Understanding and Organizing Health Care Systems Nov 9th 2010
What is a health care system?
^Z}u]v]}v}(}µU}Pv]Ì]}vU(]vv]vPvuvPuvZµou]v]vZo]ÀÇ
of health services }Z}µo]}v_
- Most countries have a formal health care policy
- Guiding principles (ex: Canada)
- Missions: health system goal go beyond provision of HC services
o Health Canada is committed }]u}À]vPZo]À}(oov[}ov}ul]vP
this countries }µo]}vu}vPY^
- But.. in reality = curative, medicalized, biomedical
Key Questions: What are the major ways of classifying health care systems?
- Two simple variables for classifying HCS
1) Financing and Delivery of HCS
2) Public or Private
Financing: how funds are collected to pay for HC services
Delivery: means by which HC is provided
Health System Typologies
Keep in mind:
- W]Àvµo]Çu}((]vv]vPvo]ÀÇ(}µv]v}ZY
Navarro
Political Economy approach accounts for:
- Political system/distribution of political power
- Ownership and social structure of production
- Distribution of income and resources
- Historical attributes (ex: SAPs, labor movements )
Key Questions: What historical and political factors have led to different trajectories of health care
systems development?
- Important patterns, archetypes of health care systems
- Compare circumstance of the development of these HC: Germany, UK, Soviet Union, China, US
One of the earlier examples of state-guaranteed HC coverage
- Industrial revolution (late 18th/19th century)
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- Working class sought protection against unpredictability of health
Box 12.1W'uvÇ[^}]o/vµv^Çu
- Publicly funded social health insurance
- }u]vP^]lv(µv_
- Prospective system of diagnosis-related fees
- Fee for service, under regulated rates
- Select any provider
}ÆíîXîWh<[E]}voZoZ^À]
- Comprehensive coverage
- Funded thru taxation
- Free at point of service
- PHC overseen by national government
- Specialists employed by public hospitals
- Independent GPs as gatekeepers
Box 12.3 A centrally planned health care system the former Soviet Union
- Centrally planned
- Prevention, occupational and community health
- Doctors = state employees
- Full coverage
- Funded thru general revenues
}ÆíîXðWDl^}]o]u]vZW}o[ Republic of China
- ^(}}}}[Çuv}vt local workers selected by comrades to be given medical
training not trained health care professionals (low cost and 90% of people covered)
- Two systems: urban and rural
- Public and private funding and provision
- Private health expenditures high
}ÆíîXñWhvÇu],oZWhv]^~}voÇÀo}v]}voZ}v[}À]Y
- Public overage for some
- Large uninsured population
- Proliferation of for-profit HC plans
- Mix of public and private financing and delivery
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