HCM 500 MR S.docx PDF

# HCM 500 ## M1 ### 1. Definition and Characteristics of a Health System: A health system is defined by the World Health Organization (WHO) as the sum total of all the organizations, institutions, and resources whose primary purpose is to improve health. * Its components include staff, funds, info...

# HCM 500 ## M1 ### 1. Definition and Characteristics of a Health System: A health system is defined by the World Health Organization (WHO) as the sum total of all the organizations, institutions, and resources whose primary purpose is to improve health. * Its components include staff, funds, information, supplies, transportation, communication, and overall guidance and direction. * A health system involves various inputs like financial, material, and human resources, and operates within social, political, cultural, and economic contexts. ### 2. WHO Building Blocks of Health System: The WHO identifies six key building blocks that are necessary for the functionality of any health system: 1. **Health information systems:** aid healthcare professionals in analyzing data from healthcare facilities, enabling informed decision-making on disease spread and health issues, and aiding governments in creating policies to improve quality of life. 2. **Medical technology:** Ensures equal access to vital medical products, vaccines, and technologies, ensuring quality and safety through unbiased access. 3. **Health financing:** Ensures citizens can access appropriate healthcare without financial burden due to health conditions, thereby reducing financial barriers to healthcare access. 4. **Leadership and governance:** balanced health system, with an authority determining and implementing policies, addressing immediate concerns, and addressing future challenges. 5. **Service delivery:** Delivering safe, quality health interventions to those in need. 6. **Health workforce:** Ensuring a responsive, fair, and efficient workforce. ### 3. Essential Functions Provided by Public Health: Essential public health functions include disease prevention, health promotion, and health protection. * Public health services aim to ensure safe and effective interventions, promote equity in health service delivery, and improve population-wide health outcomes. ## M 2 ### 1. Definition of Measurement Used to Describe the Burden of Disease The burden of disease is measured using several methods, including: * **Prevalence:** Measures the number of individuals with a specific disease in a population at a given time. * **Incidence:** Refers to the number of new cases of a disease in a population over a specified period. * **Disease-specific mortality:** The number of deaths due to a particular disease per time period, usually expressed per 1,000 or 100,000 people per year. * **Case fatality rate:** The rate of death among individuals diagnosed with the disease. * **Disability-adjusted life years (DALY):** A measure that accounts for years lost due to illness, disability, or early death. * **Quality-adjusted life years (QALY):** Considers both the quantity and quality of life lived. * **Health expectancy and Healthy life years:** Focus on the overall life expectancy and how much of it is spent in good health. ### 2. Health Systems Concerns Related to Communicable and Non-Communicable Diseases Health systems face significant challenges in dealing with both communicable and non-communicable diseases: * **Communicable diseases:** These are infectious diseases that spread from person to person. Health systems must address disease prevention, early diagnosis, and treatment. There is also the need for resources like vaccines, medications, and public health campaigns to control the spread of infections like HIV/AIDS, malaria, tuberculosis, and emerging diseases (e.g., Zika, Ebola). * **Non-communicable diseases (NCDs):** These include chronic diseases like heart disease, diabetes, cancer, and mental illness. They are often driven by risk factors such as lifestyle choices (smoking, poor diet), environmental conditions, and aging. Health systems must focus on long-term management, prevention, and addressing rising worldwide mortality from NCDs, particularly in developing countries. ### 3. Mental Health Definition and Challenges of Health Systems to Address It * **Definition:** Mental health refers to medical conditions that affect a person's thinking, mood, ability to relate to others, and overall daily functioning. Common mental illnesses include depression, anxiety disorders, and obsessive-compulsive disorder (OCD). * **Challenges to addressing mental health in health systems:** 1. **Stigma:** Undermining confidence in seeking treatment and system effectiveness. 2. **Underdiagnosis and lack of early treatment:** Untreated mental illnesses can lead to disability, unemployment, substance abuse, homelessness, and suicide. 3. **Limited access to care:** Under-resourced mental health services limit access to effective treatments and support. 4. **Economic burden:** Untreated mental illness can result in substantial economic costs, as seen in the U.S., where it costs $100 billion per year in lost productivity and healthcare expenses. ## M3 ### 1. Determinants of Health Determinants of health are the factors that influence an individual's quality of life and health outcomes. These include a combination of biological, behavioral, social, and environmental factors, with the key categories being: * **A. Physical Determinants (impact of 'place' on health)** 1. **Natural environment:** Green spaces and weather conditions. 