IDSB04H3 Chapter Notes - Chapter 11: Health System, Curative Care, Prostate Cancer

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Published on 19 Apr 2017
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IDSB04 Chapter 11 Reading
Chapter 11 - Understanding and Organizing Health Care Systems
Key Questions:
- Ho do a soiety’s alues shape its health are syste?
- How do different countries organize their health care systems and what are the current approaches to health reform?
- What are the main factors affecting the organization and delivery of care?
- Health oes ot just fo a soiet’s health ae sste o health interventions, but from different joining political, social,
economic, medical/public health, and cultural factors including living, working, and environmental conditions, social and tax
policies, and larger context of financial and trade regimes, the control of resources and the distribution of wealth and power
- A patiula ifluee o health sstes is edializatio ediie’s epadig puie ito othe aeas of life ad
biomedicialization (based on the dominant techno scientific paradigm)
- Diseases-mongering = the selling and labeling of conditions such as pre-diabetes, pre-hypertension, prostate cancer
o This creates new markets for large-scale consumption of medical products
- Over-diagnosis also burdens the health system and makes access to care harder for those who have serious health needs
- Medical-industrial complex
o Big Pharma, private insurance companies, medical real estate, medical supplies and equipment these are all
crafted research and social policies in favor of their interests and maximum profits
- Health care systems also have their own power dynamic
o Internal occupational divisions of labor which create hierarchies among workers (ex. Managers, physicians, nurses,
support staff etc.)
o Power divisions based on the predominance of the medical model the doctors have power over the nurses,
midwives etc., which is in favor of scientific expertise where physicians are seen to have all the knowledge
What Is a Health Care System?
- Health care systems = the combination of resources, organization, financing, and management that culminate in the delivery
of health services to the population
- The organization of the health care system in each country is a reflection of its political trajectory, class dynamic and societal
ideals/values
- Health policy is also influences by the political and economic order
o TNCs have the power to influence public policies which affects the ability of national governments to shape social,
work and policy environments
- The larger capitalist system impedes the realization of equitable health systems in the public domain
- Many countries have a formal health policy in the national constitutional together with the right to health or the entitlement
to health care
- Health policy is usually focused on curative, medicalized care, underemphasizing community, preventive and integrated
services while privileging biomedical and behavioral models over a political economy of health approach
Classifying Health Care Systems: A Political Economy Approach
- The means of classifying health care systems according to two variables
o The financing and delivery of health care services
This means how funds are collected to pay for health care services (public revenues taxes, social
insurance OR private insurance, employers, and/or user fees)
o Whether each of these occurs in the public or private sector
How health care is provided public delivery, hospitals, clinics; are the owned and operated by the state
Table 11-2 Evolution of Health Systems
- These shape whether health is viewed as a human right rather than a commodity or privilege
Health System
Type 1: Private
Type 2: Pluralistic
Type 3: National Health
Insurance
Type 4: National Health
Service
Type 6: Socialized
Health Service
Political and ideological
values
Health care as an item
of personal
consumption
Health care as primarily
a consumer good
Health care as an
insured, guaranteed
service
Health care as a state
supported service
Health care as a right
and state-provided
public service
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Position of the physician
Solo entrepreneur
Sola entrepreneur and
member of practitioner
group
Private solo or group
practice and/or
employed by hospitals
Private solo or group
practice and/or
employed by hospitals
State employee
Ownership of facilities
Private
Private, not-for-profit,
and public
Not-for-profit and
public, some private
Mostly public
Entirely public
Source of financing
Private out-of-pocket
payments
Mix of private, out-of-
pocket, and public
Primarily public single-
payer
Public monopsony
Public monopsony
Administration and
regulation
Market
Market, some
government
Government, some
market
Government
Government
Prototype
Most countries until the
19th and 20th century
United State, Peru,
Nigeria
France, Taiwan, Japan,
Costa Rica
Italy, Sweden (de facto)
Former Soviet Union,
Cuba
- The typology offers a way of understanding but it does not explain how these differences materialized
- The interplay of health care system features with:
o The political system and distribution of political power, wealth and resources
o The ownership and social structure of the economy
o Historical attributes
Principles of Health Care Systems
Key Questions:
- What basic principles (should) inform the variety of health care systems across both HICs and LMICs?
