Health Care System PDF

HEALTH CARE SYSTEM MS. MARTINA DEANNE C. MENDOZA, RMT DEFINITION OF HEALTH CARE SYSTEM According to Bertalanffy (1968), a “system” is an arrangement of parts, and their interconnections come together for a purpose. Roemer (1991), defined heath system as the combination of resources, org...

HEALTH CARE SYSTEM MS. MARTINA DEANNE C. MENDOZA, RMT DEFINITION OF HEALTH CARE SYSTEM According to Bertalanffy (1968), a “system” is an arrangement of parts, and their interconnections come together for a purpose. Roemer (1991), defined heath system as the combination of resources, organization, financing, and management that culminate in the delivery of health services to the population. It refers to all the organizations, institutions, resources, and people whose primary purpose is to improve health (WHO, 2000). GOALS & FUNCTIONS OF HEALTH SYSTEM Improving the health of populations ❑ It is the overarching goal of a health system. Health status should thus be measured over the entire population and across different socioeconomic groups. Populations must be protected from existing and emerging health risks. GOALS & FUNCTIONS OF HEALTH SYSTEM Improving the responsiveness of the health system ❑ Responsiveness refers to providing satisfactory health services and engaging people as active partners. It embodies the values of respectfulness, dignity, confidentiality, autonomy, quality, and timeliness in the delivery of health services. Responsive health systems maximize people’s autonomy and control, allowing them to make choices and placing them at the center of the health system. GOALS & FUNCTIONS OF HEALTH SYSTEM Providing fair health financing ❑ An ideal health system provides social and financial risk protection in health. Thus, all health systems must be adequately funded to provide essential services to all citizens. WHO defines a fairly financed health system as one that does not deter individuals from receiving needed care due to payments required at the time of service, and one in which each individual pays approximately the same percentage of their income for needed services. 4 VITAL HEALTH SYSTEM FUNCTIONS Health service provision ❑ The most visible product of the health system is public and private health service provision. A health service is any service, not limited to clinical services, aimed at improving health of populations. Preventive measures as well as promotion of a healthy way of living to avoid illnesses also form part of the best systems. 4 VITAL HEALTH SYSTEM FUNCTIONS Health service inputs Health service inputs, or managing resources, means generating the essential physical resources for the delivery of health services which include medications, human resources, and medical equipment. 4 VITAL HEALTH SYSTEM FUNCTIONS Stewardship ❑ Stewardship, or the overall system oversight, is the main responsibility of the government. This function sets the direction, context, and policy framework for the overall health system. ❑ The core of the stewardship function includes: a. Identifying health priorities for allocation of public resources; b. Identifying an institutional framework; c. Coordinating activities with other systems related to external health care; d. Analyzing health priorities and resource generation trends and their implications; and e. Generating appropriate data for effective decision-making and policy making on health matters. 4 VITAL HEALTH SYSTEM FUNCTIONS Health financing Collecting Revenues Health System Pooling Financing Financial Risk Strategic Purchasing HEALTH FINANCING ❑ Revenue collection ▪ Revenue is earned from payments for health care services. The mechanisms for revenue collection include general taxation, direct household out-of-pocket expenditures, mandatory payroll contributions, mandatory or voluntary risk-rated contributions, donor financing, and other forms of personal savings. HEALTH FINANCING ❑ Revenue collection ▪ This entails collection of money to pay for healthcare services. ▪ Revenue collection mechanisms are general taxation, donor financing, mandatory payroll contributions, mandatory or voluntary risk-rated contributions, direct household out-of-pocket expenditures, and other forms of personal savings. ▪ Traditionally, each method of revenue collection is associated with a specific way of organizing and pooling funds and buying services. ▪ For example, public health systems are typically financed through general taxation, and social security organizations are usually finances through mandatory contributions from workers and employers (payroll contributions). HEALTH FINANCING ❑ Risk pooling ▪ Refers to the collection and management of financial resources in a way that spreads financial risks from an individual to all pool members (WHO, 2000). ▪ It is the core function of health insurance mechanisms. ▪ Participation in effective risk pooling is essential to ensure financial protection. ▪ Two main models: Bismarck & Beveridge model HEALTH FINANCING ❑ Bismarck model (Bismarck’s Law on Health Insurance of 1883) ▪ This is named after the Prussian Chancellor Otto von Bismarck who invented the welfare state as part of the unification of Germany in the 19th