31505391 Introduction to Health care management Health Policy and Healthcare Delivery By Hatim Jaber MD MPH JBCM PhD 5 7 02 2018 1 Course Content 31505391 Week ID: 737645
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Faculty of Medicine Health Economics and Policies (31505391)Introduction to: Health care management. Health Policy and Healthcare Delivery
By Hatim JaberMD MPH JBCM PhD5+7 -02- 2018
1Slide2
Course Content 31505391 Week 1 Introduction to Course introduction to Health: health value, health determinants. Week 2 Introduction to: Health care management Health Policy and Healthcare Delivery.Week 3 The scope of health economics :Economics and Health Economics .Week
4 Demand and Supply Demand for Medical Care. Supply of public health . Week 5 The Market for Health Insurance.Week 6 Financing health care Economic in Health Policy Cost and price.Week 7 Health systems performance analysis. Measurement and evaluation in health care.Week 8 Midterm assessment (Exams.) 21-3-2018
Week 9
Public Goods, Market Failures, and Cost-Benefit Analysis.Week 10 Economic evaluation . Economics and efficiency cost analysis and cost effectiveness.
Week 11
Economic effects of Bad habits including smoking and alcohol consumption
Week 12 Quality Improvements in healthcare delivery Methods to improve health care delivery.Week 13 Human resources in Healthcare delivery.Week 14 Health Markets and Regulation and Economic regulation of health markets.Week 15 Final assessment (Exams.)
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Week 2Management and Health Administration Types of Health Care Systems and its componentsThe Cycle of Care and Levels of Health care Resources, and Financing Quality and Healthcare Planning Health policyInternational and national health policy and The state, the private sector and health policy.Health policy reform
Supervision, monitoring and EvaluationHow People Invest to Maintain Good Health and Why People Invest in Good HealthWhat is good health? What leads to good health and bad health? How do people make choices about investing in their health? Does public policy have a role in helping low income people maintain good health status?Investing in health. The economic burden of disease. Universal Health Coverage: definition and importance.
3Slide4
Presentation outlineTimeManagement and Health Administration Quality and Healthcare 08:00 to 08:20
Types of Health Care Systems and its componentsThe Cycle of Care and Levels of Health care 08:20 to 08:30Planning Health policy
The state, the private sector and health policy.
08:30
to 08:40
Health policy reform
08:40 to 08:504Slide5
Definitions and conceptsManagement: The organization and coordination of the activities of a business in order to achieve defined objectives. The act of directing people towards accomplishing a goal.Management is the
operational part of administration.Administration: the activities that relate to running a company, school, or other organization Health administration, a field relating to leadership, management and administration of public health systems, hospitals and hospital networks
Policy: set of ideas or plans that is used as a basis for
making decisions, especially in politics, economics, or business.
5Slide6
6DefinitionsMANAGEMENT is both a SCIENCE and ARTAs a SCIENCE, management has basic rules and principles.As an
ART, successful managers learn through experience, they follow flexible, adaptive, innovative approaches to fulfill objectives.Management is a
decision making process
translating the policies
into
plans
, implementing those plans, and evaluate the plans and the interventions to re-plan to achieve better resultsSlide7
7DefinitionsManagement is getting things effectively done to achieve desired objectives through proper planning, efficient
implementation and evaluation to identify the needs for re-planning.Management is thus a dynamic process.Effectiveness is the degree to which a stated objective is being achieved.Efficiency is the optimized (balanced) use of resources (Human resources, equipment, supplies, money, space, time & informationSlide8
What is care management?Many different things to different peopleResource coordinationUtilization managementFollow-upPatient educationClinical management8Slide9
Good ManagementHighlights prioritiesAdapts services to needs and to changing situations (dynamic)Makes most of limited resourcesImproves the standard and quality of servicesMaintains high staff morale9Slide10
10Management Process I. Planning II. Implementation:OrganizingStaffingLeading/DirectingControlling /Monitoring
III. EvaluationSlide11
A systems view of management
Process
Inputs
Outputs
Human resources
Non-human resources
Conversion
mechanism
Objectives
achievement
11Slide12
Definition of Administration“ The process of achieving defined goals at a defined time
through the guidance, leadership, and control of the efforts of a group of individuals and the efficient utilization of non-human resources bearing in mind adequacy, speed, and economy to the utmost possible level.”
