Chapter 11 Book Notes

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University of Toronto Scarborough
International Development Studies
Anne- Emanuelle Birn

Chapter 12: Understanding and organizing health care systems What is a health care system? - Within the health sector, the element that most affect health are public health activities such as water supply and sanitation, food inspection, vector insect control, disease surveillance, reduction of industrial pollution, and regulation of pharmaceuticals. But many dont take these into account. - The organization of the health care system in each country is a reflection of its political trajectory and societal ideasvalues. It is also influenced by the international political and economic order. - Roemer says: A health care system is the a combination of resources, organization, financing, and management that culminate in the delivery of health services to the pop. o Health care systems tend to focus on medicalized care, at the expense of community-based, integrative services. Closely related to this is the fact that HC systems tend to privilege biomedical and behavioural models over the other ones. - Win every country, there is an entity, usually a ministry of health. They may be the dominant provider of medical care, or its main function may be to supervise and regulate the work of other organization. - Health policy is usually focused on curative, medicalized care and underemphasizes community, preventive, and integrated services. - A bona fide health policy would focus on a range of societal determinants of health, many of which are outside of the direct influence of ministries of health - **An important characteristic of health care systems according to Donald Light is their relation to a societys cultural and political values: o 1) mutual aid values; underlying aim of health system is to help fellow members of society and their families when they are ill o 2) societalstate values; main goal of health system is to strengthen the nation through a vigorous, healthy population o 3) professional values; purpose of the health system is to provide the best possible care to every sick patient o 4) Corporatist values: the role of the health care system is to join buyers and sellers, providers and patients, who then decide on the range and cost of services to be provided. - Health care systems are further shaped by the extent to which health is viewed as a public good & human right as opposed to a commodity or privilege Table 12-1:Public vs Private Financing & delivery - no health systems that are privately financed & publicly delivered - Korea, Canada, New Zealand, Thailand largely publicly financed, mix of private public delivery - US privately financed & privately delivered (except public financing for seniors, disabled, military) - United kingdom, Cuba, Spain Publicly financed & delivered Health system typologies Political economy of health system - *Simplest way of classifying health systems is two variables. o 1) the financing and delivery of health care services o 2) whether each of these occurs in the public or private sector. - Financing comes from income from state-owned enterprises, taxes, user fees, etc. - Delivery is the means by which HC is provided. -Public means: hospitals are owned by the government, medical practitioners are employed, contracted, subsidised by govt. -Private means: that hospitals and practitioners operate outside of the government o Critiques: -few countries fit neatly into a single category - the typology doesnt explain how the differences in HC systems come about - Navarro: capitalism governs financing and delivery of health services. o Navarros Alternative P-E Approach to Health Systems Analysis considers: political system & distribution of political power; ownership and social structure of production; distribution of income & resources; historical attributes. - The political economy approach to health analysis seeks to take into account: 1) the political system and distribution of political power, 2) the ownership and social structure of production, 3) distribution of income and resources, 3) historical attributes. *Roemers typology: economic level and health care policy. - Milton Roemers classification of health care systems is perhaps the best known and mostly widely replicated typology. 2 key points: o 1) The level of economic development of a country (GNPcapita) o 2) the degree to which the market andor the state influence the distribution of health care goods and services. - Roemers typology distinguishes among 4 different types of health care policies, based on the level of state protection against market forces. 12-2 o Critiques: - doesnt consider changing nature of pol, econ and social systems (USSR, China have undergone huge changes) - many countries have a mixture of priv and publ financing and delivery - private systems might not be for-profit
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