2. **Built environment:** Infrastructure like buildings, sidewalks, and roads. 3. **Worksites, schools, and recreational settings.** 4. **Housing and community design:** Support or hinder healthy living. 5. **Exposure to toxic substances and physical hazards.** 6. **Physical barriers and aesthetic elements affecting comfort and safety.** * **B. Social Determinants of Health Status** 1. **Availability of resources** like safe housing, local food markets, and healthcare. 2. **Healthcare access**, including primary and preventive services. 3. **Emerging technologies affecting healthcare information access.** 4. **Language and literacy barriers.** 5. **Quality of education and job opportunities.** 6. **Community resources** like leisure activities, public safety, and social support networks. 7. **Exposure to crime and violence, socioeconomic conditions, and transportation options.** * **C. Other Determinants** 1. **Individual behavior**, including diet, physical activity, substance use, and hygiene practices. 2. **Biology and genetics**, including age and genetic predispositions. ### 2. Consumer-Driven Healthcare Plan (CDHP) A Consumer-Driven Healthcare Plan (CDHP) is a type of health insurance model that gives consumers more control over their healthcare spending by using special savings accounts. * These accounts allow members to pay for routine healthcare expenses, with some key features being: * **Three-Tiered System:** 1. **Health Savings Account (HSA):** The first tier involves an allocation of money provided by the employer to cover initial healthcare costs. 2. **Health Reimbursement Account (HRA):** Once the allocated money is exhausted, consumers pay for healthcare out-of-pocket until the deductible is reached. 3. **Flexible Spending Account (FSA):** After reaching the deductible, the healthcare plan covers the remaining costs. * **CDHPs often have high deductibles, meaning that consumers must pay a significant amount out-of-pocket before the insurance covers the costs.** * **Advantages:** * It insures more people more efficiently, providing wider coverage. * Increases consumer choice of healthcare providers. * Encourages market competition by rewarding quality care. * Strengthens provider-patient relationships. * Provides health incentives for individuals to make better health choices. * Allows for the use of non-traditional therapies. * **Disadvantages:** * Employers may limit access to these plans, leading to biased selection. * Higher premiums for the sick, as those with chronic conditions may face more financial strain. * Neglect of preventive care, as individuals may avoid care to save money. * Erosion of employee benefits, as some benefits may be reduced. * The system is often too complicated for many consumers to navigate effectively. ### 3. Epidemiological Transition The epidemiological transition refers to changes in patterns of disease and mortality within a society as it develops economically. * As societies progress through different stages, the primary causes of death and disease shift. There are typically three stages: 1. **Age of Pestilence and Famine:** * This stage is characterized by high mortality rates, largely due to infectious diseases, malnutrition, and widespread famine. * Life expectancy is low, and population growth is slow. 2. **Age of Receding Pandemics:** * In this stage, mortality begins to decline progressively as public health measures, improved sanitation, and medical advances reduce the impact of pandemics and infectious diseases. * Life expectancy increases, and population growth accelerates. 3. **Age of Degenerative and Man-made Diseases:** * Mortality continues to decline, but non-communicable diseases (NCDs), such as heart disease, cancer, and diabetes, become the leading causes of death. * These NCDs are often associated with lifestyle and behavior choices, such as diet, physical inactivity, and smoking. * Public health efforts increasingly focus on prevention and management of chronic diseases rather than infectious diseases. * Understanding the epidemiological transition helps policymakers anticipate shifts in healthcare needs and adjust strategies to improve public health in the face of changing disease patterns. ## M4 ### 1. Micro and Macro Policy-Making in Healthcare System * **Micro Policy-Making:** * **Microeconomics** analyzes economic interactions at individual producer and consumer levels. * **Focuses on decisions** made by physicians, patients, hospitals, pharmaceutical companies, and insurance firms. * **Policy Marketplace Model:** Healthcare actors act as suppliers and demanders of goods and services. * **Power imbalances exist,** with large pharmaceutical companies having more influence. * **Government Regulation:** Non-governmental groups form alliances with government agencies to influence healthcare policy. * **Macro Policy-Making:** * **Macro Policy-Making Overview:** * **Macroeconomics:** Examines economic activity at sectoral, regional, national, and international levels. * **Policy Systems Model:** Views healthcare systems as complex, interdependent, and cyclical. * **Longest's Model of Policy Development:** Recognizes inputs from stakeholders, forms policies in government bodies, and implements through government agencies and partnerships. | Feature | Micro