12Slide13
Elements of Administration:PlanningOrganizationStaffingDirectingCoordinating
ReportingBudgetingSupervising Evaluation
13Slide14
Health Care AdministrationHealth care administration
is the process by which knowledge, energies and social structures
are systematically utilized to achieve specific objectives
.
Functions
Planning function : What do we need to do to improve health? Anticipated action
for
tomorrow
2. Management function
:
What
to do and
how
to do it?
Action
for
today
3. Evaluation function:
Does what we have planed work?
14Slide15
Levels of AdministrationThere are also 3 levels of administration.
Centrallevel
Intermediate
level
Local Level
Ministry of health
directorates of health
e.g. health office,
Hospital, health
care unit
15Slide16
16Slide17
Levels of Health CarePreventivePrimarySecondaryTertiaryRestorativeContinuing
17Slide18
Preventive and Primary Care SettingsSchool health servicesOccupational health servicesPhysicians’ officesClinicsNursing centersBlock and parish nursing
18Slide19
Secondary and Tertiary Care SettingsHospitals/medical centersEmergency departmentsMedical unitsIntensive care Psychiatric facilitiesRural hospitals
19Slide20
Restorative Care SettingsHome health careRehabilitation centersExtended care facilities20Slide21
21Slide22
QualityCarrying out interventions correctly according to pre-established standards and procedures,with an aim of satisfying the customers of the health system and maximizing results without generating health risks or unnecessary costs.
22Slide23
Dimensions of QualityTechnical competenceAccess to serviceEffectivenessEfficiencyAmenitiesInterpersonal relationsContinuity
Safety 23Slide24
What Is Health Care Quality?“The degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
-- Institute of Medicine
24Slide25
Health PolicyHealth policies are public policies or authoritative decisions that pertain to health or influence the pursuit of healthHealth policies affect or influence groups or classes of individuals or organizations25Slide26
Health policy can be understood as the:...courses of action (and inaction) that affect the sets of institutions, organizations, services and funding arrangements of the health system. It includes policy made in the public sector (by government) as well as policies in the private sector. But because health is influenced by many determinants outside the health system, health policy analysts are also interested in the actions and intended actions of organizations external to the health system which has an impact on health (for example, the food, tobacco or pharmaceutical industries
(Buse, Mays & Walt, 2005:6)).26Slide27
Public vs. Private PolicymakingPublic PolicyPolicy that is established by the federal, state, and local levels of governmentPrivate PolicyPolicy that is established by private organizationsPublic Policiesare authoritative decisions
made in the legislative, executive, or judicial branches of governmentintended to direct or influence the actions, behaviors, or decisions of othersHealth Policythe aggregate principles, stated or unstatedthat characterize the distribution of resources, services, and political influences
that impact on the health of the population
27Slide28
Forms of Health PoliciesThere are five main forms of health policiesLawsRules/RegulationsOperational DecisionsJudicial DecisionsMacro Policies28Slide29
29A GOOD HEALTH POLICY SHOULD: Goals and targets
Be reasonably explicit (clear) in terms of values, Provide a
road map for the future
,
Give scope for transparent
follow up
of the ProposalsBe useful as a tool for changeSlide30
The Policy CycleThe formation and implementation of health policy occurs in a policy cycle comprising five components:1.) issue raising2.) policy design 3.) public support building
4.) legislative decision making and policy support building 5) legislative decision making and policy implementation30Slide31
31
THE “IDEAL” POLICY CYCLE
E
T H I C S
P OL I T IC
SSlide32
32"Power is the ability to make others do what you want them to do"
Authority can be used to mean power given by the state (in the form of government, judges, police officers), it is
legalized power.
Sources of Political Power
TANGIBLE
NON TANGIBLEMoney - InformationOrganization - Access to leadersPeople - Access to mediaVotes - Expertise Legitimacy
Offices - SkillsSlide33
33Types of policy interventionsRegulatory
A. Regulate productsSpecify who, where, when products can be used; how they should be made, etc.)
E.g., drugs, supplements , syringes, gloves, instruments, etc…..
