Health Systems Lesson 1 PDF

# Introduction to Health Systems ## Health: * A state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity * Is a fundamental human right and ... a most important world-wide social goal." ## Health Care * refers to chemicals, devices, and services u...

# Introduction to Health Systems ## Health: * A state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity * Is a fundamental human right and ... a most important world-wide social goal." ## Health Care * refers to chemicals, devices, and services used by people to improve their health ## Health Insurance ## System * A system of paying for unpredictable needs for health care * Set of connected things or parts forming a complex whole * Set of things working together as parts of a mechanism or an interconnecting network ## Physiology * Set of organs in the body with a common structure or function ## Health System * A set of inter-related services, processes and capacities that include: 1. Direct service delivery to the population 2. Supporting services that make service delivery possible 3. Health workforce and their development 4. Physical infrastructure needed to deliver the health services 5. Financing arrangements-might include health insurance, direct payments by patients, public funding, international aid ## 6. System of regulation and licensing that protects the public from, unsafe products, ineffective medicines or inept treatment ## Note: A good health system delivers effective, appropriate, safe, quality health care to those who need it; when they need it. ## Common Mistake of Health System: 1. Think that the public sector service delivery system is "the health system" 2. Think that studying health system means looking at the organization chart of the public sector ## Health System Basics (WHO, 2007): - **Health System (def.)** * Consists of all organizations, people and actions whose primary intent is to restore or maintain health. * Includes efforts to influence determinants of health as well as more direct health-improving activities. * It is MORE than the pyramid of publicly owned facilities that deliver personal services. - **Guiding values and principles** * Values and goals enshrined in the Alma Ata declaration. * WHO’s commitment to gender and human rights. * World Health Report of 2000 ## Health Systems Goals: - **Overall Outcomes (World Health Report 2000):** * Improving health and health equity through ways that are: * Responsive * Financially fair * Best or most efficient use of available resources - **Intermediate Goals:** * Greater access to and coverage for effective health interventions * Provider quality and safety are not compromised ## System building blocks * Leadership/governance * Health care financing * Health workforce * Medical products, technologies * Information and research * Service delivery ## Goals/outcomes * Improved health (level and equity) * Responsiveness * Financial risk protection * Improved efficiency ## Leadership and Governance * Ensuring the existence of strategic policy frameworks combined with: * Effective oversight * Coalition-building * Provision of appropriate regulations and incentives * Attention to system design * Accountability ## Health governance (stewardship) context: * Wide range of functions carried out by governments to: * Improve population health while ensuring: * Access to services * Quality of services * Patients’ rights * Examples: * Administrative details * Logistics and Operations * Planning and Policy Making * Monitoring and Evaluation ## Governance: Roles, responsibilities and relationships (Interplay) of: * Public sector * Private sector * AND Voluntary sectors (including civil society) ## In pursuit of national health goals * Ensure clarity AND actualization of health system vision-mission ## Mandate (E.O. No. 119, Sec. 3): The Department of Health (DOH) shall be responsible for the following: formulation and development of national health policies, guidelines, standards and manual of operations for health services and programs; issuances of rules and regulations, licenses and accreditations; promulgation of national health standards, goals, priorities and indicators; development of special health programs and projects and advocacy for legislation on health policies and programs. The primary function of the Department of Health is the promotion, protection, preservation or restoration of the health of the people through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services. ## THE DOH IS THE LEAD AGENCY FOR PHILIPPINE HEALTH CARE ## Devolution - RA 7160 (Local Government Code of 1991) * The act by which the Philippine Government "devolved" basic services (health services, agriculture extension, livelihood development, forest management, barangay roads and social welfare) to Local Government Units (barangay, municipality/city, province) ## Implementation of Devolution in 1992: * Management and delivery of health services * From DOH to locally elected provincial, city and municipal governments ## 4 Essential Health System Functions * Service provision * Resource generation * Financing * Stewardship ## Devolution in ARMM: * Retained centralized character of its health system * DOH ARMM directly runs its provincial and municipal health facilities (hospitals, RHUS) ## Interlocal Health Zones (ILHZs) * Inspired by WHO District Health System * Pseudo legal entities * (Ideally) An integrated health management and delivery system based on defined administrative and geographical area * District Hospital + surrounding/covered municipalities * Usually composed of adjacent municipalities with similar health needs * Resource sharing * Common health goals * Mutual planning, policy formulation, health operations implementation and monitoring and evaluation ## HEALTH CARE FINANCING ## Good Health Financing: ### Two Main Characteristics: * Raises adequate funds for health to ensure that people get to use needed services * People who use health services are shielded from financial catastrophe or impoverishment associated with having to pay for them ## Health and Health Care are major political and economic issues ## Health financing impacts the analysis of: * Health policies * Fund sources * **Effectiveness and efficiency of health services for populations** ## Health Financing Goals: * Raising sufficient funds for health * Ensure adequate spending on health * Effective allocation of finite financial resources to different types of public and personal health services * Pooling financial resources across population groups and sharing financial risks * Using funds for health efficiently and equitably ## Philippine Health Financing * 4.6% of GDP (World Bank, 2012); Global average is 10.2% * Very high proportion of out-of-pocket (OOP) spending * Presently: * Fragmented * Inequitable ## Main fund sources: * Government * Private (OOP, HMOs, life insurance, etc.) * Social Health Insurance * Others (grants, aid, etc.) ## Filipino households continue to bear the heaviest burden (2012, PSA) – 57.6% OOP ## The National Health Insurance Program: RA 7875 * National Health Insurance Act of 1995 * Established the Philippine Health Insurance Corporation (PHIC) More commonly known as: PhilHealth ## PhilHealth * **Employed Sector Program** * Compulsory coverage: ALL government AND private employees * **Individually Paying Program** * Voluntary coverage: self-employed and "others" * **Sponsored Programs** * Covers "poorest of the poor" (Quintiles 1 and 2) * **Overseas Filipino Workers** * **Lifetime Member Program** * 60 y.o. and above who have completed 120 monthly contributions (before) * Senior Citizens automatically covered (2015) ## Population needs determine the development and sustaining of health workforce * Education, training and continuing competence * Utilization, management and retention * Strategic response to evolving and unmet health service needs * Governance, leadership and partnerships for sustained HRH contributions to improved population outcomes * Regulation * Deployment * Compensation * Continuing career enhancement and development ## To achieve the best health outcomes possible: * Sufficient numbers * Right mix of staff * System-wide deployment and distribution (equitable) * Established job-related-norms * Enabling work environments * Just compensation/payment systems - right kind of incentives