PHCL 411 Course Contents Overview of the Health care systems Professional Economic and Public Aspects of Health Care System Pharmacy and Health Care System Medication Use and Distribution System ID: 808444
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Slide1
Pharmacy In Health Care System
PHCL 411
Slide2Course Contents
Overview of the Health care systemsProfessional, Economic and Public Aspects of Health Care SystemPharmacy and Health Care SystemMedication Use and Distribution SystemThe Structure of Health Care System in Saudi ArabiaThe Organization of Health Care System in Saudi ArabiaFinance and Regulation of Health Care System in Saudi ArabiaAccreditation of Health Care System in Saudi ArabiaThe Role of Insurance and Private Sector in Health Care System in Saudi Arabia
Group Project Presentation
Slide3health care system
Slide4According to the World Health Organization (WHO) , the Saudi health care system is ranked 26th among 190 of the world’s health systems
It comes before many other international health care systems Canada (ranked 30), Australia (32), New Zealand (41), and other systems in the region such as the United Arab Emirates (27), Qatar (44) and Kuwait (45)Despite these achievements, the Saudi health care system faces many challenges which require new strategies and policies by the Saudi Ministry of Health (MOH) as well as effective cooperation with other sectors.
Introduction to health care system
Slide5Consist of a number of interrelated subsystems .
Each of these subsystems has a purpose which, if attained, aids the larger system in reaching its overall goals.For examples the healthcare systems of U.S.A, Canada , Saudi Arabia,
Components of Healthcare Systems
Slide6Health care system in the United States
Health care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector .
health insurance is now primarily provided by the government in the public sector, with 60-65% of healthcare provision and spending coming from programs such as Medicare ,Medicaid , Tricare , the children's Health insurance program , and the veterans Health Administration
Slide7Health care system in the United States
The U.S census Bureau reported that 49.9 million residents, 16.3% of the population, were uninsured in 2010 (up from 49.0 million residents, 16.1% of the population, in 2009).According to the world health organization (WHO), the United States spent more on health care per capita ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation in 2008.
The United States had the fourth highest level of government health care spending per capita ($3,426), behind three countries with higher levels of GDP per capita: Monaco, Luxembourg, and Norway.
Slide8Health care system in the United States
The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study).
The common wealth fund ranked the United States last in the quality of health care among similar countries, and notes U.S. care costs the most
Slide9Comparison between Canadian and American Health Care system
Canadian health care system
United States health care
system
Coverage: Universal and comprehensive
Access: No financial Barriers
Private insurance: Small
Payers model: single
Cost control: High and Centralized
System capacity: High degree of control
Coverage: Mixed: Medicare and private
Access: Financial Barriers
Private insurance: Large
Payers model: multiple
Cost control: Low and fragmented
System capacity: Low degree of control
Slide10Overview of Healthcare
system in Saudi Arabia
Slide11Table of contents
Introduction to health care system
Aspects of health
Determinants of health
Components of Healthcare System
Health and System Goals
Overview of the Healthcare System in the Kingdom of Saudi Arabia
Demographic and economic patterns of Saudi Arabia
Slide12Table of contents
Pharmaceutical Care
Levels of health care Health insurance in Saudi Arabia
Brief overview of health services development
How do you become a Pharmacist in Saudi Arabia
Role of pharmacist in health care
Comparative Health Care Systems
Challenges facing the current health system
Elements of Saudi health system reform
What Makes a Good Healthcare System
Slide13Introduction to health care system
What is health care system?
A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health.
A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction.
A health system needs to provide services that are responsive and financially fair, while treating people decently
.
(WHO)
Slide14Introduction to health care system
Health is a complex and multidimensional issue. Many of the factors influencing over all health either not in the traditional domain of health care or are difficult to influence , e.g.: Water quality , diet , genetics , and consumption of tobacco & other.The most famous modern definition of health was created during a Preamble to the Constitution of the World Health organization adopted by the international health conference in new York
Slide15Introduction to health care system
According to World Health Organization's (WHO's) "health "is defined as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.Historically, all the great advances in health have been caused by prevention of diseases.
Slide16Aspects to health
Most people accept that health can be divided into two broad aspects - physical and
mental health.Physical health : For humans, physical health means a good body health, which is healthy because of regular physical activity (exercise), good
nutrition
, and adequate rest.
Physical health is defined as health relates to anything concerning our bodies as physical entities
Slide17Aspects to health
Mental health: Mental health refers to people's cognitive and emotional well-being. A person who enjoys good mental health does not have a mental disorder. According to WHO, mental health is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community".
Slide18Determinants of health
The health of individual people and their communities are affected by a wide range of contributory factors. People's good or bad health is determined by their environment and situations WHO says that the following factors probably have a bigger impact on our health than access and use of health care services:1.Where we live
2.The state of our environment 3.Genetics 4.Our income
Slide19Determinants of health
5. Our education level 6 .Our relationship with friends and familyWHO says the main determinants to health are: Our economy and society ("The social and economic environment"),Where we live, what is physically around us ("The physical environment"), What we are and what we do ("The person's individual characteristics and behaviors")
Slide20Components of Healthcare SystemHealth care system Consist of a number of interrelated subsystems .Each of these subsystems has a purpose which, if attained, aids the larger system in reaching its overall goals.For examples the healthcare systems of U.S.A, Canada , Saudi Arabia, and other countries
Slide21Elements of Healthcare System
Inputs ( human resources , material , technology , information , capital , …….Outputs ( patient care , acceptable costs , training , other objectives ) .Process
Feedback
Outcome (improvement in infant mortality rate and life expectancy at birth
Slide22Overview of the Healthcare System
in Saudi ArabiaThe Ministry of Health is responsible for the supervision of healthcare and hospitals in both the public and private sectors. The system offers universal healthcare coverage.The healthcare system has two tiers. One is a network of primary healthcare centers and clinics. The second tier is represented by the hospitals and specialized treatment facilities located in urban areas.
Slide23Overview of the Healthcare System
in Saudi ArabiaIn 1970, there were 74 hospitals with 9,039 beds; by 2005, there were 350 hospitals with nearly 48,000 beds. The Ministry of Health operates 62% of the hospitals and 53% of the clinics and centers; the remaining facilities are operated by government agencies, including the Ministry of Defense, the National Guard, the Ministry of the Interior, and several other ministries, as well as by private entities
Slide24Overview of the Healthcare System
in Saudi ArabiaThe breakdown of facilities is as follows:1) Ministry of Health Facilities
These serve the general public and are located in both the large cities and the small towns throughout Saudi Arabia.2) Military Hospitals
These serve members of the Saudi Arabia armed forces and members of their families, according to the branch of the military in which the individual serves.