B. Regulate consumers
E.g., age for consuming service, i.e. vaccination, family planning
C. Regulate service providers or producers
E.g., who can prescribe medications, who can perform eye exams; who can produce pharmaceuticals D. Regulate promotion/advertising
(what, to whom, when)
E.g., restrict tobacco or alcohol, pharmaceuticals, health claims made by products, etc.Slide34
34Disadvantages of public policy
Its not easy to influence the policy process
The process moves
very slowly
It’s
not easy to
adaptThere are almost always unintended consequences .The process can be co-opted to achieve other purposes {e.g., revenue ( income, profit) generation}Slide35
35Health policy includes a variety of activitiesPublic HealthFocus on population
Sanitation Disease control Infant mortality Nutrition Occupational health
Environmental health
Health Care
Focus on treatment of the i
ndividual Access Service delivery Standards for practice and treatment Funding AccountabilitySlide36
Important DistinctionsHealth vs. Health CareHealth refers to a state of the human body and mindHealth Care refers to chemicals, devices, and services used by people to improve their healthHealth insuranceA system of paying
for unpredictable needs for health care36Slide37
The planning function
Definition: planning is a team work involving an organized, intelligent attempt to select
the best alternative(s) to achieve specific objectives in efficient manner.
The purpose of planning
1. To match limited resources with unlimited problems 2. To
use resources effectively and efficiently
. Minimize or eliminate wasteful use of resources.
3. To
develop the best course of action
to accomplish pre-defined
objectives.
37Slide38
38Planning steps
( 1) Situational
analysis
( 2)
Environmental & situational
Analysis
( 3) Prioritization
( 4) Statement of objectives
( 5) Exploration of alternative solution
( 6)
Choice
of
one solution
( 7)
Implementation
( 8)
EvaluationSlide39
Factors that may disturb health care planning:
Political instability.Economic crises.
Administrative
inefficiency.
Complexity
of health care determinants.
Conflicts between (among) decision making groups.
Natural
disasters.
Haphazard
(random)population distribution.
39Slide40
What is a Health Care System? System: “a collection of components organized to accomplish a specific function or a set of functions”. The parts of a system can be referred to as its elements or components
The environment of the system is defined as all of the factors that affect the system and are affected by it. 40Slide41
What is a Health Care System?A Health Care System: “the complete network of agencies, facilities, and all providers of health care in a specified geographic area.” (Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.) “an organized plan of health services.”Every country has a health care system, however fragmented it may be among different organizations or however
41Slide42
Health Care SystemsHealth care systems are designed to meet the health care needs of target populations. In some countries, the health care system has evolved and has not been planned, whereas in others efforts have been made by: governments,trade unions, charities, religious,
or other coordinated bodies to deliver planned health care services targeted to the populations they serve. 42Slide43
The different levels of health systemsHealth systems operate at, and across, the macro, meso and micro levels43Slide44
The interconnections among the health system building blocksA set of six functions, or building blocks
44Slide45
Delivery System DesignMultiple levelsRegional/National: macrosystemIntegrated Medical Care Organization: mesosystemPractice level: microsystem
45Slide46
46These functions of Healthcare system include: Oversight, policy making, regulations,
Health service provision; preventive services, clinical services, health promotionFinancing and managing resources; pharmaceutical, medical, equipment, information. Slide47
Centrallevel
Level
Peripheral
Level
Ministry of Health
“
Central planning
”
General Directorate of health
Adaptation of central plans to local requirements
”
Hospitals
Health Centers
Mobile units
The health care system represented in
the following diagram:
Intermediate
Provide health care service
47Slide48
What is a Health Care Delivery System?Three major components that make up the Health Care Delivery System are:FacilitiesPractitionersEntities
48Slide49
What is Health Sector-System Reform ?Reform means positive change,
HSR implies “sustained, purposeful and fundamental change”–to address the needs of the communities for provision of equitable healthcare services.(Berman, 1995).
