سیکل اصلاحات بخش سلامت

Introduction

• Health sector reforms can be viewed as a cycle.
• Ideally, the policy change process includes six steps: defining the issues, identifying their causes, developing plans, making political decisions about initiatives, implementing plans, and evaluating outcomes.
• The cycle starts again with the emergence of new issues that policymakers must address.
• In reality, reforms are rarely simple.
• Reform efforts may begin at different points in the cycle, skip stages, or combine several stages.
• For instance, reform advocates may begin by identifying a problem, such as inadequate resources in state clinics and hospitals.
• Alternatively, reformers may initiate the cycle with their preferred solution, like advocating for a new national social insurance program.
• Regardless of the approach, the policymaking cycle is a useful way to guide health reforms.

The Cycle of Governance

• The cycle includes identifying the problem, defining the issue, drafting the policy, adoption, implementation, and evaluation.
• Decision-makers across the cycle deal with ethical and political issues.

Ethics and Policy in Reform

• Analysis of experiences and providing reminders to reform implementers will be crucial.
• It is essential to consider them as part of the reform process.
• The diagram visually represents key aspects, especially the ethical and political components, emphasizing that decision-makers throughout the reform cycle grapple with these issues.
• Questions like "What are the right priorities?" and "How can political pressures be managed?" are always present.
• Our approaches necessitate clearly examining the ethical foundations of health policies.
• Disagreement with the idea that all health systems share or should share the same values.
• The text asserts that all policy positions, including their own, have ethical dimensions.
• The set aims to clarify its values and goals, letting readers judge its usefulness.
• Rejects the notion that health sector reform is purely technical, advocating instead for direct and comprehensive consideration of political factors at all stages.
• Focuses on the initial four stages, including problem statement, diagnosis, policy development, and political decision-making, with a summary of all six stages and their connections.
• Each "control knob," vital for diagnosis and policy development, is discussed in the second part.
• Despite lacking a distinct implementation phase, practical guidance based on global experiences is provided in the relevant sections on "control knobs."
• Emphasizes that theoretical debates alone have limited value; reform managers must realistically consider the specific context of their country.
• Stresses that issues in the healthcare system are rarely resolved permanently.
• Health systems must adapt to ongoing challenges as countries evolve.

New Changes

• Successful reforms often raise public expectations, increasing the demand for more reforms
• The reform process is imperfect, with managers often encountering unintended consequences and discovering flaws initially unnoticed.
• Due to these reasons, the reform cycle is usually repeated.
• Each stage of the health reform cycle and the necessary tasks are reviewed

First Stage: Problem Statement

• One of the most important stages of health sector reforms, is often overlooked
• Healthcare systems provide numerous statistics on their performance, but it's important to determine which ones warrant public attention.
• Shock or crisis often initiate the reform process.
• Conflicting interests typically lead to differing opinions on defining the problem and suitable solutions.
• A country with average income facing a regional economic downturn.
• The organization responsible for management and planning, or the Ministry of Economy and Finance, claims that the health sector consumes a significant portion of the limited government budget.
• The associations of physicians state the main issue is the decline in the quality of healthcare due to the inconsistent increase in doctors' salaries in relation to the inflation rate.
• The managers of social insurance funds assert that the main issue is the government's failure to pay its share to the retirement insurance funds.
• Hospital directors argue that the inability to secure capital for renovating hospitals is hindering them.
• Real issue is which new technology is the right one?
• Defining an issue can be approached with two types of questions, normative or descriptive

Descriptive vs Normative Questions

• Normative or prescriptive: What constitutes a well-defined problem?
• What makes poor performance in one area a more suitable priority compared to similar areas?
• The answers to these questions raise questions of ethics and philosophy.
• The ethical aspects of health sector reforms will be discussed more comprehensively in Section 3.
• Empirical or descriptive: Which social processes shape our understanding of issues? What determines the problem statement which reform managers encounter?
• The formation of the problem statement and how to manage the political aspects of health sector reforms will be addressed in Section 4.
• Emphasizes that the healthcare sector should be seen as a means, not an end, and issues should be defined in terms of outcomes.

