HRBA to Health

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International Development and Globalization
Sonia Gulati

February 3, 2014 Global Ranking of Health Systems **Midterm; Nothing on HRBA to Education, 50 Multiple choice, combination of memorization and application questions • Because the wealthy population chooses to invest only into the private sector of health care, the public sector is neglected (ie. Middle class having to pay more or newer costs for things like doctor’s notes) o US spends a big portion of GDP on healthcare but public health care still not up to par in quality.  Some tax based programs (such as Medicare) but only targets certain groups, like the destitute, elderly, military families • ObamaCare: offers new benefits and programs such as; o Insurance companies required to cover more o Insurance companies cannot limit lifetime care o Illegal to charge higher premiums for sickness o Short summary of benefits rather than long documents (currently very complex to navigate US health system) o Three health plans that cover a core set of essential health benefits for those that are not health insured (marketplace coverage), Health System Differences Globally • Physician-to-population ratio; o LIC; 2.8 physicians per 10,000 o LMIC; 10.1 physicians per 10,000 o UMIC; 22.4 physicians per 10,000 o HIC; 28.6 physicians per 10,000 o Consider brain drain,  Top three countries physicians flee to are the US, Canada, and the UK • Complementary and alternative medicine; o Generally speaking, in developing countries, there are traditional treatments (such as homeopathy, yoga, acupuncture, etc.), while western countries are dominated by allopathic medicine. o However, some countries, like India, will teach med students traditional and allopathic medical treatments. o Women more likely to use healthcare system in developed countries and more likely to be on prescription medicine. Health Systems and Globalization • People who are healthier are more likely to be more productive, retire early, not call in sick to work, etc. • In developing countries, health can be increased with basic interventions, such as providing bed-nets. • In developed countries, more complicated due to burden of disease, long-term management, and thus bigger interventions are needed. • Globalization; profit making becomes more of a priority. o Health system has a market; selling of pharmaceuticals, marketing hi-tech machines such as MRIs, rights to technology/patents (some countries want to maintain intellectual property rights) Financing Health System • Health systems financed through the public first, as well as through organizations, donors (some controversial donors, such as tobacco industry) • Analysis of cost-effectiveness; getting the most by spending the least o Invest in individuals in the lower socio-economic bracket o Look at current activity and outcome effectiveness o What can you to do modify/eliminate services? o Adding more healthcare workers or throwing money is not good enough;  How is the money being used? • Consider developing countries building beautiful, fancy hospitals with no way of maintaining it.  If Sweden enjoys better health than Uganda, life expectancy is almost twice as long, that’s because Sweden spends way more per capita. • However, Pakistan spends almost precisely the same per person as Uganda but has better life expectancy. • The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship for them; o Reduce/eliminate user fees for the vulnerable by subsidizing—this requires a strong, efficient, well-run health care system that can detect conditions early and has ability to treat and rehabilitate. o Sufficient capacity of well-trained motivated health workers o System for financing o Access to essential medicines and technologies • Consider the “sliding scale” and the benefits/consequences for implementing • “Free of charge” services; o Doesn’t necessarily increase accessibility  Are you able to affordably transport to get such treatment?  Individuals cannot miss work to access a treatment  Under-the-table corruption and discrimination still a factor • Failures of health care system; o Inverse care; richest consume greatest amount of healthcare o Impoverishing care; millions impoverished still trying to pay for healthcare o Fragmented care; excessive specialization threatens routine care o Unsafe care; unsafe and unsanitary healthcare leading to medical errors and hospital-acquired infections o Misdirected care; emphasis on secondary and tertiary care obscures potentially greater benefits of primary care Canadian Healthcare System • Social Health Transfer; federal government provides funding for educational system, social system, recently separated from other transfer to make more transparent • Federal government provides funding through cash and tax transfers to the provinces and territories to help pay for healthcare services, but the delivery of services is a provincial/territorial responsibility. • Stewardship principle; guidance to healthcare system to regulate practices of different healthcare professions. • Regulated healthcare professions act; create governing bodies at provincial level, called colleges, that would regulate the practice of different healthcare professions o Makes sure doctors are licenced, practicing competently and ethically, etc. o Ministry pr
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