Sustained
Purposeful
Fundamental
Change
49Slide50
Overall HSR Objectives The overall objectives is: “to improve the health status of the population through provision of equitable, affordable and efficient quality health care services”
Equity
Quality Assurance
Efficiency
Good
Governance
SustainabilityCommunity Participation
50Slide51
Components of reformAccording to Cassels, health sector reform includes:Improving the performance of civil servicesDecentralizations
of power and resourcesImproving functions of national health ministriesBroadening health financing mechanisms
Introducing managed competition
Privatization???????????
51Slide52
Current interest in HSRD EE C
V OE NL OP MI I
N E
G S
Increasing
Poverty
VolatileSocio-economicBrittle Governance
Population
Growth
Unemployment
Inequitable
Healthcare
access
Lack of
Social
Protection
52Slide53
Presentation outline7-2-2018TimeHow why People Invest to Maintain Good Health?08:10 to 08:20
Investing in health. 08:20 to 08:30The economic burden of disease.
08:30
to 08:40Universal Health Coverage: definition and importance.
08:40
to 08:50
53Slide54
How improved health leads to increased personal and national incomeAdapted from WHO World Health Report 1999 and Ruger, Jamison, Bloom. Health in the economy. In: Merson, Black, Mills, eds. International public health, 2nd
edn. Sudbury: Jones and Barlett, 2006.54Slide55
Evidence for health improvements stimulating economic development551 Jamison, Lau, Wang. Health’s contribution to economic growth in an environment of partially endogenous technical progress. In: Lopez-Casasnovas, Rivera, Currais, eds. Health and economic growth: findings and policy implications. Cambridge, MA: The MIT Press, 2005: 67-91.
Jamison, Lau, and Wang reviewed literature and concluded that 11% of economic growth in low- and middle-income countries from 1970-2000 was from reductions in adult
mortalitySlide56
Better Health Increases “Full Income” People place a high value on living a longer, healthier lifeNational income accounts measure income in a narrow sense“Full income” is a broader concept that values income accounting as well as mortality risk56
We
used
“full income
” approach to
better assess health’s
contribution to a nation’s economic well-beingSlide57
Myanmar government expenditure on health as % of total government expenditure compared to countries of similar (Gross national income) GNI per capita, 2004-13
GNI per capita, 2014Kenya: $1,280Myanmar: $1,270Mauritania: $1,260
Kyrgyzstan: $1,250Bangladesh
: $1,080
Source: World Health Organization Global Health Expenditure Database
57Slide58
ConclusionsEvidence is compelling: there is an enormous payoff from investing in healthBetter health stimulates economic growth Better health has a value in and of itself
Growth in “full income” quantifies both income growth and the value of increased life expectancyHigh priority for investing in health and in investments that affect health (e.g. water and sanitation)58Slide59
HOW MUCH COST FOR HEALTH IS
RATIONAL?If a car
worth $10,000
would cost $15,000
to
repair after an accident
, an insurer would only pay $10,000. The impossibility of
replacing
the
body
,
and
the
consequent absence
of
a market value
for it,
precluded
any
such
ceiling on health
costs.
59Slide60
60Slide61
61Slide62
62Slide63
GLOBAL BURDEN OF DISEASEThe burden of
disease approach is a systematic, scientific effort to quantify the comparative magnitude of health loss
due to
diseases, injuries,
and
risk factors
by age, sex, and geography for specific points in time.The
burden
of
disease can be thought
of
as a
measurement
o
f the
gap
between
current health
status
and an ideal situation
where
everyone
lives into old
age,
free of
disease
and
disability.
63Slide64
GLOBAL BURDEN OF DISEASEThere are
more than 7 billion people in the world and hundreds of millions experience disease or injury each year
.
Taken as a
whole
,
the:combined pain, suffering,
loss
of
productivity
and
unrealized
hopes
and
D
reams
are our
world’s
burden
of
disease
.