Slide25Overview of the Healthcare System
in Saudi ArabiaSaudi Arabian National Guard (SANG) SANG has four hospitals which provide care to the soldiers of the Saudi Arabian National Guard and their dependents:King Abdul-Aziz Medical City, Riyadh (650 beds, formerly the King Fahad National Guard Hospital);
King Abdul-Aziz Medical City, Jeddah (350 beds, formerly the King Khalid National Guard Hospital);
Slide26Overview of the Healthcare System
in Saudi ArabiaKing Abdul-Aziz Medical City – Dammam (100 beds);The Saudi Arabian National Guard also operates clinics in Riyadh and Taif.
Saudi Arabian Ministry of Defense and Aviation (MODA)It includes the Saudi Arabian Army, the Royal Saudi Naval Forces, the Royal Saudi Air Force and Royal Saudi Air Defense
Riyadh Military Hospital Al
Kharj
, Riyadh (1,000+ beds);
Slide27Overview of the Healthcare System
in Saudi ArabiaPrince Sultan Cardiac Center, Riyadh (150+ beds);North West Armed Forces Hospital, Tabuk (350 beds);
Ministry of the InteriorThis serves members the ministry of the interior, including the police and customs collectors.Security Forces Hospital, Riyadh (500 beds), serves the Ministry of Interior personnel.
Slide28Overview of the Healthcare System
in Saudi ArabiaReferral HospitalsEvery citizen is eligible to go to the referral hospitals for specialized care. These facilities include:King Faisal Specialist Hospital & Research Centre-Riyadh Site (700 beds);
King Faisal Specialist Hospital & Research Centre-Jeddah Site (250 beds);King Khalid Eye Specialist Hospital, Riyadh (360 beds);
Slide29Overview of the Healthcare System
in Saudi ArabiaPrivate FacilitiesFor-Profit: Saudi German Hospital, Jeddah; Dr. Erfan & Bagedo Hospital, Jeddah; Al-
Habib centers and Kingdom Hospital, RiyadhSaudi ARAMCO Hospital, Dhahran (480 beds); serves employees of the oil company Saudi ARAMCO, and their family membersSocial Insurance Hospital, Riyadh (GOSI) (300 beds)
Royal Commission Hospitals, which
Slide30Demographic and economic patterns
of Saudi ArabiaAccording to last official census in 2010 placed the population of Saudi Arabia at 27.1 million, compared with 22.6 million in 2004
The annual population growth rate for 2004 to 2010 was 3.2% per annumAccording to United Nation projections, it is estimated that the population of Saudi Arabia will reach 39.8 million by 2025 and 54.7 million by 2050
Slide31Demography of Saudi Arabia
The last official census in 2010 placed the population of Saudi Arabia at 27.1 million, compared with 22.6 million in 2004.The annual population growth rate for 2004 to 2010 was 3.2% per annum ,and the total fertility rate was 3.04
Saudi citizens comprise around 68.9% of the total population; 50.2% are males and 49.8% females.67.1% of the population are under the age of 30 years and about 37.2% are under 15 years;
Slide32Demography of Saudi Arabia
The population over the age of 60 years is estimated at 5.2%According to United Nation projections, it is estimated that the population of Saudi Arabia will reach 39.8 million by 2025 and 54.7 million by 2050.This is a natural outcome of the high birth rate (23.7 per 1000 population), increased life expectancy (72.5 years for men, 74.7 years for women).
Slide33Overview of health services development
Health services in Saudi Arabia have increased and improved significantly during recent decades .The first public health department was established in Mecca in 1925 based on a royal decree from King Abdulaziz.
This department was responsible for sponsoring and monitoring free health care for the population and pilgrims through establishing a number of hospitals and dispensaries.While it was an important first step in providing curative health services, the national income was not sufficient to achieve major advances in health care
Slide34Overview of health services development
The majority of people continued to depend on traditional medicine and the incidence of epidemic diseases remained high among the population.The next crucial advance was the establishment of the MOH in 1950 under another royal decree.
Twenty years later, the 5-year development plans were introduced by the government to improve all sectors of the nation, including the Saudi health care system.Since then, substantial improvements in health care have been achieved in Saudi Arabia.
Slide35Current Structure of health system in Saudi Arabia
Currently the MOH is the major government provider and financer of health care services in Saudi Arabia, with a total of 244 hospitals (33 277 beds) and 2037 primary health care (PHC) centers .The Ministry of Health is responsible for the supervision of healthcare and hospitals in both the public and private sectors.
The healthcare system has two tiers. One is a network of primary healthcare centers and clinics that provide preventive, prenatal, emergency, and basic services, as well as mobile clinics for remote rural areas.
Slide36Current Structure of health system in Saudi Arabia
The second tier is represented by the hospitals and specialized treatment facilities located in urban areas.In 1970, the first of the government’s five-year plans to promote development in a variety of areas, including healthcare, was instituted.
In healthcare, the plan only meant establishing the necessary infrastructure of hospitals, clinics, pharmacies, laboratories and research facilities, but hiring expatriate staff to work in the facilities and encouraging Saudis to pursue careers in the healthcare field.
Slide37Pharmaceutical Care
The principal goal of pharmaceutical care is to achieve positive outcomes from the use of medication that improves patients' quality of life. These outcomes include:
cure of a disease;
elimination or reduction of symptoms;
arresting or slowing a disease process;
prevention of disease;
diagnosis of disease;
desired alterations in physiological processes,
all with minimum risk to patients.
Slide38Levels of health care
PRIMARY HEALTH CARE
SECONDARY HEALTH CARE
TERIEARY HEALTH CARE
>2000
Around
400
Slide39Brief overview of health services
developmentHealth services in Saudi Arabia have increased and improved significantly during recent decades
The first public health department was established in Mecca in 1925 based on a royal decree from King Abdul-AzizThis department was responsible for sponsoring and monitoring free health care
The next crucial advance was the establishment of the MOH in 1950 under another royal decree
Slide40Brief overview of health services
developmentTwenty years later, the 5-year development plans were introduced by the government to improve all sectors of the nation, including the Saudi health care systemSince then, substantial improvements in health care have been achieved in Saudi Arabia
Slide41Role of pharmacist in health care
Pharmacist are health professionals who practice the science of pharmacy The fundamental role of pharmacists is to distribute drugs that have been prescribed by a healthcare practitioner to patientsOne of the most important roles that pharmacists are currently taking on is one of pharmaceutical care. Pharmaceutical care involves taking direct responsibility for patients and their disease states, medications, and the management of each in order to improve the outcome for each individual patient. ROLE OF PHARMACIST IN GLOBAL HEALTH
Slide42Role of pharmacist in health care
Pharmacists should adequately inform patients and the general public about unwanted effects of medicines, and should monitor such unwanted effects and their consequences in collaboration with other health care professionals and the appropriate authoritiesRole in Health measurement
Slide43Role of pharmacist in health care
Role in Transmitted Diseases Pharmacist can educate people by giving information that explain disease, its transmission, risk reduction and prevention against disease. Patient counseling is one of the important role that a community Pharmacist can provide.Role in Epidemiology : Epidemiology is the study of the distribution and prevention of health related events in specific population
Slide44Role of pharmacist in health care
Role of pharmacist to Provide up-to-date information about New Guidelines, New Medications , News reports about medications Provide answers to patient questions before They are asked to medical staff , Drug-drug interactions, Drug-food interactions , Drug-disease interactions
Slide45Challenges facing the current health system
FinancialManpowerGeographical
Population:Growth
Aging
Demanding
Changes in Disease patterns (NCD)
New medical technologies and new medications
Slide46Elements of Saudi health system reform
To Change the Role of MOH to be Responsible for:
Primary Health Care Services
Preventive medicine
Standardization of medical practice
Supervision of health system
Health system Support
To Establish The National Organization of Hospitals
To Establish The National Health Fund
Slide47What Makes a Good Healthcare System
WHAT MAKES A GOOD HEALTHCARE SYSTEM
Slide48What Makes a Good Healthcare System
The University of Chicago established the first master's degree program in 1934. now it is the American College of Healthcare Executive (ACHE). About 60 graduate programs were accredited by the Accrediting Commission on Education for a professional Health Services Administration.