Policy-Making | Macro Policy-Making | |---|---|---| | Focus | Individual actors (physicians, patients, hospitals, etc.) | System-wide issues (costs, national policies, international trends) | | Economic Approach | Microeconomics (analysis of individual interactions) | Macroeconomics (analysis of broader economic activity) | | Model | Policy Marketplace Model (exchange of healthcare goods and services) | Policy Systems Model (interdependent, cyclical system) | | Government Role | Indirect influence through regulation and alliances with nongovernmental groups | Direct influence through policy formation and implementation | | Policy Development | Focus on individual exchanges and power imbalances | Focus on system-wide factors and cyclical nature of policy-making | ### 2. Problems Related to Policy-Making Healthcare Systems 1. **Cost, Quality, Access, and Outcomes:** Balancing rising costs, high-quality care, improved access, and favorable health outcomes. 2. **Government Intervention vs. Non-Intervention:** Determining the appropriate level of government intervention in healthcare. 3. **Disparities in Access:** Uneven access to care, particularly for disadvantaged populations, especially in poorer and wealthier nations. 4. **Technological Advancements and Globalization:** Balancing rapid technological changes with economic constraints. 5. **Measuring Health Outcomes:** Despite Health IT's potential, many systems remain inefficient and unsustainable. 6. **Sustainability:** Addressing cost control, resource allocation, and technological adaptation is crucial for long-term sustainability. ### 3. Key Solutions Proposed by Price Waterhouse Coopers (PWC) Study for Sustainability of Health Systems PWC's study outlined seven key strategies to achieve sustainability in health systems: * **Quest for Common Ground:** Develop a national consensus on healthcare responsibilities to address disparities and align goals. * **Digital Backbone:** Implement a nationwide, integrated system of clinical and administrative information for improved efficiency and coordination. * **Incentive Realignment:** Ensure access to care and promote accountability among providers and patients. * **Quality and Safety Standardization:** Implement standardized measures to hold providers accountable. * **Resource Deployment:** Balance competing demands of different parts of the healthcare system. * **Innovation:** Embrace technology and healthcare processes for sustainability and cost control. * **Adaptability:** Prioritize patient-centered care and adapt to diverse patient populations and health conditions. ## M5 ### 1. Difference between Intergovernmental Organizations (IGOs) and Non-Governmental Organizations (NGOs) * **Intergovernmental Organizations (IGOs)** * **Establishment:** Created by treaties among sovereign states, and the member states are usually countries. These organizations are formal and established by a legal agreement or treaty. * **Function:** IGOs are established to foster cooperation among member states, resolve conflicts, and improve international relations. They focus on global matters like environmental protection, human rights, health, economic development, etc. * **Example:** United Nations (UN), World Health Organization (WHO), World Bank, African Union. * **Non-Governmental Organizations (NGOs)** * **Establishment:** NGOs are typically non-profit organizations that are independent of any government. They operate based on voluntary participation and are not established by treaties. * **Function:** NGOs can operate locally, nationally, or internationally. They focus on specific causes such as human rights, poverty, education, healthcare, and more. NGOs can have an operational role (direct project implementation) or an advocacy role (promoting certain causes). * **Example:** Médecins Sans Frontières (Doctors Without Borders), Oxfam International, Amnesty International. ### 2. Branches of the United Nations System and Their Roles and Responsibilities * **General Assembly:** The main oversight arm of the UN. It is a deliberative body where all member states are represented. The General Assembly makes decisions on peace, security, budget, and new membership. * **Security Council:** Responsible for maintaining international peace and security. It has the power to impose sanctions and authorize military action. * **Economic and Social Council (ECOSOC):** Coordinates economic, social, and related work of the UN and its specialized agencies. It focuses on sustainable development, poverty reduction, and health improvements. * **International Court of Justice (ICJ):** Settles legal disputes between states and provides advisory opinions on international legal issues. * **Secretariat:** The administrative arm of the UN, led by the Secretary-General. It handles day-to-day operations and implements programs and policies adopted by other branches. * **Trusteeship Council:** Originally established to oversee the administration of trust territories, ensuring their advancement towards self-governance. ### 3. Aims and Focus of United Nations Programs and Different NGOs * **United Nations Programs:** * **UNICEF (United Nations Children's Emergency Fund):** Focuses on providing food, health care, and emergency relief for children, operating in over 190 countries. * **UNDP (United Nations Development Programme):** Works on reducing poverty, inequality, HIV/AIDS, and environmental sustainability. It