64Slide65
Relationship between burden of disease measures and economic evaluation of healthcare interventions for the 3 broad disease groups of the Global Burden of Disease study.65Slide66
GLOBAL BURDEN OF DISEASEThe Global Burden of Disease Study 2010 (GBD
2010) has three related but distinct uses:to provide a coherent picture of
which diseases, injuries, and risk factors
contribute the most to health loss in a given
population;
to
compare population health across communities and over time;and to help guide an assessment of where health information systems are strong or weak
by identifying
which
data sources are missing, are of low
quality,
or are highly
uncertain
66Slide67
GLOBAL BURDEN OF DISEASE SURPRISES-20201. Rapid rise
of chronic disease73% of GBD by
2020
2.
High
level mental
illness3.7% of GBD – depression3. Violence, war,
injuries
12% deaths
worldwide
41% deaths < 20
years,
USA
4. Alcohol and
Tobacco
Tobacco
#1
instigator
Fastest gain, underdeveloped
nations
5. Significant increase in
cancer
Number
1 killer in many
countries
67Slide68
BURDEN OF DISEASE AND GLOBAL RISKFACTORS
The leading global risks for mortality in the
world are:
High blood pressure (responsible for 13% of deaths
globally),
Tobacco use (9%),High blood glucose (6%),
Physical inactivity (6%),
and
Overweight and obesity
(5%).
These
risks
are responsible
for
raising
the
risk
of
chronic diseases such as heart disease, diabetes and cancers. They
affect
countries across all income groups: high, middle and
low.
68Slide69
The leading global risks for burden of disease as measured in disability- adjusted life
years (DALYs) are:Underweight (6% of global DALYs) and
Unsafe sex (5%), followed
by
Alcohol use (5%)
andUnsafe water, sanitation and hygiene (4%).Three of these risks
particularly
affect
populations in low-income countries
, especially in the regions
of
South-East Asia and sub-Saharan
Africa
.
The
fourth risk
–
alcohol use
–
shows
a
unique
geographic and sex pattern,
with
its
burden highest
for
men in
Africa,
in middle-income countries in
the
Americas and in some high-income
countries.
BURDEN
OF DISEASE
AND
GLOBAL
RISK
FACTORS
69Slide70
CHANGING DISEASE BURDENSource: Murray CJL, Lopez AD. Science 1996;274:740–743
Changing Disease Burden 1990–2020Expected to
Decrease
Lower respiratory infections Diarrheal
disease
Perinatal
conditionsMeaslesCongenital anomalies MalariaMalnutrition Anemia
Expected to
Increase
Depression
Heart
disease
Cerebrovascular
disease
Traffic
accidents
Chronic obstructions/ pulmonary
disease
War,
violence, suicide
HIV
Lung
cancer
70Slide71
SCHEMA FOR ASSESSING NON-FATALHEALTH OUTCOMES
Disease
Impairment
Disability
Handicap
Polio
Paralyzed
legs
Inability
to
walk
Unemployed
Brain
injury
Mild
mental retardation
Difficulty
learning
Social
isolation
71Slide72
POVERTY: A BREEDING GROUND FORCOMPROMISED
―LIFESPAN AND ―HEALTH
SPAN
“
Poor
people
are often
sick
because they are
poor
,
and
sometimes
poor
people
are poor because they are
sick.”
–
Nils
Daulaire,
MD,
PhD
President,
Global Health
Council
Source: Global
Health
Council
72Slide73
THE ECONOMIC BURDEN OFNon-Communicable diseasesNon-communicable diseases represent a high cost to society and contribute to social inequities.Available cost estimates indicate a large and growing burden to individuals, families, and the public and private sectors.Complications of non-communicable diseases incur considerable costs; for example, diabetic nephropathy was estimated as the most costly complication of diabetes in the Americas.Non-communicable disease costs are expected to rise; in the next ten years alone, cancer costs will rise by one-third.
Knowledge and technologies exist to bring down the burden of non-communicable disease. Paying for non-communicable disease prevention and management is an investment.73Slide74
What isUniversal Health Coverage?UHC
UHC means that all individuals and communities receive the health services they need without suffering financial hardship74Slide75
Universal Health Coverage Forum 2017Tokyo Declaration on Universal Health Coverage: All Together to Accelerate Progress towards UHC 2017 UHC Global Monitoring Report. According to this report, much remains to be done to achieve UHC: At least half of the world’s population still does not have access to quality essential services to protect and promote health.