Health Education : The objective of health education is to provide the individualized information necessary for patients to modify their behavior, all in an effort to live a healthier life. Pharmacists actively promote good health practices through their own personal example
Slide49What Makes a Good Healthcare System
United States master's degree programs have more than 25,000 graduates.Educational programs provide a generic education in health services, rather than hospital, management . Some offer specialty preparation in hospital, nursing facility, or ambulatory services management.
The most common educational preparation for HSO managers is the master degree.
Slide50What Makes a Good Healthcare System
The didactic portion for accredited programs is two academic years; 4 Semesters. Most programs include field experiences of varying lengths. Many require a 1-year residency that allows application of the academic preparation under the guidance of an On-Site preceptor.
The basic curriculum in accredited health services management graduate programs covers eight areas: -1. Assessment and understanding of health status of populations; determinants of health and illness; and factors influencing the use of health services.
Slide51What Makes a Good Healthcare System
2 . Understanding of the organization, financing and delivery of health services, drawing on the social science disciplines ( economics, law, political science, physiology, sociology, and related disciplines).3 Understanding of, and development of skills in, economic, financial, policy, and quantitative analysis.
4 Understanding of the values and ethical issue associated with the practice of health services administration, and the development of skills in ethical analysis
Slide52What Makes a Good Healthcare System
5 Understanding of, and development of skills in, positioning organizations favourably in the environment and managing these organizations for continued effectiveness.6.Provision of opportunities for development of leadership potential including stimulating creativity, and interpersonal and communication skill development.
7 Understanding of, and development of skills in, the management of human capital information resources.8 Understanding of, and development of skills in, evaluation methods to assess organisational performance and, in particular; methods to assure the quality of services provided.
Slide53What Makes a Good Healthcare System
AS with the graduate programs, rapid growth in the number of undergraduate programs preparing health services management personnel occurred its the late 1960s and early 1970s.
Master programs prepare graduates to become senior-level line or staff managers for pharmacy ; baccalaureate programs train middle-level supervisors or department managers.
Slide54Licensure, Certification, and Registration of Caregivers
Slide55Licensure, Certification, and Registration of Caregivers
Licensure: a process performed by government that allows someone to engage in an occupation after finding that the applicant has achieved a certain minimum competency . Physicians and dentists are always licensed, for example .
Registration: qualified individuals are listed on an official roster maintain by government or nongovernmental body (registered nurse)
Slide56Certification
A process by which a nongovernmental agency or association grants recognition to someone who meets its qualification (Nurses-midwives are certified for example).PhysiciansNonphysical Caregivers : Dentists, Physician Assistant, Pharmacists, Technologists, & other .
Slide57Professional ,Economic and Public Aspects of health Care System
Slide58LIST OF CONTENTS
Introduction to health system Goals of health care system Professional aspects of health care system
Economic aspect of health systemPublic aspect of health care system
Challenges for health care reform
Slide59Professional ,Economic and Public Aspects of health Care System
Introduction to health system
A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. And it needs to provide services that are responsive and financially fair, while treating people decently.
A health system is broader than the (relatively) simple function of delivering clinical care, and should maximize its potential for prevention and the promotion of equity
.
Slide60Professional ,Economic and Public Aspects of health Care System
Introduction to health system A health system encompasses:…the complex interaction and feedback occurring among global contexts, organizational capacities, inter-organizational relationships, institutional environments and population health.
Strengthening health systems and making them more equitable have been recognized as key strategies for fighting poverty and fostering development
Slide61Professional ,Economic and Public Aspects of health Care System
The goals of health system according to the
WHOGood health, responsiveness to the expectations of the population,
fair financial contribution
Progress towards them depends on how systems carry out four vital functions:
provision of health care services,
resource generation,
financing,
stewardship.
Slide62Professional ,Economic and Public Aspects of health Care System
Other dimensions for the evaluation of health systems include quality,
efficiency, acceptability,
equity .
They have also been described in the United States as "the five C's": Cost, Coverage, Consistency, Complexity, and chronic illness
Also, continuity of health care is a major goal.
Slide63Professional ,Economic and Public Aspects of health Care System
Professional aspects of health care system In Saudi Arabia, many health professionals are expatriates of various nationalities.
A gradual change has been observable, with increased numbers of Saudi nationals becoming qualified and taking up employment in the health sector.In 2002 figure of 15.6 physicians/10 000 populations compares favorably with the WHO minimum recommendation of 1 physician/10 000 populations for developing countries, and the WHO Eastern Mediterranean Region average of 9.4 physicians/10000 populations
Slide64Professional ,Economic and Public Aspects of health Care System
Professional aspects of health care system The annual large influx of pilgrims during the Haj season dramatically alters the health worker/population ratio as doctors, nurses, pharmacists and allied health personnel are drawn from the different parts of the country.
The pilgrimage poses special problems, not only in terms of the number of people, but also the special health problems associated with this diverse group.
Saudi Arabia provides the essential man power and other resources needed to manage Haj season safely
Slide65Professional ,Economic and Public Aspects of health Care System
Professional aspects of health care system The Saudi health system is unique in that medical consultations are overwhelmingly doctor– patient encounters, unlike in other settings where there are different mixes of personnel.
Examples of the latter include physicians, clinicians and nurse practitioners in the United States, physicians and barefoot doctors in China, and physicians and medical auxiliaries in most Asian and African countries.
The burden of the Saudi approach can better be appreciated by the enormous workload of health centre physicians in some areas.
