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Faculty of Medicine  Health Economics and Policies Faculty of Medicine  Health Economics and Policies

Faculty of Medicine Health Economics and Policies - PowerPoint Presentation

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Faculty of Medicine Health Economics and Policies - PPT Presentation

31505391 By Hatim Jaber MD MPH JBCM PhD 29012018 Presentation outline Time Introduction to course 31505391 0800 to 0820 Health as social and economic issue 0820 ID: 738868

social health economic week health social week economic inequalities care determinants economics factors physical introduction life approach policy mental

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Slide1

Faculty of Medicine Health Economics and Policies (31505391)

By Hatim JaberMD MPH JBCM PhD29-01-2018Slide2
Slide3

Presentation outlineTime

Introduction to course 3150539108:00 to 08:20

Health as social and economic issue.

08:20

to 08:30

Determinants of health

: Genetic factors , Socioeconomic factors , Environmental factors

08:30

to 08:40

Determinants of

(inequalities in)

health: Exogenous determinants of health

08:40

to 08:50Slide4

معلومات وقواعد عامةالالتزام والوقت ساعات العمل في المكتب :الأحد- الاثنين –الأربعاء 10-12 الحضور والغيابالامتحانات

المراجع والكتبBjörn

Ekman

,

2015,

Introduction to Health Economics: Theory, Practice, and Policy

- Course Note for the Health Economics Course organized by WHO-EMRO and the MENA Health Policy Forum (MHPF) Slide5

Introduction to course 31505391 Course

Title : Health Economics and Policies Credit Hours : 2 Credit HoursCalendar Description : 15 weeks/ Second Semester - 3

d year (

2017/2018)

Teaching Approaches :

2 Lectures (50min) per week (mon + wed—8:00 -8:50 am) for 15 weeks Slide6

Introduction to course 31505391(cont…)General Objective: Introduce the key concepts

of healthcare management and administration , health policy, health economics and economic evaluation, including how it can serve as a useful tool in prioritizing interventions or strategies for implementation in the health system.Slide7

Introduction to course 31505391 (cont…)Course Goals:

Discuss health value, health determinants, and health behaviors.Describe the health policy making process and the factors influencing itDefine and understand health insurance markets within health care management. Understand governmental health insurance programs and health reform policies.Discuss the role of profit and not-­for-­profit provider firms in the health care industry. To understand the specific nature of the health care service in implementing economic principles and techniquesUnderstand and Interpret and appropriately apply the key concepts of economics within the context of the health systemDescribe major types of economic evaluation and to understand their use in the decision-making process.

To describe direct, indirect, intangible and opportunity costs.To understand the effect of some economic factors on health status of society.Gain historical and current information on health related markets in Jordan and in the rest of the world and its application to health care markets.

Discuss demand and supply model of the health care industries.

Discuss the roles of both public and private sector financing of health care and the division between public and private health care goods and services.

Understand the role of professional education, training and licensing in physician and allied health professions, and their effects on quality and cost of health care.

Understand economics of bad habits including smoking and alcohol consumption.

Discuss evaluation of medical technology, regulations of health care delivery physicians.

Discuss components of health care delivery including hospitals and the pharmaceutical industry.Slide8

Introduction to course 31505391 (cont…)Method of Instruction : Lectures

2 Lectures (50min) per week (mon + wed—8:00 -9:00 am) for 15 weeks Evaluation and Grading : two exams (MCQ)Midterm - assessment = 50% Final Examination = 50% Slide9

Introduction to course 31505391(cont..) Course Content

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.)Slide10

Week 1Overview of course syllabus and time table.Health as social and economic issue.

Determinants of health: Genetic factors , Socioeconomic factors , Environmental factors Determinants of (inequalities in) health: Exogenous determinants of healthThe social and economic environment and healthThe value of health: Health related quality of life Health vs. Welfare/Utility

Value in Health and Health CareMeasuring Value in Health Care

Definition of health behaviorsSlide11

What is health?

Nutritious foods help us stay healthy.

