Faculty of Medicine Health Economics and Policies - PowerPoint Presentation

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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

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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.

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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.

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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

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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.”

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Elements of Administration:PlanningOrganizationStaffingDirectingCoordinating

ReportingBudgetingSupervising Evaluation

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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?

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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

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Levels of Health CarePreventivePrimarySecondaryTertiaryRestorativeContinuing

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Preventive and Primary Care SettingsSchool health servicesOccupational health servicesPhysicians’ officesClinicsNursing centersBlock and parish nursing

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Secondary and Tertiary Care SettingsHospitals/medical centersEmergency departmentsMedical unitsIntensive care Psychiatric facilitiesRural hospitals

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Restorative Care SettingsHome health careRehabilitation centersExtended care facilities20Slide21

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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.

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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

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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

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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.

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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.

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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

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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

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Delivery System DesignMultiple levelsRegional/National: macrosystemIntegrated Medical Care Organization: mesosystemPractice level: microsystem

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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

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What is a Health Care Delivery System?Three major components that make up the Health Care Delivery System are:FacilitiesPractitionersEntities

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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

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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

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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???????????

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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

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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

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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

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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.

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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.

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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

.

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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

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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

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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.

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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

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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

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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

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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.

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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

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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

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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