Slide66Professional ,Economic and Public Aspects of health Care System
Professional aspects of health care system There are a number of health care centers of excellence, such as the King Faisal Specialist Hospital and Research Centre and the King Khalid Specialist Hospital for Eye Diseases in Riyadh.
The military hospitals, university hospitals and some private hospitals also have state-of-the-art equipment and well-qualified personnel.
There is an air ambulance service that provides prompt transfer of patients from one part of the country to the other to optimize care.
This arrangement helps to minimize the need for overseas treatment.
Slide67Professional ,Economic and Public Aspects of health Care System
key current human resource issues and concerns.The health worker/population ratio in Saudi Arabia has improved in the last 10 years to facilitate accessibility to health services.
Increased number of health colleges and institutes, and increased training and scholarship budget allocation is aiming to provide the health services with different and qualified health specialties to cover the issue of shortage in health human recourses with expansion of Saudization of health jobs.
Slide68Professional ,Economic and Public Aspects of health Care System
Professional aspects of health care system Human Resource Training Institutions for Health
Type of institution current planned
No
of institutions capacity No of institutions capacity target year
Medical school 10 1861 2 120 2013
School
of dentistry 4 373 2 74 2013
School of
pharmacy 4 625 3 150 2012
Nursing schools
43 9813 8 1600 2010-15
Paramedical colleges 4 1200
2 120 2012
School of public
health not applied
Slide69Professional ,Economic and Public Aspects of health Care System
Professional aspects of health care system Saudi Board for Health specialties with MOH cooperation is responsible for accreditation, and registration mechanisms for HR Institutions
Human resources policy and reforms over last 10 years
Increase number of qualified health workers.
Saudization, in the previous 7th five year plan reached 50.9%
Increased number of health colleges and institutes.
Issue of guidelines for policy and procedures aiming to raise the quality of health work
Slide70Professional ,Economic and Public Aspects of health Care System
Economic aspect of health systemEconomics is concerned with the allocation of scarce resources among their competing uses, on the face of unlimited human wants.
Among these wants are health care services for which we cannot use exactly the same Economic Principles we use for other goods and services; because they have special characteristics that make them different than the others.
That is why a special branch of economics is developed to deal with them called “Health Care Economics”.
Slide71Professional ,Economic and Public Aspects of health Care System
Economic aspect of health systemHealth Care Economics is a new branch of Economics concerned with how to apply the Economics Tools for heath care issues and explain its different aspects to make them more analyzable.
It also offers measures to determine if a certain policy will increase or decrease the economic efficiency and the equitable distribution of health care services.
Of course, economic analysis cannot help in all the concerns of health professionals and the general public in the area of health care services.
Slide72Professional ,Economic and Public Aspects of health Care System
Economic aspect of health systemThe particular problems suitable for economic analysis are those related to scarcity of resources. In this respect, economics can explain the most preferable choices of the society when its available resources are not enough to satisfy all its needs.
That is usually the case in all societies because of the strong competition between the different needs of each society such as education, health care, security, defense, roads, ….etc.
Slide73Professional ,Economic and Public Aspects of health Care System
Economic aspect of health systemEconomics Tools:
The most used two economics tools for the analysis of health care services are:The marginal analysis which deals with optimization problems.
Supply and demand analysis which is used for predicting the new equilibrium situations.
Slide74Professional ,Economic and Public Aspects of health Care System
Marginal analysis is used to assist people in allocating their scarce resources to maximize the benefit of the output produced.
Simply getting the most value for the resources used.
Marginal analysis: The analysis of the benefits and costs of the marginal unit of a good or input.
Slide75Professional ,Economic and Public Aspects of health Care System
DEMAND AND SUPPLY ANALYSIS1. The law of demand states that consumers will purchase more of a good at lower prices and less of a good at higher prices.
2. The law of supply states that producers will sell less of a good at lower prices and more of a good at higher prices.
3. Equilibrium exits when there is no reason for a situation to
change.
When
equilibrium exits, the quantity people plan to buy is equal to the quantity that producers plan to sell.
The
laws of demand and supply cause the market to move to equilibrium.
Slide76Professional ,Economic and Public Aspects of health Care System
Economic aspect of health systemThe Assumptions of Health Care:
There are many assumptions concerning health care that makes it different from other industries. The following are some examples: 1. Consumers of health care services lack information concerning their health problems and how they should be treated.
2. Uncertainty about the medical expenditures the patients or the government may have to pay.
3. Uncertainty about the results of treatment.
Slide77Professional ,Economic and Public Aspects of health Care System
Economic aspect of health system4. The double role played by the doctor as an agent for the patient and as a supplier of the medical service, at the same time
5. The large number of non-profit medical firms which determine the prices of their services based upon their costs only.6. Barriers to entry in the medical profession and in certain tasks delivered by the different health professionals.
7. The desire of the society to provide each of its individuals with the minimum level of health care.
Slide78Professional ,Economic and Public Aspects of health Care System
Economic aspect of health systemTo sum up the forgoing discussion, health care economics benefits the health care sector in many ways, which are:
1. It provides a background by which medical care issues could be analyzed2. Economics can be used in the traditional aspects such as predictions and planning which are required in any other sector or industry
Slide79Professional ,Economic and Public Aspects of health Care System
Economic aspect of health system3. It enables the evaluation of the effects of medical legislations and regulations on the supply and demand in the four interrelated health care markets, which are:
The final market for health care.The market for health care institutions.
The market for health care manpower.
The market for health care education with all its levels and types.
Slide80Professional ,Economic and Public Aspects of health Care System
Economic aspect of health system4. Economics provide measures to evaluate health policies in order to achieve efficiency and equity in health care.
5. Economics determine the costs and benefits of the different health care choices.
Slide81Professional ,Economic and Public Aspects of health Care System
Public aspects of health care systemThe public health system once was thought of as comprising only official government public health agencies
now is understood to include both other public-sector agencies (such as schools, Medicaid and environmental protection agencies, and land-use agencies) and private-sector organizations whose actions have significant consequences for the health of the public.
The public health system includes the following four main components:
Slide82Professional ,Economic and Public Aspects of health Care System
Public aspects of health care system1-Mission – The
mission of the public health system includes its goals at any point in time and how, at the conceptual level, these goals are operationalized. At the beginning of the 21st century, the mission of public health is to ensure conditions in which people can be healthy.
2-Structure
– The
structural capacity
of the public health system is the cumulative resources and relationships necessary to carry out the important processes of public health
Slide83Professional ,Economic and Public Aspects of health Care System
Structural capacity includes the following elements:information resources,
organizational resources, physical resources,
human resources,
fiscal resources.
3-Process
– The practice of public health can be thought of in terms of the key
processes
through which practitioners seek to identify, address, and prioritize community or population-wide health problems and resources and the outputs of these more fundamental processes, public health’s interventions, policies, regulations, programs, and services.
