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Week 10 readings.docx

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University of Toronto Mississauga
Grace Barakat

Week 10 readings: Inequalities in the provision and Utilization of Health services Models of medical care -collectivist: provide health care on the basis of need rather than ability to pay -anti-collectivist: funding health care coming from private health care insurance schemes Principles of health service delivery -primary health care is provided in home, in a clinic, or health center. include basic medical attention -range of services offered, such as prescribing immunization, screening for nutrition -includes dental -need to be offered locally -secondary care is offered in a hospital, where patients may be admitted for treatment that cannot take place in a health center or clinic -in essence, the secondary sector offers more specialized care and will often be less concerned with prevention and more with cure -further specialist care may be referred to a tertiary center that will have facilities not available in smaller hospitals (example cancer) Geographies of rationing -developed nations are currently experiencing a health conundrum (life expectancies increase, so too do the costs of the health care system) -as a result, the provision of health services is inevitably tied up with issues of resource allocation, priority-setting, or “rationing” -questions of a geographical, as well as an economic, political, and managerial nature -issues arise concerning where to locate the supplies -In Canada inequities in access arise in urban and rural areas -first, we can aim to provide services that are efficient (provide services that maximize health benefit while minimizing cost) -effective (treatments we offer having real benefit, or are we wasting resources on providing services that offer little health gain) -equitable (services being provided uniformly to the populations they are designed to serve) -equity in the provision of services must not be confused with equality. Geographically, equality suggests that there should be an even distribution of services per hear of population. But what matters much more is equality in relation to need, and this is what we understand by equity -to what extent are services being provided to those who need them -inverse care law: those in most need of health care are less likely to find it available Does size matter? -one advantage of larger, more concentrated units is that these are more likely to be center of clinical expertise and excellence, since the carrying out of larger numbers of procedures permits skills to be developed and refined -a further advantage of larger centers is that they can reap economies of scale (size) and scope (using the same facilities for a variety of purposes) -set against these benefits are the increased travel costs, possibly lower rates of utilization, since, as we shall see later, rates of use decline with distance The need for health care -developed, or developing, world: in the latter the basic needs for life, such as access to safe drinking water or an adequate supply of nutritious food, are far from universally met, although they are taken for granted in the developed world. -In developed countries, “need” takes on a different dimension -the gap between need and demand is sometimes referred to as “expressed need” -example some people will demand surgery to change their sex, surgery which they could argue is needed to fulfill their life but others would argue is a waste of scarce resources Inequalities in the provision of health services Health care provision in developing countries -there is an inverse relation, with those countries in “burdened” regions accounting for a much smaller fraction of global health expenditure than is the case in established market economies -the range of risk factors for health varies dramatically between the developed and the developing world -3 fundamental objectives of any health system 1. improving the health of the population they serve 2. responding to people’s expectations 3. providing financial protection against the costs of ill health -universal access for all is typically accessed more by the better-off members of society, and efforts to reach the poor have failed -in most developing countries, where the populations were concentrated in rural areas, major ubran hospital received about two-thirds of govt. funding for HC -new universalism: hybrid model. Has strong fundamental principles of primary care but focuses on the high-quality delivery of essential care for everyone, defined primarily on the basis of cost-effectiveness, rather than all possible care for the entire population or only the simplest and most basic care for the very poor -structuralist perspective argues better housing, nutrition, and safe water are required otherwise the “cured” children simply become reinfected -Millennium development goals: goal 1 is to eradicate hunger and extreme poverty -of all MDGs, the least progress has been made around increasing access to adequate sanitation and safe drinking water -The World Bank is the major donor to developing countries and sets fiscal targets, the response to which in Third World countries has been to cut social rather than military expenditure and to enlarge the role of the private sector in health care delivery. -the role played by mutli-national drug companies in providing health care in the developing world is well documented; so too, is their lack of willingness to provide essential drugs to the poor in those countries -4 suggested ma
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