Health Care PDF - University of Belgrade

Faculty of Medicine University of Belgrade Institute of Social medicine Health care Prof. Janko Jankovic, MD, PhD  Health care The health care is a business process consisting of efforts made by trained and licensed professionals for the benefit of and to improve...

Faculty of Medicine University of Belgrade Institute of Social medicine Health care Prof. Janko Jankovic, MD, PhD  Health care The health care is a business process consisting of efforts made by trained and licensed professionals for the benefit of and to improve, maintain or restore health status of an individual and community via the prevention, diagnosis, treatment, recovery, or cure of disease, illness, injury, and other physical and mental impairments in people. The fundamental purpose of health care is to enhance quality of life by enhancing health. Health care must focus on creating social profit to fulfill its promise to society.  Health care concept Essential health care should be made accessible at a cost a country and community can afford , with methods that are practical, scientifically sound and social acceptable (WHO, 1978) The Universal health coverage means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship (WHO, 2016) The contemporary concept of health care is based on prevention  Health care is unique because It is the world’s biggest industrial sector It is the world’s biggest employer It is the worlds biggest employer of women It is characterised by three defining features: o the range and diversity of stakeholders o complex ownership and resourcing arrangements and o the professional autonomy of many of its staff  Health care process Health care is studied from various perspectives by different disciplines using different sources of information o Policy perspective – policy analysis of health system, primary care, integrated care,… o Economic perspective – efficiency of care provision and costs control o Management operational perspective – redesign/improve logistics within a health care system/facility o Quality perspective – health care as a determinant of health outcomes  Health care process Examples of health care processes: o admission, ambulatory, emergency… o acute, long-term, … palliative, home, direct / indirect, o professional/paraprofessional…nursing.. o amputation, health education, self-care, o prenatal, tertiary… Activities, ethics, principles, values, priorities, objectives, providers, funding, and other conditions are defined by legal acts in every country.  Key principles health system in any context o Availability of health care and equity for all citizens o Material security of citizens o Macroeconomic efficiency o Microeconomic efficiency o Freedom of choice for the consumers o Adequate autonomy for the service providers  The Contexts of Care Living Environment o homes, communities Social Environments o families, population and cultural groups Psychological Environments o illness and other modes of human information processing Technological Environments o broadband, telecom, household Health Services Environments Drivers for change o Care delivery  Health care in rural settings o Poverty o Aging population o Rural economic decline o Large geographical distances o Inadequate transportation o Physician shortages and other providers o Lack of health care facilities o Low motivation of health professionals o Difficulties in getting formal health insurance o Different forms of informal payments POOR HEALTH STATUS OF RURAL INHABITANTS  Demographic and epidemiological transition  The age of the population depends on natality, mortality and net migration  Improving nutrition, sanitary conditions, vaccines, antibiotics and other drugs, advancement of medical technologies, improving population standards have led to a declining mortality rates  Reduction of fertility and birth rates due to the introduction of birth control measures  Aging population  Both in developed and developing countries there is a growing burden on chronic non-communicable diseases (cardiovascular diseases, cancers, injuries)  In developing countries, morbidity and mortality from infectious diseases is still high  Current drivers – technology  Information  Technology  Networking Consumer Management The most important step is to recognize that health care is a knowledge based service Clinic  Current drivers - health care environment Health care delivery system and institutions o Tighter resources o Lack of direction o Greater demands Technology Quality o Job cuts o Uncertainty o Inability to adapt and change rapidly  Current drivers o Education and practice o Changing consumer role o Professions o New patient environments o Internet o Globalisation o Migration o Increasing public accountability…..  