Doctors, hospitals & medicines help us get healthy

if we’re sick

.

Regular exercise helps keep us strong and

healthy.Slide12

Definition: ‘Health …’‘…

is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’(WHO, 1948)

‘Health is only possible where resources

are available to

meet human needs

and where the

living and working environment

is protected from life-threatening and health threatening pollutants, pathogens and physical hazards

’(

WHO, 1992)Slide13

Concepts of Health Biomedical : “ health is the absence of disease”- (Germ theory of disease).

Ecological Concept: Health is an

Dynamic Equilibrium between Man and his Environment. Imbalance results in Disease.

Psychosocial concept:

Psychological,

Social,

Cultural ,

Economic, Political

factors are included in defining and measuring health.

Holistic concept: I

nclude all the factors of the other concepts in addition to all human activities such education, communication, agriculture, industry, housing , recreation etc.Slide14

Physical , Mental & Social Health Physical health deals with the body’s ability to function.Mental heath deals with how we think, feel and cope

with daily life.Social Health deals with the way react with people within our environment. Slide15

New philosophy of HealthHealth is a Fundamental right

Health is the essence of Productive lifeHealth is IntersectorialHealth is Integral part of DevelopmentHealth is central to Quality of Life

Health Involves Individuals, Families, Communities Local, National and International responsibilities

Health and its maintenance is a Social Investment

Health is

Worldwide Social Goal

.Slide16

16Slide17

DIMENSIONS OF HEALTHHealth is multidimensional and are interrelated, each has its own nature Physical Dimension“Perfect functioning” of the body. It conceptualizes health biologically as a state in which every cell and every organ are functioning at optimum capacity and in perfect harmony with the rest of the body.

Mental DimensionAbility to respond to many varied experiences of life with flexibility and a sense of purpose.Mental health has been defined as “a state of balance between the individual and the surrounding world, a state of harmony between oneself and others17Slide18

Social DimensionHarmony and integration with the individual, between each individual and other members of society, and between individuals and the world in which they live. “quantity and quality of an individual’s interpersonal ties and the extent of involvement with the community.”

Spiritual DimensionSpiritual health refers to “something” that transcends physiology and psychology.18Slide19

Emotional DimensionRelates to “feeling.” it reflects emotional aspects of humanness.Vocational DimensionWork often plays a role in promoting both physical and mental health. Physical work is usually associated with an improvement in physical capacity, while goal achievement and self-realization in work are a source of contentment and enhanced self-esteem.

OthersA few other dimensions have also been suggested such as philosophical dimension, cultural dimension, socioeconomic dimension, environmental dimension

, educational dimension, nutritional dimension, and so on.

19Slide20

DETERMINANTS OF HEALTH

Health

Biological

Gender

Environment

Health services

Behavioral & sociocultural condition

Socioeconomic

Aging

Other factor

20Slide21

Determinants of healthSlide22

Socioeconomic Conditions● Economic status: Economic situation in a country is an important factor in morbidity, increasing life expectancy and improving quality of life, family size and pattern of disease

● Education: Illiteracy correlates with poverty, malnutrition, ill health, high infant and child mortality rates. ● Occupation: Productive work provides satisfaction, promotes health and improves quality of life.● Political system: timely decisions concerning, resource allocation, choice of technology etc

22Slide23

Health ServicesTo be effective, the health services must reach the masses, equitably distributed, accessible at a cost the country and community can afford and social acceptable.Aging of the PopulationA major concern of rapidly aging population is increased prevalence of chronic diseases and disabilities that deserve special attention.Gender

Women’s health is gaining importance in areas such as nutrition, health consequences of violence, aging, lifestyle related conditions and the occupational environment. There is an increased awareness among policy makers of women’s health issues, and encourages their inclusion in all development as a priority.23Slide24

Economic DeterminantsIntersection between social (e.g. job) and economic (income) determinants is fuzzy.Concept of “social class”

is less accepted here.Social status is more than income, though income is an important determinant.“Status Syndrome” (Marmot)24Slide25

Effects of DisparitiesComplex relationship between determinants and outcomes.Some “determinants” are likely outcomes of others.

