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**Policy :
-Agreement or consensus
-Setting OBJ
-monitor progress
-Goals and Aims
-”Saving lives: healtheir nation ” ENG
**Health Policy :
-Descion/plans/ action taken to acheive healthcare & Goals.
1-defines vision for future( Short medium term)
2-outlines PRiorities, consesic & inform ppl
***HPdevelopment:
Continous process
-asses situation
-Formulate policy
-implement monitor
-Evaulate
-revise
x process Non linear
Evaluate–> Formulate–>implement—> monitor
(E-F-I-M)
————–
**LT health policy:
–physican ass 1989
-National concept 10/1991
-93 & 97 conference
-98 : NHP approved parlament & Board
Obj:
-Equity
-Life Quality ↑
**Documents:
| Article 25 (1948) | -everyone…beyond control (13 pts) -motherhood& childhood ..same protection |
| Alma-Ata(1978) | -‘‘Health for All 2000” -Primary health Care& Disease prevention” health 2000Principles: 1.Ensure Equity Health (↓gap in status btwn countries & groups in Country) 2.+5 years of life( full physical mental & Social Potential) 3-Adding health to life(↓ disease& diability) 4-+ years : ↑ life expentacy |
| Ottowa Charter (1986) | ^Empowerment: 1-build public policies 2-supportive Enviroment 3-Community 4-personal skills 5- Re-orientation of health servies |
| Ljublna( | ^Principles: -coherent HEalth policy -Listen to Citizens -Reshape health delivery -Reorient Human resources -Strenth Management -Learn from experience |
| Jakarta( | -↑ invetments in health -↑ Social resp -↑ colaoration in health promotion -infrastructure ↑ |
| Health 21 | 1 GOAL: achieve full health potential for all 2 aims: I- ↑ & protect people health II- ↓ suffering 3 Values: -Health is a Human right -Equity in health solidatory ( country ,groups and gender) -accountiblity of diff groups |
| Verona | -mulisectoral Coloboration -investment to health: Health<–> Economi<–> Social |
| Millienuin (2000-2015 ) | -tackle poverty il helath and↑ life by 2015 1-Eradicate extreme povery& hunger 2- achieve universal 1 education 3-Gender equality empower Women 4- ↓ child death 5-↑ mothers health 6- HIV combat 7- envi friendly 8- Global partership |
health 2020:
***WHO :
-directing and cordinating authority -global health matter -Evidence- based policy -Monitor & Asses Trends -health guidlines& Standard -health research -help countries -Geneva,president 5 Years | ^WHO world: -Geneva ^ EU: -copenhagen ^ Meditera: -Ciaro ^South east : -new delhi ^western pacific : -Manilla ^ Africa: Brazaville, congo ^ Americas : -washington DC . |
Function:
-Strategic center—> Disease outbreaks& Emergency
-International health regulation (IHR)—–>estblish rules for countries
– access to Quality
-educate& manage health workforce
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I-Health resources:# hospitals/beds/physican/GP/ nurses per 100 K
II- Ulitization & expenditure: THE from GDP (%) /THE,PPP/public health % of THE
—————–
**Health system:
-Promote , Restore & Maintain Health
-includes all Organizaton , ppl and resources to improve health action
^^Boundaries of HS:
2-Narrowetst: MOH + individual health services
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2-non personal & collective medical services but exclude intersectoral action (water nad sanitation programs)
<
3-All Actors instituiion & resources incuding Intersectoral ![ WHO ]
*HS vs other Systems:
1- external environment
2-continous evolution of technologies
3-workforce management difficulty
4-x potential goal of service delivery !