800 million people are spending at least 10 percent of their household budget on out-of-pocket health care expenses, and nearly 100 million people are being pushed into extreme poverty each year due to health care costs.
75Slide76
76Slide77
Universal Health CoverageThe first objective is that everybody should be able to access a full-range of health services including promotion, prevention, treatment, rehabilitation and palliative care.The second objective is to ensure protection from the financial
risk associated with seeking care.77Slide78
Formal Definition of Universal Coverage78 |
World Health Assembly Resolution 58.33, 2005:
Urged countries to develop health
financing systems to:
Ensure
all
people have access to needed servicesWithout the risk of financial ruin linked to paying for
care
Defined
this as achieving
Universal Coverage:
coverage
with
health services;
with
financial
risk
protection;
for
all
Reconfirmed
in
WHA64.9
of
2011
and
many
Regional
Committee
ResolutionsSlide79
Universal Health Coverage79 |
Health services: prevention, promotion, treatment, rehabilitation – not just treatment
Coverage with services of good
quality
Universal Health Coverage
(UHC)
for MDG and sustainable development dialogueUHC is a destination:New technologies
Increasing
costs
Increasing population
or
changing in population age
structure
Changing disease
patternsSlide80
Universal Health CoverageUHC combines two key elements: the first relating to people’s use of the health services they need andthe second to the economic consequences of doing so.
Two components of Coverage
Coverage with
needed services
Coverage with
financial risk protection
80Slide81
81Slide82
The Three Dimensions (policy choices) of Universal Coverage
82 |
The importance Of
Human rights
and
equity
in filling the BOXSlide83
Why is moving towards UHC important?Health Benefits:better access to necessary care and improved population health, with the largest gains accruing to poorer peopleEconomic Benefits:Political Benefits
83Slide84
Key guiding principles to inform the design of global UHC policies:1 Equitable AccessAll people should have equitable access to essential health care services.2 Efficiency
Health systems should use resources effectively and efficiently.3 QualityHealth systems should guarantee access to quality infrastructure, service and care.4 InclusivenessTransition to and implementation of Universal Health Coverage should include engagement of all relevant stakeholders to maximize patient needs
5 AvailabilityEssential health services and products should be available to all those who
need them.6 AdaptabilityDiverse approaches should be encouraged
to facilitate
UHC based healthcare
financing and delivery.7 ChoiceHealth systems should preserve patient choice in health care services and delivery.8 InnovationSociety should encourage investments in R&D across the spectrum of prevention, diagnostics, treatment, care and support.84Slide85
Universal Coverage and FinancingWorld Health Assembly Resolution 58.33, 2005: Urged countries to develop health financing systems to: Ensure all people have access to needed services
Without the risk of financial catastrophe linked to paying for careDefined this as achieving Universal Coverage85Slide86
Millions more suffer financially when they use health services86
|
-
90
E
U
R
S
E
A
A
M
R
W
P
R
A
F
R
E
M
R
30
60
Number
of
people
(million)
impoverishment
catastrophicSlide87
Inputs & processes Health Financing Health workforce Infrastructure Information Governance Service Delivery
OutputsService access
and readiness
Service quality
and
safetyService UtilizationOutcomes
Coverage
of i
n
t
e
r
v
e
n
tions
Coverage
with
a
method
of
financial risk
protection
Risk
factors
Impact
Health
status
Financial
Risk
Protection
Responsiveness
Monitoring and evaluation results
chain
87
|
Level
and distribution
(equity)
Social
DeterminantsSlide88
Universal Health Coverage exists when all people receive the quality health services they need without suffering financial hardship.
88Slide89
GLOBAL PREVALENCE OF UNIVERSAL HEALTH COVERAGE89Slide90
Three Fundamental
Health
Financing
Challenges
for
Achieving
Universal
Coverage
Raise
sufficient funds for
health;
Ensure/maintain
financial
risk
protection – i.e.
ensure
that
financial
barriers do
not
prevent people
using needed health services nor
lead to
financial ruin when using
them;
Minimize
inefficiency and inequity
in
using resources,
and to assure transparency and accountability.
90Slide91
91Slide92
Thank You92