Transcript Introduction to Comparative Health Care Systems Lecture 3 Tracey Lynn Koehlmoos, PhD, MHA HSCI 609 Comparative International Health Systems.

Introduction to Comparative
Health Care Systems
Lecture 3
Tracey Lynn Koehlmoos, PhD, MHA
HSCI 609 Comparative International Health
Systems
Overview
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Define Health
Define Health Services System
How can we compare?
Why should we compare?
Defining Health
• WHO:
– Health is not merely the absence of disease,
but the state of physical, mental and social
well-being.
Fundamental conditions for health:
Peace, shelter, education, food, income,
stable ecosystem, sustainable resources,
social justice, equity
Determinants of Health
Access to Health Services
Physical and Mental
Well-Being
Physical Environment
Social Environment
The Iron Triangle or the Holy Grail?
All nations
struggle to
balance access to
healthcare
with quality and
cost efficiency.
Is there one perfect solution for all nations?
Health Care in General
• Health status is central to quality of life
• In every advanced country, healthcare is
the largest economic activity—consuming
between 5% and 16% of the GDP.
• Health services workforce >10 % of all
workers in most OECD nations.
• All countries are engaging major
healthcare reform with an emphasis on
cost efficiency.
Common Challenges of Developed
Nations
• Aging population—Europe, USA, Japan
– 30-40% of consumption in some countries
– Need for long term care
• Indigent citizens—how to include everyone
• Incorporating technology
– Rationing expensive procedures
– Overuse in some countries
• Rising costs—What GDP % is too high?
Defining a Healthcare System
The combination of health care institutions,
supporting human resources, financing
mechanisms, information systems,
organizational structures that link
institutions and resources, and
management structures that collectively
culminate in the delivery of health services
to patients. (Anderson, 1989a)
Roemer Model
MANAGEMENT
RESOURCE
PRODUCTION
ORGANIZATION
OF
PROGRAMS
ECONOMIC
SUPPORT
Our definition of a
healthcare system lends
itself to the use of
the Roemer Model
DELIVERY
OF
SERVICES
Components to Compare
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Organization of the Program
Management of Health Services System
Economic Support of Health Services
Production of Health Services Resources
Delivery of Health Services
• Not in the Roemer Model—but look for the
use of Information Systems and advanced
technology!
Paradigms for Comparison
• National Health Service Model (Beveridge):
– Universal coverage, tax-based financing
– National ownership of production
• Social Insurance Model: (Bismarck Model)
– Universal social security (employer, employee
taxes)
– Public/Private ownership of production
• Private Insurance Model:
– Employment-based private insurance
– Private ownership of production
NO ABSOLUTES, VARIATIONS IN ALL APPLICATIONS!
Major Influences on Systems
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Environmental Influences
Historical Record
Demographic Influences
Economic Influences
More: Cultural, Political, Social Influences
• Public Health and Disease Prevention—
What makes the population need health
services? (Lifestyle, pollution, unsafe?)
Health Outcomes to Compare
Infant
Mortality
Life Expect Life Expect
Male
Female
76.3
81.7
Canada
5.3
Japan
3.6
77.6
84.6
UK
5.8
75.0
79.8
US
7.2
73.9
79.4
(1997-2000)
Value of International Comparison
• Understand and appreciate common
healthcare problems
• Understand how characteristics of the
delivery system impact population
outcomes
• Impact of mental illness on culture
• Comparative strategies for reform and
increasing quality and containing costs
Conclusion
• There is no “Gold Standard” for health
services systems just the ability to adapt,
reform and learn.
• Werner Christie (Norwegian MoH) said,
“The whole healthcare system is futile, as
the average death rate is still 100%”
• This course should teach you about the
range of possibilities and give you tools to
apply in your own life and work.