Sector Reforms Around The World
Balance the Iron Triangle (Access-Quality-Cost) Reorient MOH (make them smaller or more functional, performance, accountability, modernization, separate provision from financing, competition, Chronic-Acute Care) Institute user charges-Accountability Institute or expand health insurance schemes Decentralize-Empowerment Third party Contracts with private/public providers
Sustainability:
The capacity of health services to function with efficiency, including the financial, environment and social interaction that guaranties an effective service now and in the future, with a minimum of external intervention and without limiting the capacity of future generations to fulfill their needs.
Adapted from Gallopin Gilberto. A systems approach to sustainability and sustainable development. Sustainable Development and Human settlements Division. ECLAC/Government of the Netherlands. Project “Sustainable Assessment in Latin America and the Caribbean” Santiago de Chile, March 2003
Areas and Dimensions Sustainability of Processes Sustainability of Organizations The dimensions of sustainability grouped in five areas: are The environment Socio-Cultural Institutional Capacity Development The Financial Dimension The Political Dimension