Universality
- Universality of a health care system shows the proportion of residents who have a legal right to obtain benefits and care
o Even with universality, some groups are still excluded refugees, recently arrived immigrants, undocumented
people
Accessibility
- This means that all residents are equally able to obtain care in terms of geography, resource availability (ex. The number of
clinics or health care professionals)
- Access can be impeded by factors such as cost, inadequacy of transportation, hours of operation, lost wages from work
absence
- Portability is also important which means that people can obtain care throughout the country and are not confined to one
geographic location
Equity
- The absence of unjust, unfair and avoidable differences in health according to socially-defined population groups this refers
specifically to:
o Equity in access to and utilization of health care services financial, physical, organization, or cultural accessibility
o Equity in resource allocation ex. By regional, or employment status
o Equity in he quality and delivery of services
o Equity in health outcomes
- The poorest and most oppressed populations experience the greatest illness and premature mortality than those who are
privileged
Comprehensiveness
- The array and extent of necessary services that are publicly provided and/or covered through insurance mechanisms
- Priority-setting which seeks to determine what constitutes comprehensiveness in different political and cultural contexts
people have to choose what is medically necessary
Affordability and Sustainability
- Affordability is the extent to which the system can be financed through agreed upon means (taxes, premiums, out-of-pocket
etc.) and how it fits with social values
- A sustainable system is financially accessible, uses resource appropriately and is societally acceptable
Quality
- Can be based on perception (the notion that one set of practitioners is better than another) or more objective measures such
as procedures or types of providers
Participation
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- The participation of citizens in the design, delivery, financing, and monitoring of health care systems may lead to increased
equity and public responsiveness
- This also unfolds in terms of social movement demands around public funding and quality, access and equity of care
Organizational Coherence, Health Promotion, and Intersectoral Cooperation
- A well-integrated system enhances equity, limits duplication and waste in administrative functions, maximizes efficiency and
minimizes confusion on the part of providers and the public
o On the other hand, fragmented health services are not comprehensive, responsive to needs, or integrated and
coordinated at different levels or fail to provide continuity of care
- Health promotion focuses on building and engaging the larger societal conditions that foster good health
o This includes adequately addressing health concerns
Health Care System Archetypes
Key Questions:
- Which health care systems serve as organizational archetypes?
- What historical and political factors have led to different trajectories of health care system development?
- AN organized system to oversee the health care of large populations is a relatively recent development that is linked to the
capitalist state
Social Health Insurance: Germany
- Gea’s sste of soial isuae oigiated i the 1880s and provides on of the earliest examples of state-guaranteed
health care coverage
- During the century of Industrial Revolution, workers began to form voluntary mutual-help groups, where members agreed to
make regular contributions to a common fund that would provide cash benefits in the even of sickness or unemployment
- These sickness funds are non-pofit ogaizatios ad do’t poide edial ae dietl, ut athe futio as fiaial
intermediaries
Box 11- Basi Featues of Gea’s “oial Insurance System
- Publicly funded social health insurance is compulsory for employees earning up to 54 900 (euros) and their dependents, financed through shared payroll
and income taxes; coverage for low-income and unemployed persons is government-subsidized
- Health insurance is provided through than 130 competing nonprofit, autonomous, nongovernmental health insurance plans sikess fuds
- Public, private nonprofit, and a growing number of private hospitals are reimbursed for patient care by sickness funds through a perspective system of
diagnosis-related fees
- Ambulatory care physicians, in solo or shared private practice, and organized in regional associations, are paid by capitation or fee-for-service, under
negotiated rates
- Patients are free to select any generalist or specialist physician
National Health Service: United Kingdom
- Long tradition of mutual aid societies and of government regulation of medical practices and the welfare of the poor
- The biggest contribution was to unify social policy across classes by proposing a single social insurance scheme for the whole
nation, financed through income taxes
- Basic protection which was through a public and universal health service
Box 11-2 Basic Features of the NHS
- Comprehensive coverage for all residents
- One system funded mostly through taxation (with structural differences under devolved local administrations in Northern Ireland, Scotland, and Wales)
- Mostly free at the point of service, although cost sharing is growing
- The national government oversees primary care and delivery of most specialty and hospital care services through trusts, contracting to the private sector
for some elective surgery
- Hospital medical consultants (specialists) are generally employed in public hospitals
- Independent GPs act as gatekeeper to specialized care and are paid through primary care trusts through a mix of capitation, salary, and fee-for-services
methods
- Other health professionals, including dentist, optometrists, and pharmacists, practices on a more independent commercial basis with few subsidies
A Centrally Planned Health Care System: The Former Soviet Union
- It was born of radical change
- The initial major issue in the SU was the control of epidemic diseases
- The Russian Communist Party set immediate tasks
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