Future of health care… o Patients will have the same access to knowledge as professionals - Professionals and patients will become more equal partners o Self-care will become steadily more important - Health care systems will increasingly be concerned with chronic not acute disease o There is a chasm between what health care could do and what it does - Evidence will become steadily more important o Health will increasingly be at the centre not at the edge of politics – Issues like ethics, learning, and leadership will continue to be important The Clinical Iceberg model (adapted from Last, 1963) Tertiary health care -> more than 500,000 citizens Demand for Secondary health care -> 50,000 – 500,000 citizens formal care Primary health care -> 2,000 – 50,000 citizens Demand for lay care Felt need but unexpressed Unfelt need Healthy A map of the health system Population Direct payment / Providers of services patients Health services Insurance coverage regulation Taxes and premiums Government / Financing professional agents body regulation Source: Mills and Ransom, 2001  Health systems are under the constant pressure Public expectations Social-demographic Evidence based changes medicine Participation, New scientific Health systems knowledge transparency Financial Globalization sustainability Changes in disease models and risk factors  Providers of health care  Access to the health professions o Training of health professionals o Manpower planning o Licensing for health professionals  Functioning of health care providers o Auditing standards of professional performance o Physicians liability o Professional or ethical codes o Disciplinary bodies  Structural aspects o Public, private and mixed sectors o The integration of health care providers in institutions o Cost-containment  Factors that shape healthcare services delivery and organization Economic factors o National income, scarcity of resources Sociodemographic factors o Distribution of wealth i.e. inequality o Differences in population density o Growth rates of population Political factors o The level of urbanization o Stability of government o Literacy and education of population o Displaced populations o External influences (e.g. World Bank) Historical factors Geographical factors o Colonial inheritance o Natural conditions that influence o Concentration of facilities in urban areas agriculture, communication, transport and nutritional status o Centralized planning  ALMA ATA CONFERENCE 1978 - CONCEPT OF PRIMARY HEALTH CARE CANADA 1982 – CONCEPT OF HEALTHY POLICY EUROPEAN STRATEGY „HEALTH FOR ALL” OTAVA CHARTER – 1986  International initiative to promote primary care: Alma Ata declaration, 1978 Philosophy of thinking about health and health care: 1. The importance of equity as a component of health 2. The need for community participation in Background of the Declaration: decision making Broadening the concept of health; an 3. The need for multisectoral approach to understanding the wider concept of ill health; a health problems desire to incorporate greater involvement of 4. The need to ensure the adoption and use of communities a shift in developmental thinking towards social ends; a recognition of the appropriate technology inappropriateness of many of the healthcare 5. An emphasis on health promotion activities structures inherited by developing countries to tackling their predominant health problems  Alma Ata declaration, 1978 o Alma-Ata declaration can be seen Some criticism: as a result of the changing trends o Too general, no clear, measurable toward primary care that were targets part of the thinking about o Response: Health and Population organization of care in previous Development Conference in Italy, decades 1979, defined more concise, o It was important in bundling these selective PHC goals known as GOBI convergent trends and formulating (Growth monitoring, Oral rehydration treatment, a consistent strategy to achieve Breastfeeding, and Immunization), health care for all and later o The vision is still relevant today o GOBI-FFF (adding food supplementation, female literacy, and family planning)  Astana declaration, 2018 o While the world have made great strides in health outcomes globally over the past 40 years, there are still many ongoing challenges. o The new declaration will renew political commitment to primary health care from o A primary health care (PHC) Governments, non-governmental approach is the most effective way organizations, professional organizations, to sustainably solve today’s health academia and global health and and health system challenges. development organizations. o The PHC approach is foundational o The new declaration is also a chance to to achieving shared global goals in commemorate the 1978 Alma-Ata Universal Health Coverage (UHC) Declaration on Primary Health Care, and and the health-related Sustainable reflect on how far we have come and the work that still lies ahead. Development Goals (SDGs).  