IDSB04H3 Chapter 11: IDSB04 Chapter 11 Reading

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University of Toronto Scarborough
International Development Studies
Anne- Emanuelle Birn

IDSB04 Chapter 11 Reading Chapter 11 Understanding and Organizing Health Care Systems Key Questions: How do a societys values shape its health care system? 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 comes not just from a societys health care system or health interventions, but from different joining political, social, economic, medicalpublic 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 particular influence on health systems is medicalization (medicines expanding purview into other arenas of life) and biomedicialization (based on the dominant techno scientific paradigm) Diseasesmongering = the selling and labeling of conditions such as prediabetes, prehypertension, prostate cancer o This creates new markets for largescale consumption of medical products Overdiagnosis also burdens the health system and makes access to care harder for those who have serious health needs Medicalindustrial 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 idealsvalues 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, andor 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 112 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 Type 4: National Health Type 6: Socialized Insurance Service Health Service Political and ideologicaHealth care as an item Health care as primarilyHealth care as an Health care as a state Health care as a right values of personal a consumer good insured, guaranteed supported service and stateprovided consumption service public service
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