Slide84Professional ,Economic and Public Aspects of health Care System
Public aspects of health care systemThe processes of public health are those that identify and address health problems as well as the programs and services consistent with mandates and community priorities.
4-Outcome
– The immediate and long-term changes experienced by individuals, families, communities, providers, and populations are the system’s
outcomes
, the cumulative result of the interaction of the public health system’s structural capacity and processes, given the macro context and the system’s mission and purpose.
Slide85Professional ,Economic and Public Aspects of health Care System
Public aspects of health care systemOutcomes can be used to provide information about the system’s overall performance, including its efficiency, effectiveness, and ability to achieve equity between populations.
Slide86Professional ,Economic and Public Aspects of health Care System
Public aspects of health care systemWhat Is Public Health Quality
Quality in public health is the degree to which policies, programs, services and research for the population increase desired health outcomes and conditions in which the population can be healthy.
Slide87Professional ,Economic and Public Aspects of health Care System
Public aspects of health care systemPublic Health Aims:
The nine aims help guide public health practices across the entire system to ensure quality for increasing positive population health outcomes.1. Population-centered
:
Protecting and promoting healthy conditions and the health for the entire population
2. Proactive:
Formulating policies and sustainable practices in a timely manner, while mobilizing rapidly to address new and emerging threats and vulnerabilities
Slide88Professional ,Economic and Public Aspects of health Care System
Public aspects of health care systemPublic Health Aims:
3. Equitable: Working to achieve health equity4. Health promoting:
Ensuring policies and strategies that advance safe practices by providers and the population and increase the probability of positive health behaviors and outcomes
5. Risk reducing:
Diminishing adverse environmental and social events by implementing policies and strategies to reduce the probability of preventable injuries and illness or negative outcomes
Slide89Professional ,Economic and Public Aspects of health Care System
Public aspects of health care systemPublic Health Aims:
6. Vigilant: Intensifying practices and enacting policies to support enhancements to surveillance activities
7. Transparency:
Ensuring openness in the delivery of services and practices with particular emphasis on valid, reliable, accessible, timely and meaningful data that is readily available to stakeholders, including the public
8. Effective:
Justifying investments by using evidence, science and best practices to achieve optimal results is areas of greatest need
Slide90Professional ,Economic and Public Aspects of health Care System
Public aspects of health care systemPublic Health Aims:
9. Efficient: Understanding costs and benefits of public health interventions and to facilitate the optimal use of resources to achieve desired outcomes
Slide91Challenges for Health Care Reform
Challenges for health care reform1. Provide universal coverage. Enact systematic health care reform guaranteeing access to affordable health care for all individuals from the health care providers of their choice.
2. Eliminate health disparities. Dedicate more resources to assuring health equity and eliminating the disparities that persist in vulnerable populations. Payment for preventive interventions should include psychosocial initiatives and innovative care models.
Slide92Challenges for Health Care Reform
Challenges for health care reform3. Focus health care resources on wellness, disease prevention and primary care. Promote a greater supply and usage of primary care professionals as defined by the Institute of Medicine, including certified nurse‐midwives (CNMs) and certified midwives (CMs).
4. Improve care integration and coordination. Promote seamless consultation, collaboration and referral among providers and institutions to improve consumer access to health care services and to their personal health information.
Slide93Challenges for Health Care Reform
Challenges for health care reform 5. Align payment systems with evidence‐based practice and optimal outcomes rather than on maximizing billable interventions. Promote collection and transparent reporting of standardized performance measures by all providers and institutions.
6. Improve women’s access to high quality care.7. Recognize that women play a key role in the health of the family and they often access the health care system through their reproductive health care provider.
Slide94Challenges for Health Care Reform
Challenges for health care reform8. Preserve direct access to the full range of reproductive and primary care services for women of all ages from the providers of their choice.
9. Improve quality and value by strategically expanding the use of CNMs and CMs as integral members of the health care team by ensuring licensed independent provider status, universal access to hospital privileges and equal payment for professional services in all 50states and US territories
10. Educate more midwives by expanding funding for scholarships, clinical sites and loan repayment.
Slide95Challenges for Health Care Reform
Challenges for health care reform11. Expand funding for midwifery research, demonstration projects and collaborative training of midwives and physician residents. Provide incentives for innovative delivery models such as community‐based birth centers and group prenatal car
12. Significantly improve maternal and infant health. Promote high quality, evidence‐based maternity care emphasizing normal birth and the appropriate use of technology and medical interventions.
Slide96Organization of health care system in Saudi Arabia
Slide97Table of content
Brief history of the health care system organization organizationCentral organization
Regional Health OrganizationPublic Health Care System
Private Health Care System
Levels of health care
International health and health related organizations
Slide98Brief history of the health care system
As said before a public health department was established in 1925, by a Royal decree from King Abdel- Aziz Al-Saud, based in Makka AlMukrma, with branches in provinces, followed by establishment of dispensaries, hospitals, and laboratories.This was the beginning of emphasis on prevention and environmental health.
The first school of nursing was opened in 1926, followed by the school of heath and emergences in 1927.In 1951, the Ministry of Health was established. From that date the health services expanded.
Slide99Brief history of the health care system
From 1970 to 1980, health services were predominantly curative as most health personnel had received their formative training in patient-oriented, hospital-based medical institutes.There was a general population expectation of curative care.
This care was delivered through a network of hospitals and dispensaries,
preventive care was delivered by health offices and to some extent through maternal and child health care centers
Slide100Brief history of the health care system
Disease control activities, such as for malaria, tuberculosis, leprosy, schistosomiasis and leishmaniasis, were handled by vertical programs.
Episodic outbreak control activities were managed through the health offices.
In the early 1980s, the concept of primary health care (PHC) became popular, with the WHO slogan ‘Health For All’ (HFA) gaining recognition.
A ministerial decree in 1980, led to the establishment of the health centers, administratively integrating the existing dispensaries, health offices and maternal and child health (MCH) centers into one unit.
Slide101Brief history of the health care system
At the same time, health posts were upgraded to health centers, thus paving the way for the delivery of integrated health services, i.e. initiation of the PHC approach.
there are 1848 PHC centers, and 200 hospitals run by Ministry of Health. The MOH budget increased from 2,8% of the total National budget in 1970 to 6,4% in 2004.
http://
www.moh.gov.sa/Ministry/OpenData/Pages/OpenDataLibrary.aspx
The Saudi health system was established by a Royal decree in 2002, aimed to insure the provision of comprehensive and integrate health care to all inhabitants in Saudi Arabia in an equitable, affordable and organized manner
Slide102Organization
Saudi Arabia is a welfare state with health services right to every citizen .
Ministry of Health (MOH) and about 20 other government agencies and the Private Health Sector .
MOH is the most important providing 60% of hospital services, 50% of Health centers services.