Levels of health care Size of population 500 000 - 5 000 000 Tertiary Region Secondary 100 000 - Health care 500 000 District Primary 2000 - Health care 50 000 Community 1-10 Self care Family Healthcare level Administrative region Types of healthcare organizations in Republic of Serbia o Dom zdravlja (Primary health care center) o Apoteka (Pharmacy) o Bolnica (opšta i specijalna) (Hospital, general and specialized) o Zavod (ambulatory services that are dealing with primary healthcare for particular population groups, or for particular types of pathology) o Zavodi (Institutes that are active at all three levels): IPHs, Blood Transfusion Institute; Institute for Virology, Vaccines and Sera…) o Klinika (Clinics) o Institut (Institutes) o Kliničko-bolnički centar (Clinical-hospital center) o Klinički centar (Clinical center)  Organizational Structure of the Public Health System in Serbia Ministry of Health Health Tertiary Insurance Republic Public health Fund Health Institute care Clinical Center of Serbia level Clinical Clinical Hospital Institute Center Center Secondary health HIF Public health care branches institutes level General General Special General Hospital Hospital Hospital Hospital Specialized HEALTH CENTRE Institution Primary Primary Primary Primary Health health Health Health Centre care Pharmacy Centre Centre Pharmacy level Health Health Health Health Health Health Health station station station station station station station  Health care institutions  Setting up health care institutions o Planning of institutions, o Licensing and accreditation  Functioning of health care institutions o Legislation on quality control, o The liability and the safety, o Maintenance and control of technical equipment, functioning of laboratories  Legislation concerning the structure of the health care institutions o Public, private or mixed systems o Coordination of services between various institutions o The impact of labor legislation o Cost-containment  Primary health care: Commonalities o The first contact with the health system o Acts as gatekeeper to hospital care and to drugs o To a variety of extent, provides a multiprofessional approach to patients’ needs  Primary health care: Differences a) Service delivery (solo practices, group practices, or multiprofessional health centers and polyclinics) b) Employment status of doctors (independent contractors/employed/dual jobholding) c) Population served (geographically defined/list system/no defined population) d) Prevailing remuneration of GPs (capitation, fee for service, etc) e) Referral restrictions (gatekeeping/direct access to specialists) f) Levels of internal integration between staff (unprofessional; multiprofessional; teamwork) g) Level of external integration with other services (e.g. social services, public health, education services) h) Level of integration of staff education and training in primary care (undergraduate/basic; postgraduate/post-basic; continuous professional development)  Secondary health care: Hospitals (1) “An institution which provides beds, meals, and constant nursing care for its patients while they undergo medical therapy at the hands of professional physicians. In caring out these services, the hospital is striving to restore its patients to health”. (Miller, 1997).  Hospitals play a central role in the delivery of health care  They are organized for populations of more than 50,000  The importance of hospitals: o 50-70% of the overall healthcare budget is being spent on hospitals o They are positioned at the apex of the health care system, which means that the policies they adopt determine access to specialist services, and have a major impact on the overall health care o The specialists who work in the hospital provide professional leadership o Technological and pharmaceutical developments that are incorporated in hospital services can potentially contribute significantly to population health  Secondary health care: founders of hospitals  By the public sector  Historically, hospitals were often founded and funded by religious  By health organizations (for orders, or by charitable individuals profit or nonprofit) and leaders  General / specialized hospitals  By health insurance companies  Teaching (university) hospital /  By charities (including direct other charitable donations)  Secondary health care: changes and challenges  Hospitals are facing growing and rapidly changing pressures: o Changes in the age structure of populations o Changing in the patterns of disease and dominant morbidity o Opportunities for medical interventions with new knowledge and technology o Public and political expectations o New types of care require new configurations of buildings, professionals with different skill mix, and new ways of working  They are complex institutions, which often appear resistant to change, although they are incrementally changing  Secondary health care, trends: acute care hospital beds Figure 1. Acute care hospital beds per 100,000 population Secondary health care, trends: average length of stay in acute hospitals Figure 2. Average length of stay in acute care hospitals in days  Key challenges in health care in Serbia o Inequity of access to health care and inequalities in health (benefits are not the same accross the population- disadvantage groups like elderly in rural settings, Roma people, disabled, refugees and internally displaced persons are at highest risk) o Inadequate education planning and employment of health professionals (deficit of vascular and toracic surgeons, radiologists, patologists, clinical biochemistry and pharmacology, nurses etc.) Thank you for your attention!