Intro to Healthcare Systems

• Health care is a business process involving trained, licensed professionals enhancing and restoring health status for individuals and communities
• This happens via prevention, diagnosis, treatment, recovery, along with the cure of disease, illness, injury, and physical/mental impairments
• Enhanced quality of life by improving health is the fundamental purpose of health care
• Social profit is a focus of health care in order to fulfill the promise to society

Health Care Concepts

• Essential health care should be affordable and accessible at a country and community level, and be practical and socially acceptable (WHO, 1978)
• Universal health coverage means all people and communities can use effective promotive, curative, rehabilitative and palliative health services without financial hardship (WHO, 2016)
• The contemporary concept of health care is based on prevention

Uniqueness of Health Care

• Health care is the world's largest industrial segment and employer
• Health care is characterized by the wide range of stakeholders along with the complexity in ownership/resourcing, and the professional autonomy of its staff.

Health Care Processes

• Health care is analyzed from various perspectives by different disciplines, using diverse information sources
• Policy Perspective: Policy analysis of health systems, primary and integrated care
• Economic Perspective: Focuses on efficient care and cost control
• Management Perspective: Aims on redesign/ improve logistics within health care system/facility
• Quality Perspective: Sees health care as a determinant of health outcomes.
• Example health care processes are admission, ambulatory, emergency, acute, long-term, palliative, home, direct/indirect, amputation, and prenatal services
• Nursing is a paraprofessional heath care process.
• Legal acts in each country define activities, ethics, principles, values, priorities, objectives, providers, funding, and other conditions in the healthcare system

Key Principles of a Health System

• Availability of health care and equity for all citizens
• Material security of citizens
• Macro and Microeconomic efficiency
• Freedom of choice for consumers
• Adequate provider autonomy

Contexts of Care

• Living Environment: Homes and Communities
• Social Environment: Families, population, and cultural groups
• Psychological Environment: Illness and modes of information processing
• Technological Environment: Broadband, telecom, household
• Health Services Environment: Care Delivery is a key factor for change.

Health Care in Rural Settings

• Rural areas face challenges like poverty, aging populations, economic decline, large geographical distances, inadequate transportation, and limited providers/facilities
• Low motivation of health professionals, along with difficulties obtaining formal health insurance and different forms of informal payments are challenges within healthcare

Demographic and Epidemiological Transition

• Population age depends on natality, mortality, and net migration
• Improved nutrition, sanitary conditions, vaccines, antibiotics, medical technology, lead to declining mortality rates
• Reduced fertility and birth rates are attributed to birth control measures
• Both developed and developing nations face a growing burden of chronic non-communicable diseases (cardiovascular diseases, cancers, injuries).
• Morbidity and mortality from infectious diseases are prevalent in developing countries

Current Health Drivers

• Technology, information and networking are drivers for recognition that healthcare is knowledge-based
• Health Care Environment: Tighter resources, lack of direction, greater demands, job cuts, uncertainty, and an inability to adapt rapidly are major factors for delivery systems

Other Current Drivers

• Education and Practice
• Changing consumer role
• Professions
• New patient environments
• Internet
• Globalisation
• Migration
• Increasing public accountability

Future of Health Care

• Patients will have the same access to knowledge as professionals, and both will become equal partners
• Self-care will gain importance and health care shifts to chronic care management
• A discrepancy exists between the potential and reality of health care driving the importance for evidence
• Health will be at the forefront of politics, and issues like ethics, learning, and leadership will be prioritized

Clinical Iceberg Model

• The clinical iceberg model illustrates various health care levels with the healthy population at the base, followed by unfelt and felt needs, then demand for lay care
• Tiered Health Care: Primary (2,000-50,000 citizens), Secondary (50,000-500,00 citizens), and Tertiary (more than 500,000 citizens)

Health System Mapping

• A health system map shows interactions among populations/patients, providers of services, financing agents, and government/professional bodies
• Populations directly pay providers for health services based on taxes, premiums, insurance coverage and regulation, all while receiving resources

Pressures on Health Systems

• Pressures include public expectations, social-demographic changes, participation/transparency, globalization, disease model changes, evidence-based medicine, plus new knowledge and financial sustainability.