century. ▪ It uses an insurance system – the insurers are called sickness funds – usually financed jointly by employers and employees through payroll deduction. HEALTH FINANCING ❑ Bismarck model (Bismarck’s Law on Health Insurance of 1883) ▪ It is observed in Germany, France , Belgium, Netherlands, Japan, Switzerland, and, to a degree in Latin America. HEALTH FINANCING ❑ Beveridge model (Bismarck’s Law on Health Insurance of 1883) ▪ This model is named after William Beveridge, the social reformer who designed Britain’s National Health Service. ▪ In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library. ▪ In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government as the sole payer, controls what doctors can do and what they can change. HEALTH FINANCING ❑ Beveridge model (Bismarck’s Law on Health Insurance of 1883) ▪ Countries using the Beveridge plan or variations of it include Great Britain, Spain, most of Scandinavia and New Zealand, Hongkong, and Cuba. HEALTH FINANCING ❑ Strategic purchasing ▪ It is the way most risk-pooling organizations or purchasers use collected and pooled financial resources to finance or buy health care services for their members. WHO HEALTH SYSTEM FRAMEWORK World Health Report (2000) defines the six building blocks and priorities which are necessary in strengthening health systems and improving the overall health outcomes. WHO HEALTH SYSTEM FRAMEWORK Service delivery – those which deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources. Health Workforce – one which works in ways that are responsive, fair, and efficient to achieve the best health outcomes possible, given the available resources and circumstances. Information – one that ensures the production, analysis, dissemination, and use of reliable and timely information on health determinants, health systems performance, and health status. WHO HEALTH SYSTEM FRAMEWORK Medical Products, Vaccines, and Technologies – ensure equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy, and cost-effectiveness, and their scientifically sound and cost-effective use. Financing – raises adequate funds for health, in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. Leadership and Governance – involve ensuring strategic policy frameworks exist and are combined with effective stewardship, coalition-building, the provision of appropriate regulations and incentives, attention to system-design, and accountability. THE PHILIPPINE HEALTH SYSTEM 1970: Primary Health Care for All – Developed a largely centralized government-funded and operated health care system. 1979: Adoption of Primary Health Care Strategy – promoted participatory management of the local health care system 1982: Reorganization of DOH – integrated public health and hospital services 1986: Milk Code 1986 – prevention and nutrition to promote breastfeeding. 1988: The Generics Act (RA 6675) – prescriptions are written using the generic name of the drug in an attempt to lower expenditure on drugs by promoting and purchasing non- branded medicines. 1991: Local Government Code (RA 7160) – transfer of responsibility of health service provisions to the local government units 1995: National Health Insurance Act (RA 7875) – aims to provide all citizens a mechanism for financial protection with priority given to the poor THE PHILIPPINE HEALTH SYSTEM 1996: Health Sector Reform Agenda – major organizational restructuring of the DOH to improve the way health care is delivered, regulated, and financed. 2005: FOURmula One (F1) for Health – adoption of operational framework to undertake reforms with speed, precision, and effective coordination 2008: “Access to Cheaper and Quality Medicines Act” (RA 9502) – promotes and ensures access to affordable quality drugs and medicines for all 2010: Kalusugang Pangkalahatan (AO 2010-0036) – provided universal health coverage and access to quality health care for all Filipinos 2013: Sin Taxes for Health – generating extra revenue for the DOH by discouraging harmful consumption of alcohol and tobacco 2019: Universal Health Care Law – enrolling all Filipinos automatically in the National Health Insurance Program administered by PhilHealth. All Filipinos are guaranteed equitable access to quality and affordable health care services LEADERSHIP & GOVERNANCE The DOH is mandated to provide national policy direction and develop national plans, technical standards, and guidelines of health. It also provides technical assistance, capacity-building, and advisory services for disease prevention and control and supplies medicines and vaccines. Under the Local Government Code (1991), LGUs were granted autonomy and responsibility for their own health services. National health programs are coordinated by DOH through the LGUs. DECENTRALIZED & CENTRALIZED The Department of Health, as mandated, has the duty in: ❑Developing health policies and programs; ❑Enhancing partners’ capacity through technical assistance; ❑Leveraging performance for priority health programs among these partners; ❑Developing and enforcing regulatory policies and standards; ❑Providing specific programs that affect large segments of the population; and ❑Providing specialized and tertiary level care.