Outcomes of the Measures

• Different ethical theories offer varying perspectives on which outcomes are most important.
• In Section 5, a specific set of performance goals will be discussed, reflecting the ethical views relevant to health sector reforms.
• Important outcome is the health status of society How long do people live, what disabilities do they have, and how do these disabilities differ among various population groups?
• The second set of outcomes is the level of satisfaction that healthcare provides among citizen.
• The third set of outcomes is protection against financial risks.
• The ability of the healthcare system to protect individuals from significant financial pressures that may arise due to illness.

Actions for Improving the Health Sector

• Accepting the focus on outcomes may be difficult for some reform managers.
• Individuals with a strong commitment to a particular policy often initiate the reform process with their preferred solution.
• Those who support the acceptance of competitive credits for health insurance, expanding family medicine, hospital autonomy, etc.
• Without explaining these policies how these policies will improve the functioning of the system.
• Many individuals in government are not accustomed to being "performance-oriented."
• Often focus is on spending budgets, for production or compliance.
• Issues are defined as the inability to comply with specific norms or laws, rather than the outcomes of what has or has not been done.
• Mental habits are difficult to change.
• T. S. Kuhn, a historian of science, explains that these formulaic and fundamental perceptions that we call paradigm that shape our thoughts on a particular issue.
• Stress on the transparent analysis of means and goals is a strategic shift.
• Can lead to clear, practical reforms

Important Action

• The nature of the cycle, emphasizes what was noted in the first section that the health sector is rarely resolved permanently
• Although permanent solutions are impossible, with countries transforming.
• The system for taking care of health has to take on challenges too

How to make an action

• A good example of a use of statistics to identify where there is a need for action - look at how other countries approach the issue
• Benchmarking - if a country's health outcomes are lower than similarly situated countries that are spending the same amount
• Next stage, identify the causes
• This process requires the same process as Doctors identifying the cause of a patients illnesses. After defining the health system its effects, there has to be an action to identify the factors that lead to non satisfactory results. Doctors identify based on physiology and anatomy and health sector based on the five points to health listed

Problems that may hinder success

• Its not as simple, Japanese expert says there should be 5 levels of “whys” that doctors and patients must ask themselves
• The following factors hinder success -
• Government reduces budget
• As a result, it falls on them and patients to cover costs
• Insurance covers innovative scans which makes people rely on this
• Hospitals rely primarily on medical doctors The result is extra prescription made, this does the service as helping but not actually treating
• It should be mandatory for steps be taken for health and medicine

What needs to be improved

• Interested researchers should look at low cost areas to improve the state of medicine
• This also needs to be a transparent system

Designing Policies

• The challenge ahead is to search deeply and more deeply for an understanding of why the system behaves this way.
• Researchers explain that costs are higher than expected as certain medicine are too expensive.
• Factors of implementation
• State reduces hospital funding so they seek pay from others to afford the equipment.
• Payments from insurance cover new tech and medicine
• By the conventional treatment methods of China, doctors sell their medicine to patients and have general control
• For hospitals to put pressure on doctors they have payed them more based on the medicine they would prescribe

Issues with Prescribing

• Highly profitable medicine use leads to high revenue
• The fact is that to resolve it is hard to treat this type of disease, many people make different moves on how to prevent it such as insurance plans ect
• To identify the issues of this plan doctors can find the effective path to work
• Designing a policy or plan might be challenging, need the views

What to look for in new ideas

• Personal thought always overcomes thoughts of customs
• An environment where the issues will be fixed and a new policy will be made
• Make sure the stages in policy ect are included Which side of the health will focus on After all which policies should lead

New Ideas being put into the System

• Human thought can be put on the past and modern
• Focuses on solving old habits
• Give instructions on what should be done
• To be a great model, needs someone specialized in the field or known

A Need for Balance

• Balance has to be had with both expertise of how to provide care
• An economic, needs to come in and focus on things like costs and income
• Only certain actions or models that are approved can be relied upon
• The economic and policy side are what work in the field

Improving Current Methods

• The important thing that has to improve in culture is that the medical field, to be as clear and transparent as can be
• This has to be worked through the right process. Which the health industry has to go through
• The power is in the health industry
• When decisions and policies are put into place everything goes through that lens

Accepting a new reform

• Accepting the reform, has great importance and conditions that work to its advantage.
• In the diagram the the policies of that cycle should be set at the set goals
• There might be bad things happening in it but be open to change

Third Stage: Policy Development

• The process to the solution for it has to have a strong impact on both skill sets