Providers of Health Care

• Access is granted through training, manpower planning, and licensing
• Functioning involves auditing standards, physician liability, ethical codes, and disciplinary bodies
• Structurally: public, private, and mixed sectors, integration of care providers, and cost containment.

Healthcare Services and Organization Factors

• Economic: National income & wealth distribution
• Political: Government stability & external influences
• Geographical: Natural conditions affecting agriculture, communication, transport, and nutrition
• Sociodemographic: Population density, growth, urbanization, and education which all factor into health care systems.
• Historical factors influence colonial inheritance, facility concentration in urban areas and centralized planning.

Milestones in Healthcare Development

• Alma Ata Conference 1978: Concept of primary health care
• Canada 1982: Concept of healthy policy
• European Strategy for “Health for All”
• Otava Charter – 1986

Alma Ata Declaration (1978)

• Resulted from changing trends toward primary care and a shift in care organization
• It bundled convergent trends and formulated one strategy for health care for all
• Its philosophy about health recognizes the equity, community involvement, multisectoral approach, appropriate technology, and health promotion. Criticisms of the Alma-Ata
• Declaration includes it being too general
• Health and Population Italy's Development Conference 1979 offered selective PHC goals named GOBI (growth monitoring, and immunization)
• An addition was offered later named GOBI-FFF which included food supplementation, female literacy, and family planning

Astana declaration (2018)

• There are many ongoing challenges, the world has advanced greatly in health
• The primary health care (PHC) solves today sustainability
• The PHC approach is foundational
• UHC(Universal Health Coverage )
• SDGs (Sustainable Development Goals)

Levels of Healthcare

• Self-care
• Primary healthcare
• Secondary Healthcare
• Tertiary Healthcare

Types of Healthcare Organizations in Serbia

• Dom zdravlja(Primary health care center)
• Apoteka (Pharmacy)
• Bolnica (Hospital, general and specialized)
• Zavod (ambulatory services that are dealing w/ healthcare for pathology of population groups)
• Zavodi (Institutes that are active at all levels) : IPHs, Blood Transfusion Institute; Vaccine and Sera...
• Klinika (Clinics)
• Institut(Institutes)
• Klinicko-bolnicki centar (Clinical-hospital center)
• Klinicki centar (Clinical center)

Setting up health care institutions involves

• planning of institutions, then licensing and receiving accreditation
• Functioning involves legislation on quality control, liability/ the safety, plus the maintenance/control of technical equipment and laboratories

Legislation

• A structural component of health care involves public, private, and mixed systems
• Coordination of services between institutions
• Impact from labor legislation
• Cost-containment

Primary Health Care Commonalities

• First contact with the health system
• Gatekeeping hospital care and drugs
• Provides a multirole method to patient needs

Primary Health Care Differences

• Service delivery(poly, group practice, multiprofessional health centers)
• Employment status of doctors(employed dual, independent contractors)
• (geographically list system/ no specified area population)
• Prevailing doctors remuneration of GPS (fee for capitation etc)
• Referral restrictions(no access, specialist access)
• internal staff( team work, un professional, staff roles)
• External integration w/ other services(education, social, public)
• Staff integration

Secondary Health Care Characteristics

• Hospitals are central to he delivery of health care to more than 50,000 persons
• Hospitals consume 50-70% of the overall healthcare budget
• Hospitals are positioned at the apex of health care, adopt certain policies to get access to special services
• Specialists are required to become leaders within their healthcare to contribute population wide

Secondary Health Care Institutions

• Hospitals are founded and funded by the public sector, health organizations, insurance companies, charities, religious orders, and charitable leaders
• They can be general/specialized or teaching(university) institutions

Secondary Health Care Pressures

• Hospitals grow over time and face rapid changing in pressures
• Hospitals often change structure of their staff, their knowledge, their technology, and public policy
• Expectations occur along with internal structures, leading to complex institutions to change, although they are incrementally changing

Challenges in Serbia

• Disadvantaged groups are at highest risks of inequalities and access to health care which are elderly in rural regions, disabled and Roma.
• Inadequate employment and educating of health professionals deficits include surgeons, radiologists, patologists, nurses among clinicians.

Explore healthcare as a business, its key principles, and influential factors. Understand delivery challenges, future components, and the clinical iceberg model. This overview provides insight into the context of healthcare systems.