Week 10 Lecture Slides on Global Healthcare Services and Systems PDF

The Global Healthcare Services and Systems and Impact on Health Workforce OMED 1029 Mamodesan Okumagba Week 10 Outline ▪ Health system Definitions Principals of Health Systems (Building blocks) Goals ▪ Overview of G...

The Global Healthcare Services and Systems and Impact on Health Workforce OMED 1029 Mamodesan Okumagba Week 10 Outline ▪ Health system Definitions Principals of Health Systems (Building blocks) Goals ▪ Overview of Global Healthcare Systems Population health Global population health ▪ Health Service Outcome Service Coverage Out-of-pocket (OOP) expenditure on health ▪ Impact of Globalization on Healthcare Workers Global trends Solutions ▪ Summary Learning outcomes Assess the role of healthcare systems in protecting and promoting health globally Examine current debates and issues around the impact of globalisation on health systems. WHO definition of health systems A health system is the combination of all the organisations, workforce and resources whose primary purpose is to promote and, restore and/or maintain health (WHO, 2013). A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. It needs to provide services that are responsive and financially fair, while treating people decently.* Principals of Health Systems (Building blocks) What are ‘Health services are aimed at contributing to improved health or health the diagnosis, treatment and rehabilitation of the people’-WHO services? 1998 Can you think of some examples of health services?  Example of health care services Ministry of Health- Lithuania Spanish National health System National health program India National Health Service UK The Ministry of Health and California USA Child Care-Zimbabwe Image 1 by Unknown Author is licensed under CC BY-SA-NC Image 2 by Unknown Author is licensed under CC BY  1. Improving the health of the Goals of population they serve, i.e. efficiency health 2. Responsiveness, i.e., systems responding to people's legitimate expectations 3. Fair financing, i.e., providing financial protection against the costs of ill-health.* A. Efficiency Improving the health of the population they serve Health system performance or efficiency can be examined in terms of the extent to which these goals are attained, given the resources available to the system.  B. Responsiveness Responsiveness is defined as a measure of how well the health system responds to the legitimate expectations of the population. Does the quality meet the population’s expectation? Examples Dignity and confidentiality Waiting times Quality of care Availability of advanced diagnostic and therapeutic technology Availability of subspecialists and procedures C. Fair financing Fair financing suggests every member of society should pay the same share of their disposable income to cover their health costs. Take a minute: focus on how that’s different from paying the same amount Overview of Global Healthcare Systems Population Health Health Services Outcome Equity Fairness in Financing Responsiveness Indicators of Population Health UK (years) EU (years) Life Expectancy at Birth 81.3 80.9 In 1840: men’s life expectancy was 40.2 years, and women’s life expectancy was 42.3 years Gains in life expectancy slowed between 2011- 2017 in UK and EU Do you notice anything about that timing? Question for you: What are some theories you have about why life expectancy stopped improving around that time? Income inequality, strong rise in the UK beginning in the 1980s 2010 financial crisis and austerity policies Stagnation of life expectancy occurred in more deprived areas. In 2020, we see a drop in life expectancy not seen since World War II Global Population Health Globally, average life expectancy (LE) at birth increased by 5.5years LIC’s recorded the biggest gains in LE 21% b/w 2000-2016 LIC’s recorded 18% in healthy life expectancy compared to 8% globally 2000-2016 Health Service Outcome KEY TERM: Universal Health Coverage (UHC) means that all individuals and communities receive the health services they need without suffering financial hardship. Target 3.8 (Sustainable Development Goals [SDG]) Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. Target 3.8 in regular English: people getting the services they need to stay healthy without going into horrifying amounts of medical debt” Two indicators have been chosen to monitor target 3.8 within the SDG framework: I. Health service coverage. Coverage of essential health services (repro, maternal & child, ID, NCDs, among general and most disadvantaged populations) II. Health expenditures relative to the household’s budget. Purpose: to identify financial hardship caused by direct health care payments. Important: The two indicators need to be monitored jointly. Do you understand why? Health Service Outcome Service Coverage Index (Coverage of selected essential health services scale of 1-10): Improved from 45 to 66 globally between 2000 and 2017 Improvements most notable in infectious disease intervention, lesser with reproductive and child health services. 33-49% of world population was covered by essential health services in 2017 Coverage continues to be lower in LMIC’s UHC-gapminder Map of the Universal Health Coverage (UHC) “service coverage index”, in 2019 Let’s take a quick break and talk about data Wait what? → visualization: https://ourworldin data.org/grapher/u niversal-health- coverage-index Lozano et. al. 2020 Coverage is relatively high in the US – what’s the problem? Two indicators have been chosen to monitor target 3.8 within the SDG framework: I. Health service coverage. Coverage of essential health services (repro, maternal & child, ID, NCDs, among general and most disadvantaged populations) II. Health expenditures relative to the household’s budget. Purpose: to identify financial hardship caused by direct health care payments. In the United States: 9% of the population (23 million people) owe medical debt 11 million owe more than $2,000, 3 million owe more than $10,000 Many households do not have enough money to cover the cost of a “deductible” in a private health plan 32% of single-person hosueholds with private insurance in 2019 could not pay a $2,000 bill 51% could not pay a $6,000 bill Lower-income families who have employer health coverage spend 10% of their income on health care on average https://www.kff.org/health-costs/press-release/1-in-10-adults-owe-medical-debt-with-millions-owing-more-than- 10000/ Health Service Outcome Proportion with out-of-pocket (OOP) expenditure on health care Household spending >10% of household budget on health reached 12.7% in 2015, up from 9.4% in 2000 Proportion spending >25% reached 3% in 2015 87% of people suffering OOP health payment live in LIMC’s OOP can push people into poverty Between 2000-2015, there was an increase in relative poverty due to OOP, adding 110.9 million people globally OOP-Gapminder Impact of Globalization on Healthcare Workers The Global Marketplace for Health Professionals The effect of demand and supply imbalance will increase as trade in services increase Size, composition and distribution of health workforce Composition of health workers in a country is key indicator of its capacity to scale up delivery of interventions e.g. sub-Saharan Africa Migration of Health workers Workers move from poorer to richer countries. The loss of health workers weakens the health system. While migration of Doctors get attention, the departure of other health workers can cripple the system. "Doctors and Nurses" documentary film on health workforce Impact of Globalization on Healthcare Workers 40% of all countries have < 10 medical doc per 10,000 people < 40 nursing and midwifery personnel per 10,000 population by 55% of countries