Private Sector employs 28% of physicians, 19% of nurses and provides 19% of all hospital services
Central organization :
Minister appointed by King for 4 years renewable. Two Deputy Ministers and four Assistant Deputy Ministers appointed by Council of Ministers at the recommendation of the Minister
Slide103Ministry of Health Organizational Chart
Slide104Organization
Deputy Minister for Executive Affairs has two Assistants ( Preventive and Curative health services).
Deputy Minister for Planning and Development has two Assistant ( Planning & Research and Manpower Development)
There are several Directors General and Directors ( such as Nutrition, Primary Care, Laboratories, etc…).
Regional Health Organization: ( 20 offices)
:
13 regions headed by Director General ( Riyadh, Makkah, Gassim, Assir, Gizan, Medina, North Border,Eastern Region, Hail, Tabuk, Baha, AlJouf, Najran ) 6 Director of Health Affairs ( Holy Capital ( Makkah City), or Director of Health Services in Provinces ( Jeddah,Taif, Hafr Al Batin, Al Ehssa, Bisha ) appointed by Minister of Health .
Slide105Organization
PLANNING
:
CENTRAL (Ministry of Planning) in co-operation with MOH, every five years , currrent is the Eighth ( emphasis on PHC, Co-ordination, Manpower saudization and development ).
FINANCE :
government
Slide106Organization
MINISTRY OF HEALTH BUDGET
YEAR
BUDGET BILLION
SAR
SALARIES %
OPERATION AND MAINTENANCE
PROJECTS
1999/2000
12.8
51.4%
46.1
2.5
2000/2001
13.8
52.8
42.3
4.9
2001/2002
2002/2003
-
-
-
-
Slide107Organization
MINISTRY OF HEALTH BUDGET
Slide108Organization
HEALTH MANPOWER
Problems :
mostly expatriate( non Saudis ) , gross mal-distribution of Saudi manpower ( mostly in big cities and in hospitals)
Measures to solve manpower problem : Manpower Council Deputy Minister for Planning and Development ADM for health Manpower Development
Slide109Organization
sector
Physician
Nurses
Hospitals
MOH
49%
55.5%
60.8%
Other govt
22.8%
25.8%
20.0%
Private
28.2%
18.7%
19.2%
Per 1000 population
1993
10.4
22.8
27.0
1998
17.1
33.4
23.3
Slide110Public Health Care SystemKey organizational changes over last 5 years in the public system, and consequences:
There are 13 health regions, each led by a Regional Director General for Health Services, who is directly responsible to the Deputy Minister of Health for Executive Affairs and Deputy Minister for Planning and development.
Each health regional general directorate supervises one or more of health provinces through provincial health directorate.
Each provincial health directorate supervises and manages at least one general hospital and a number of health centers, and supervises private health sector.
Slide111Public Health Care System
The policies, plans and programs of the MOH are implemented through this structure.The health directorates are reasonably autonomous in terms of staff recruitment and welfare, training, discipline, supervision and evaluation.
However, some responsibilities are shared with the MOH when necessary.
Slide112Public Health Care System
Each region has a dental centre that acts as a referral centre for the dental clinics attached to the health centers and hospitals.There are medical rehabilitation centers for speech and hearing therapy, accident injury repair and physiotherapy.
there is at least one anti-smoking clinic in each health directorate for counseling, health education and rehabilitation.
Slide113Public Health Care System
Under ‘other government’ sectors are grouped the health facilities of the military, National Guard, universities (and affiliated teaching hospitals), large multinational corporations such as Saudi Aramco oil company, and a number of specialist hospitals.
The ‘other government’ facilities carry out similar functions to those of the MOH with respect to ambulatory care and inpatient care.
Slide114Public Health Care System
Planned organizational reforms in the public system:
1. Administrative reforms including restructuring the MOH organization structure, policies procedure, and regulations.2. Implementation of the Saudi Health System.
3. Implementation of the cooperative health insurance system.
4.The Primary Health Care strengthening and expansion
5. Strengthening quality assurance in health care.
6. Privatization and corporatization of some of MOH hospital.
Slide115Levels of health care
Primary health care : Secondary health care : Tertiary health care :
First contact of persons with the health system" This is usually in PHC units found near residence or work Secondary health care is referral care from PHC This takes place in hospitals Tertiary health care is specialized / rehabilitation care .
ALMA ATA CONFERENCE :
PHC is essential heath care made universally accessible to individuals and families through their full participation , by means acceptable to them at a cost that the country can afford and it forms an integral part of the national health system of which it is the nucleus and of the overall social and economic development"
Slide116Levels of health care
ORGANIZED BY W.H.O. AND U.N.C.E.F. IN 1978 IN ALMA ATA IN KAZAKHASTAN SOLOGAN " HEALTH FOR ALL BY YEAR 2000" HFA/2000 .
COMPONENTS :
1- food/ nutrition
2- Basic sanitation / Water supply
3- Health promotion
4- Maternal and child health care
5- Control of common diseases
6- Immunization
7- Treatment of common diseases and injuries
8- Provision of essential drugs
Slide117“The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.
• Governments have a responsibility for the health of their people.
• Primary health care is the key to attaining this target as part of development in the spirit of social justice.”
Levels of health care
Slide118Levels of health care
IMPORTANCE OF PHC :
solves majority of health problems
- cheap
- convenient . near home or work suitable working hours
- family record / socioeconomic data
- hospitals will concentrate on secondary care
Slide119Levels of health care
MINIMUM GLOBAL INDICATORS FOR PHC PROGRAMMES:
These are the minimum requirements for successful PHC programme)
HFA received endorsement (approval) as policy by highest official level.( KING, PRESIDENT, COUNCIL OF MINISTERS)
Formation, strengthening and actually functioning mechanisms for involving people in implementation of strategies ( PHC friendship societies and committees)
At least 5 % of GNP (general national production) is spent on health
Slide120Levels of health care
A reasonable amount of the GNP is spent on primary health care.
Resources are Equitably Distributed .( ACCORDING TO NEEDS)
PHC is available to the whole population with at least within 15 minutes walking distance
Adequate Sanitary Facilities ( refuse collection and disposal ) in home or vicinity ( near home )
Immunization with DPT , MMR , BCG
Primary Health Care (PHC) with at least 20 drugs within one hour walk.
Slide121Levels of health care
Trained Attendants (Midwives) for pregnancy, delivery, infants health.
Adequate Nutritional Status of Children: - At Least 90 % newborns have birth weight of 2.5 kg + and 90 % of children have within normal weight for age.
Infant Mortality Rate Not Exceeding 50 / 1000 live births.
Life Expectancy at birth Not Less than 60 years.
