February 3, 2014
Global Ranking of Health Systems
Nothing on HRBA to Education, 50 Multiple choice, combination of memorization and
• 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
• 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
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
• Stewardship principle; guidance to healthcare system to regulate practices of different
• 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