HS should be stidues with other asepcts of society,NOT in Vaccum
reflects social balances and Values
**HS function :
1-Supervise Heath Resources & services ( oversitght)
2-produce and deliver personal & non personal health services (human & physcial resources /raising and poolign resources)
3-Financing health service( collecting & allocating resrouces)
imrpve ppl health / out of pocket burden / Focus on public & private sector
***HS Obj :
-Improve health of popullation
-live up to expectation
-protect agaisnt Cost of illness
^ Medical pluralism : 70-90% of health care in popular sector
***Heath Care Sectors:
1-popular (70-90%):
2- folk:
3-professionl : by laws, health sectors & professional
^^Patents Role :
1-Consumer
2-contributer to financing the system
3- providoer(sometime)(pregnant women)
4-Citizen
***HS components:
1- Resources: Human/ comodities /X / knowledge
2-Organization : mainly by govenrment/Private enterprises—–> most variable
3-Managements:planning/ Administration / regulation / legislaiton—> on political system
4-Economic support :SHI / charity / Foreign Aif /
5- Delivery : combination of 4 above = 1/2/3 health care + ambulance
——————
***Decentralization :
-the smaller the better more agile then larger ones .
-Trasnfer of power from higher to lower (STATE& procesS)
in this case to Various institutions of HS .
| Delegation | to a lower
organizational level. |
| Deconcentration | to lower Adminitrative level |
| Devolution | to lower political level |
| Privatization | to private owners |
Russia vs Norway vs Canada
| + | – |
-↑ link descion makers & users -different service and financing levels -Smaller units more flexible -easier internal coardination | -focus on own micro performance rather then Macro -↓coardinated impulses -inapp diversity -↓ comparibilty a& preidctibility |
C vs DC :
-C : better supervision ( poland & slovakia Nordic countrieS)
after they were DC
——————
**financing the HS:
1-Revenue Collections /Fun Pooling / Purchasing
which is then used to PRovide Personal / Non-Personal HS
I- Revenue collection :
from popullation
by:
-Taxation (direct from invidual/ household) / indirect( transactions) – national vs local – general or hypothetical
-SHI
-Private insurance
-Individual
-out of pocket
-Loans
II- FUND POOLING:
-difference from revie colelction , in pooling financial risk is Shared
-”accumilation of prepaid revenue on behalf of popullation;’;
-this function can be done by SHI , by if done bu diff agents we need” RISK adjusment”
III-purchasing:
”Trasnfer of pooled resources to service provider”
what affects expenses and Revenue:
-Supply and Dmand
-Contextual factors (ituation / sstructure/ envi/ culture)
Situation : political event
structural: economic base/ Political insittution / dmeography
Enviromental Factors:EU regulation
-cultural: value of communities
***Types of HS financing:
classification by :
1-OESD
2- Authors
3-Willis
| OESD | Authors | Wilis |
1- NAtional (UK) 2- SHI ( Germany) 3- Private( US) | Bismark( EU based today) -beregdean -semashko | Wellfare(govenrment) market driven (private sector) |
Bismark:
-spread risk broadly, by making SHI a MUST ( UNIVERSAL)
-redistrubte income from higher to lower paid
-Emloyers to pay part
-utelising Public, Quasi public , Non profit insititution
-SHI IS ind from government and its budgert
-shared btwn employer and emplyee
-sickness fund dep on income and is employee and employer related
-Most EU with trukey and israel
Beveridge:
State finances healthcare( NOT SHI) via TAXATION regional and local
-Not earmarked( not preplaned)
-Universal coveragE( everyone) ( liek bismarek)
-Sickness fund not Independt
-pnulic sector is resp for heathcare provision
-All people recieve same rnage of services
-NORDIC countries, UK andireland
greece, italy, portugal spain also
Semashko:
-Central organisation and control
-STATE owned and financed fron state budget
-instiution budgeting
-Free for all citizens
-depends on geo distirbution
-Policlinc main service providoer
-USSR , baltic states
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*** models of payment:
1-Free-for -serive
2- Salary , emploment contract
3- capitation
Free-for -service:
-Most common
-consumer pays provider directly
-Direct relationship with consumer with no other interferance
-max the responsiveness of privdor
Salary : or emplyment:
-health providoer emplyed by large company
-Hospital community
-emplyer pays the salary for practional in exchange for service
-provider is accountable to consumer and to employer
-guidline based ( tiem cotnraint)
-ethical problems
Capitation:
-provider is paid a fixed sum over period of time
-problem is under privding
-common in primary health care services