Slide122INTERNATIONAL HEALTH AND HEALTH RELATED ORGANIZATION
Name
Abbreviation
Head quarter
Activities
World health organization
W.H.O
Geneva,
Switzerland
Health promotion ,health legislation , control of diseases
United nations
children fund
U.N.I.C.E.F
New
York , USA
Child &mother health
Food agriculture organization
F.A.O
Rome,italy
Food production nutrition
United nations
education scientific& cultural organization
U.N.E.S.C.O
Paris
, France
Health education &training
Slide123Private Health Care System
Modern, for-profit:
The private health sector includes private hospitals, clinics, dispensaries and pharmacies. The facilities are mostly located in urban centers. The private sector has grown rapidly in recent years. Health services vary from basic medical care to highly organized specialist services.
Traditional:
There is a recently established traditional medicine department in MOH to supervise and control traditional medicine in the market.
Key changes in private sector organization:
MOH fully cooperates, and coordinates with the private health sector, either directly or through the medical units in chambers of commerce and industry in the kingdom.
Slide124Private Health Care System
Public/private interactions (Institutional), Participation in joint committees.
Plays a major role in cooperative health insurance system. Privatization and corporatization projects.
Public/private interactions (Individual),
Under-development.
Slide125Finance and regulations of health care system in Saudi Arabia
Slide126Health care financing
Health insurance governance principles Types of insurance in Saudi Arabia Council of Co-operative Health insurance FinancingStrategies for Health Industry Development PolicyHealth care funding and subsidy
Health Regulators
Contents
Slide127Saudi citizens comprise around 68.9% of the total population; 50.2% are males and 49.8% females.
67.1% of the population are under the age of 30 years and about 37.2% are under 15 years;The population over the age of 60 years is estimated at 5.2%According to United Nation projections, it is estimated that the population of Saudi Arabia will reach 39.8 million by 2025 and 54.7 million by 2050.This is a natural outcome of the high birth rate (23.7 per 1000 population), increased life expectancy (72.5 years for men, 74.7 years for women).
Finance and regulations of health care system in Saudi Arabia
Slide128Health care financing
In Saudi Arabia, the health service is in general publicly fundedThe percentage of GDP spent on health was 3.4% in 2005. In the same year the percentage of private GDP spent on health was 0.8%The government expenditure on health as a percentage of total expenditure on health was 76.2, and private expenditure was therefore 23.8.This is higher than the percentage of GDP spent on health in the neighbouring country of the United Arab Emirates, where public expenditure was 2% of GDP and private expenditure was 0.9% of GDP
Finance and regulations of health care system in Saudi Arabia
Slide129Health care financing
This can be compared with other public expenditure within Saudi Arabia, in order to get an insight into the priorities of the government.There has been an improvement over the years, and it is hoped that the government continues to move in the same directionSaudi Arabia could greatly improve its health system by investing more money in this sector.Despite the disproportionate expenditure on health, the government appears to have a fairly positive health care strategy, and looks to be constantly improving its health system.
Finance and regulations of health care system in Saudi Arabia
Slide130Health care financing
The Health System is monitored and improved by the Ministry of Health, and the progress made in this area, as well as other socio-economic factors has been vast over the past thirty years.Despite the progress already made there are still many further developments required which will become apparent as the system is explored further.
Finance and regulations of health care system in Saudi Arabia
Slide131Availability, accessibility, acceptability and quality
The ‘AAAQ’ is an element that is enshrined in General Comment 14 on the highest attainable standard of health.The concepts of ‘availability, accessibility, acceptability and quality’ are used to tell whether the highest attainable standard of health is being reachedAvailability. Functioning public health and health care facilities, goods and services, as well as
programmes in sufficient quantity
Finance and regulations of health care system in Saudi Arabia
Slide132Accessibility
covers a wide range of aspects, and as a result has four over lapping dimensions; affordability, information accessibility, physical accessibility, and non–discrimination of health services.1. AffordabilityHistorically, the health system was publicly funded by the government.
Finance and regulations of health care system in Saudi Arabia
Slide133Affordability
However, providing free medical care to all was beginning to place a great financial burden on the state, as there is no tax system.In order to improve the situation the Shoura Council passed a law in 2004 to implement mandatory health insurance for all foreign workers in the Kingdom.The law is to be implemented in a three-phase .The first phase covers all foreign workers working in large companies, and the second covers workers in small establishments. Both these phases have now been implemented.
Finance and regulations of health care system in Saudi Arabia
Slide134The third phase will cover all remaining foreign workers
2. Information accessibilityAnother aspect of the ‘AAAQ’ that Saudi Arabia is having problems meeting is a feature of the concept of accessibility: the so-called ‘information accessibility’.WHO believes the country needs to establish an efficient National Health Information System (NHIS)
Finance and regulations of health care system in Saudi Arabia
Slide1353. Physical accessibility
A further concern is the physical accessibility of health care. It is recommended that primary health care centres should be appropriately situated throughout a country and a citizen should not live more than one hour away from their closest medical centre.Saudi Arabia is a member of the Gulf Council Cooperation – “2009 for primary health care promotion”, and has implemented a family practice residency programme, to integrate care at primary health centres.
Finance and regulations of health care system in Saudi Arabia
Slide136Acceptability
: All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, as well as sensitive to gender and life-cycle requirements. •Quality: Health facilities, goods and services must be scientifically and medically appropriate and of good quality.
Finance and regulations of health care system in Saudi Arabia
Slide137Health insurance governance principles
1. Transparency and Predictability2. Accountability
3. Participation4. Efficiency and effectiveness
Finance and regulations of health care system in Saudi Arabia
Slide138Types of insurance in Saudi Arabia
Property and casualty 34% Aviation
Marine
Medical Malpractice
Car 34%
Health 32%
Finance and regulations of health care system in Saudi Arabia
Slide139Council of Co-operative Health insurance Financing
The Council of Cooperative Health Insurance (CCHI) is working to educate the private sector about the benefits of health insurance.The after-effects of the recession, which has negatively affected most of the world, have had less of an impact on Saudi Arabia’s insurance industry, which has been thriving over the past few yearsHealth insurance is leading as one of the fastest growing segments in the country’s insurance sector, becoming a key growth driver for the overall market
Finance and regulations of health care system in Saudi Arabia
Slide140Council of Co-operative Health insurance Financing
There has been much interest in investing in Saudi Arabia’s private medical care since the Cooperative Health Insurance Act in 1999. This act has provided medical insurance to all private sector workers within Saudi Arabia, successfully insuring over 8.6 million Saudi and expatriate employees and their families to date.There are many benefits of insurance for both workers and the insurance industry. Due to the surge in the number of insured workers, insurance companies have advanced their products and services to serve the target market.
Finance and regulations of health care system in Saudi Arabia
Slide141Council of Co-operative Health insurance Financing
The role of the Council of Co-operative Health insurance is to work towards educating the private sector about the many benefits health insurance has for their workers. The CCHI certifies 26 insurance firms, five third-party administration companies, and over 2400 healthcare providers.
