4 H The state and the private sector in health policy.pdf

Chapter 3: The state and the private sector in health policy WEEK 6 Key terms           Company Corporation Decentralization Industry Multinational corporation New public management Private sector Privatization Regulation Transnational corporation The role of the state in health syste...

Chapter 3: The state and the private sector in health policy WEEK 6 Key terms           Company Corporation Decentralization Industry Multinational corporation New public management Private sector Privatization Regulation Transnational corporation The role of the state in health systems  Mills and Ranson (2005) have identified the state regulatory mechanisms to regulate ◦ The quantity and distribution of services ◦ The prices of services ◦ The quality of health services  State also does public health functions. Examples? The critique of the state  In 1980s ◦ Global recession ◦ Escalating governments debts ◦ Increasing public expenditures The critique of the state  As a result …. ◦ ◦ ◦ ◦ Conservative countries came to power Reforms were introduced in many countries Dissatisfaction with state administrations ‘rolling back’ the state spread among high income countries and later to middle and low income countries ◦ International financial institutions implemented ‘structural adjustment programs’ The critique of the state  by the end of 1980s …. ◦ A global turn in favor of the market ◦ The collapse of the Soviet Union discredited the state-controlled economies ◦ Anti-state, pro-market philosophy was promoted by international agencies and private agencies The critique of the state  Reflections on health sector ◦ States failed to provide equal services ◦ Public finance was provided but no costeffective ◦ Disproportionate allocation resources ◦ Poor management decreased the efficiency ◦ Poor quality care in low income countries ◦ Issues with public health providers ◦ Politically connected people were able to access care more than others ◦ Delaying payments Reinvention of government and health sector reform  Neo-liberal economic ◦ Theory I: public choice ◦ Theory II: property rights ◦ Led to public expenditure containment and ‘internal markets’     New mechanisms to finance health care Lift restrictions on private providers Promote diversity of provider ownerships Improve accountability of providers Reinvention of government and health sector reform     Decentralization Characteristics of ‘good governance’ in the health sector? The World Bank highly influenced these reforms to low income countries. How? Why did some health reforms fail? The for-profit sector and health policy  What is the private (for-profit) sector? ◦ ◦ ◦ ◦ ◦ Characterized by the market orientation Organizations that seek profits as main feature May provide secondary and supportive services Varied: large or small, domestic or multinational Many are actors in the health policy process Non-for-profit may have charitable status but support the interest of a firma or industry  Patient groups and public relation groups also influence policies  What makes the private sector a powerful actor in health policy?  Power is the ability to achieve a desired result How is the private sector involved in health policy?  Self-regulation ◦ Efforts to establish own rules and policies for operating specific domain ◦ Two types:  regulation of market standards  regulation of social standards ◦ Voluntary codes:  Important for firms. Why?  Important for society. Why?  Weaknesses? How is the private sector involved in health policy?  The private sector is often affected by public policy and, as a result, may attempt to influence the content of such policy. Explain How is the private sector involved in health policy?  Co-regulation ◦ Presents a third way between statutory regulation and self-regulation. ◦ Viewed as public sector involvement in business self-regulation ◦ Public and private sectors negotiate to agree on a policy or regulatory objectives  Implementation responsibilities for private sector  Monitoring responsibilities for public sector Chapter 5: Government and the policy process Week 9 Characterizing government systems  Two features of government systems have a major effect on their ability to make and implement policy: ◦ Autonomy ◦ Capacity Forms of government systems  Federal versus unitary systems  Relations between the legislature, executive and judiciary  Parliamentary versus presidential systems Political parties  In democratic systems, ◦ political parties sit between societal actors and the institutions of government ◦ Parties produce manifestos and policy documents on which they campaign for ◦ Can directly affect the outcome of elections  In one party systems, ◦ One political party formulate all or most policies The role of the legislature   Constitution functions: represent people, enact legislation, oversee the executive Legislatures ◦ In democracies: elected members and they are unicameral or bicameral legislatures ◦ In presidential system: legislature has autonomy from the executive and can make policy ◦ In parliamentary system: legislature hold the government to account on behalf of the public for its performance and can request changes The influence of the executive     In most countries, most power lies with the executive Ministers and immediate advisors are the cabinet The executive and cabinet have more informational, financial, and personal sources than legislatures They draft laws and convince legislatures to initiate policies The contribution of the bureaucracy   Civil or public servants The power of the bureaucracy differs form country to country, over time and form sector to sector. The position of the ministry of health MOH Responsible for ensuring that the needs of the health sector are properly represented when decisions are made  Might have divisions relating to the main contours of the health system  MOH govern and steer the health system  “Encompasses the tasks of defining the vision and direction of health policy, exerting influence through regulation and advocacy, and collecting and using information” (WHO 2000)     MOH responsibilities (p. 97) In low and middle income countries, MOH is often seen well behind the ministry of finance, defense, foreign affairs, industry, planning and education Unfortunately, health issues tend to come to the attention of the cabinet mostly at the time of crises Relations with other ministries Other ministries have their own goals to purse and are accountable for meeting them and many not give high priority to human health implications  Many countries set up inter-sectoral bodies, eg. Sri Lanka  Many other countries set up national committees or task forces  It is important that all ministries contribute to the overall outcome. Examples!  Professional versus other sources of advice   Health professionals highly influence their advices in MOH Conflicts may arise between health professionals and other bureaucrats. Examples!