operates in around 170 countries. * **UNHCR (United Nations High Commissioner for Refugees):** Provides protection and assistance to refugees, ensuring their rights and safety. * **World Food Programme (WFP):** Ensures access to food for people in need, focusing on hunger and food insecurity. * **Non-Governmental Organizations (NGOs):** * **Médecins Sans Frontières (Doctors Without Borders):** Provides medical aid in conflict zones and areas affected by diseases, without discrimination based on race, religion, or politics. * **Oxfam International:** Works in over 90 countries, focusing on fighting poverty, providing emergency relief, and addressing social injustice. * **Amnesty International:** Focuses on defending human rights, abolishing the death penalty, and protecting refugees and migrants. * **BRAC:** Involved in economic development, education, health, and gender equality, particularly in developing countries. * **Human Rights Watch:** Conducts fact-finding investigations on human rights abuses and advocates for justice and accountability. * These organizations, both UN bodies and NGOs, work collaboratively or independently, each contributing to health, human rights, and development across the globe. ## M6 ### 1. Role of Government in Financing Healthcare The government plays a crucial role in financing healthcare across various countries, and this role can differ significantly based on the healthcare system model adopted. * The three main models for government involvement in healthcare financing are: * **Compulsory Social Insurance (SHI):** The government plays a supervisory role by establishing statutory requirements for a socialized health insurance system. Countries like Germany and France use this system. Here, citizens are required to contribute to health insurance funds, and the government regulates these funds. * **National Health Insurance (NHI):** The government collects taxes to fund healthcare services. It operates a universal health insurance system where healthcare is accessible to all citizens. Canada, Taiwan, and South Korea follow this model. * **National Health System (NHS):** In this model, the government both funds and provides healthcare services. All citizens are covered, and healthcare services are delivered through government-run facilities. England, New Zealand, and Cuba have adopted this system. * The government has to balance various dimensions, including access to services, types of services, costs, insurance coverage, safety, and quality. Additionally, the government must consider the perspectives of different stakeholders such as patients and families, healthcare providers, businesses, taxpayers, and the community as a whole. ### 2. Healthcare Financing in Saudi Arabia (KSA) Healthcare financing in Saudi Arabia is a mix of government funding and out-of-pocket expenses, with the government being the major financier of healthcare services: * **Current Health Expenditure per Capita:** $1,147 (USD). * **Domestic General Government Health Expenditure as a Percentage of GDP:** 3.9%. * **Current Health Expenditure by Revenue Source (Domestic Public):** 68%. * In Saudi Arabia, the government plays a dominant role in financing healthcare, providing public healthcare services at low or no cost to citizens. The private sector also contributes to the health system, but its role is smaller compared to the public sector. Saudi Arabia faces rising healthcare costs due to chronic illnesses like diabetes, hypertension, and obesity, which have significant impacts on health expenditure. For instance: * **Diabetes** is prevalent, affecting 14.8% of males and 11.7% of females. * **Hypertension and obesity** are also major health concerns, leading to increased healthcare spending, particularly on non-communicable diseases (NCDs). ### 3. Universal Health Coverage (UHC) and Role of Insurance in Achieving It Universal Health Coverage (UHC) refers to a system where all individuals and communities receive the health services they need without suffering financial hardship. * The role of insurance in achieving UHC is critical, as it helps distribute and mitigate health risks among the population. * **Insurance Mechanisms:** * Insurance is a key tool in financing healthcare, spreading risk, and ensuring access to health services. * There is a tension between consumers who want lower premiums and insurance companies who limit coverage to reduce costs. This complexity sometimes leaves consumers unsure about their coverage, out-of-pocket expenses, and pre-existing condition limitations. * **Saudi Arabia's UHC Goals:** * As KSA looks to achieve UHC, insurance will play an increasingly important role. Currently, a mixed model of government funding and private insurance is in place. However, KSA's Vision 2030 initiative aims to expand healthcare coverage and reduce the financial burden on individuals. * External aid may also be part of the financing mix for lower-income individuals, but private and social health insurance could help over the middle-income and higher-income groups. * Insurance models, whether private or social, are critical to achieving UHC, as they provide financial protection and enhance access to healthcare. In countries like Germany (social insurance) and Canada (government-funded NHI), insurance has successfully facilitated UHC, demonstrating how different approaches can be tailored to meet the unique needs of various populations.