Parental income associated with educational attainment and health of child. Low education associated with high tobacco use. Tobacco use associated with…..25Slide26

Social effects of DisparitiesDiscrimination?Stress?Low self-esteem?High-risk behaviors

??26Slide27

Behavioral DeterminantsTobaccoNutrition and Physical ActivityAlcoholViolence What is the origin or cause of behavior?

27Slide28

The dependent variables: health and social problemsIn other words, these are the variables which may be affected by income inequality.Based on this social gradient principle, Wilkinson and Pickett (2009a: 18) produced a list of variables for which reliable data could be found. These were: level of trust; • mental illness (including drug and alcohol addiction); • life expectancy and infant mortality; • obesity; • children’s educational performance; • teenage births; • homicides; • imprisonment rates; and • social mobility (not available for US statesSlide29

Health inequalities Slide30

Social inequalities and health

Social structureInequalities in social position

Inequalities in access to determinants

Inequalities in healthSlide31

PerceptionWhat comes to mind when I say

“health inequalities”?Difference or unfairness?

Differences, e.g. between numbers of men and women who smoke

Unfairness

,

e.g.

higher cost of fresh fruit in poorer areasSlide32

E.g. Height Being

short as an adult could be due to genetics, ante-natal difficulties such as blood vessel malformation, physical illness or condition as a child, such as polio or cystic fibrosis

Or,

poor maternal nutrition

, lack of access to food as an infant, poor nurturing relationship etc,

i.e

.

as a result of poverty and disadvantage

Being short could disadvantage social progress, or not

For any factor where there are differences or a social hierarchy, there could also be unfairness

Slide33

Theories for health inequalityRelative povertyAbsolute povertyCulture and behaviorBiological responses to stressLife course effects starting from early years

Social stratification and discriminationSlide34

Health policies say that health inequalities are related to:

Environment

Poverty

Geography

Individual differences

Combined social circumstances

Deprived areas

Social inclusion

Lifestyles

Ethnicity

Gender

Disability

Opportunities

Discrimination

Personal choices

Age Slide35

A questionFrom what you’ve heard (and what you know), what do you think should be the two main priorities to address in order to

reduce the inequalities gap in children’s health and well-being?Slide36

Two prioritiesReduce povertyImprove educational attainmentSlide37

37Inequalities in Health

It is now generally recognised that there are many reasons for health inequalities. People can suffer health inequalities for many reasons, due in the main to:The

geographical area they live in.

The

racial group

they belong to

.

Their

gender

And, perhaps most importantly, their

social class.

The common denominator of all these factors is that they all link to

POVERTYSlide38

38Approaches to Solving Health Inequalities (1)

There are two major approaches to tackling inequalities in health:

THE COLLECTIVIST APPROACH

THE INDIVIDUALIST APPROACHSlide39

39Approaches to Solving Health Inequalities (2)>THE COLLECTIVIST APPROACH<

This approach to solving inequalities is based on the view that differences in health are beyond the ability of the

individual to change

The view is that differences in health are due to major

economic

and

social problems

in society - eg. poor housing stock, unemployment, inflation

These problems impact on different people in different ways - but

poorer social classes suffer most.

Idea first found favour in the

Black Report

(1980) and

Acheson Report

(1998)

Subscribers to this view feel that improvements will only come by

concerted government action

centering on anti-poverty strategiesSlide40

40Approaches to Solving Health Inequalities (3)>THE INDIVIDUALIST APPROACH<

This approach is based on the belief that health inequalities are the result of how INDIVIDUALS choose to lead their lives

There seems to be differences in health habits

between different social classes

People of

lower social class

seem to; smoke and drink alcohol more often, exercise less and have less healthy diets

Idea is that people should be largely responsible for

monitoring own health

Government action should centre on high-profile health

advertising campaigns

etc. Approach favoured by

Tory Government

in early mid 1990s.Slide41

Thank You