There is a big future of growth for private medical care in Saudi Arabia, with supporting factors such as low penetration, strong governmental support, and rising awareness of insurance.
Finance and regulations of health care system in Saudi Arabia
Slide142Strategies for Health Industry Development Policy
Establishment of National health Related References Saudi Food and Drug Authority Saudi Commission of Health Specialties
Council of Co-operative Health Insurance
National Center for Health care Quality and Accreditation
The National Health Council
Involve Direct and Indirect Health Industry Stake Holders
Major Health Providers
Private Sector
Ministry of civil service, labor, Finance etc.
Staging of Health industry Policy Development
Finance and regulations of health care system in Saudi Arabia
Slide143Health care Funding and Subsidy:
For nationals Health care is completely funded by the government For private sector workers health care is covered by employers For religious visitors health care is paid for by the governments
For business and tourist visitors health care will be insured
Finance and regulations of health care system in Saudi Arabia
Slide144Health Regulators
The National Organizations:The National Health Council The Saudi Food and Drug Authority
Council of Co-operative Health Insurance
The Saudi Commission for Health Specialties
Ministry of health
Finance and regulations of health care system in Saudi Arabia
Slide145The National Health Council
Most important achievements of the Committee during the last period were : 1. Contribute to raise loans to the hospitals (200) million. 2. Participate in the amendment of the Regulations of the health system to meet with Undersecretary of the Ministry of Health for Executive Affairs.
And hopefully more regulations and effort will be made in the process of Saudi health care development.
Finance and regulations of health care system in Saudi Arabia
Slide146The Saudi Food and Drug Authority
The Saudi Food and Drug Authority (SFDA) was established under the Council of Ministers resolution no (1) dated 07/01/1424 H, as an independent body corporate that directly reports to The President of Council of MinistersThe main purpose of the SFDA establishment is to regulate, oversee, and control food, drug, medical devices, as well as to set mandatory standard specifications thereof, whether they are imported or locally manufactured.
The control and/or testing activities can be conducted in the SFDA or other agency's laboratories
Finance and regulations of health care system in Saudi Arabia
Slide147The Saudi Food and Drug Authority
The main objectives of SFDA can be outlined as follows:1. Observe the safety, security, and effectiveness of food and drug for humans and animal.2. Observe the safety of complementary biological and chemical substances, cosmetics and pesticides.3. Observe the safety of medical devices and its impact on public health.
4. Ensure accuracy and safety of medical and diagnostic devices.
Finance and regulations of health care system in Saudi Arabia
Slide148The Saudi Food and Drug Authority
5. Launch clear policies and procedures for food and drug, and plan to achieve and implement these policies.6. Control and supervise licenses procedures for food, drugs and medical devices factories.7. Conduct research and applied studies to identify health problems, their causes, determine its impact on public, with the consideration of methods for research / studies evaluation.
8. Disseminate and exchange information with local and international scientific and legal agencies, and setting up a database for food and drug.
Finance and regulations of health care system in Saudi Arabia
Slide149Council of Co-operative Health Insurance
Funding health care services is a central challenge faced by the government. To meet the growing population demands for health care and to ensure the quality of services provided, the Council for Cooperative Health Insurance was established by the government in 1999.The main role of this Council is to introduce, regulate and supervise a health insurance strategy for the Saudi health care market
Finance and regulations of health care system in Saudi Arabia
Slide150The Saudi Commission for Health Specialties
Saudi Commission for Health Specialties (SCHS) is body corporate scientific commission aims at development of professional performance and encouraging skills and enriching scientific intellect and suitable practical application in the field of various health specialties. It was established under the Royal Decree No. M/2 dated 6/2/1413H In compliance to (SCHS) objectives, it has undertaken the following:1. To set up professional health specialist programs and approving and supervising the same.
Finance and regulations of health care system in Saudi Arabia
Slide151The Saudi Commission for Health Specialties
2. And to set up programs for ongoing medical education in health specialties within the frame of general policy of education3. To form health scientific boards and sub-committees required for performing work and supervising and approving recommendations thereof.4. To recognize health institutions for the purpose of training and specializing after evaluating the same.
5. To supervise specialist examinations and approve results thereof through specialist scientific committees and boards
Finance and regulations of health care system in Saudi Arabia
Slide152The Saudi Commission for Health Specialties
6. To issue professional certificates such as Diploma, Fellowship, and Membership either the examination conducted by it directly or through collaboration with it.7. To coordinate with professional health boards, commissions, societies and colleges inside and outside the Kingdom.8. To evaluate and equalize health certificates.
9. To encourage preparing researches and publishing scientific articles in the field of specialty and issuance of journals or periodicals.
10. Participation in proposing general plans of preparing and development of manpower in health fields.
Finance and regulations of health care system in Saudi Arabia
Slide153The Saudi Commission for Health Specialties
11. To organize forums and press conferences for discussing internal health problems and proposing suitable solutions and following up implementation of recommendations and resolutions issued in relation thereto.12. To set up principles and standards including ethics for practicing health professions.
13. To encourage preparing health scientific researches and proposing subjects and supporting such researches and financing the same either in whole or part.14. To give approval to establishing scientific societies for health specialties.
Finance and regulations of health care system in Saudi Arabia
Slide154Ministry of health
Ministry of health is the responsible for health care system in Saudi Arabia .Currently the MOH is the major government provider and financer of health care services in Saudi Arabia, with a total of 244 hospitals (33 277 beds) and 2037 primary health care .The MOH is responsible for managing, planning and formulating health policies and supervising health programmes, as well as monitoring health services in the private sector.
It is also responsible for advising other government agencies and the private sector on ways to achieve the government’s health objectives
Finance and regulations of health care system in Saudi Arabia
Slide155Ministry of health
The MOH supervises 20 regional directorates-general of health affairs in various parts of the country.Each regional health directorate has a number of hospitals and health sectors and every health sector supervises a number of PHC centres. The role of these 20 directorates includes implementing the policies, plans and programmes of the MOH; managing and supporting MOH health services; supervising and organizing private sector services; coordinating with other government agencies
Finance and regulations of health care system in Saudi Arabia
Slide156The role of insurance and private sector in health care system in Saudi Arabia
Slide157Contents
Country Facts and Current Health SystemHealth insurance in Saudi Arabia
Staging of Health InsuranceTypes of Insurance In Saudi market:
Key Players of health care in Saudi Arabia
Budget Allocations
Sector Overview
Key Stakeholders view points
Slide158The role of insurance and private sector in health care system in Saudi Arabia
Country Facts and Current Health System
KSA has the largest and fastest growing population in the GCC.The last official census in 2010 placed the population of Saudi Arabia at 27.1 million, compared with 22.6 million in 2004.
The annual population growth rate for 2004 to 2010 was 3.2% per annum.
Fertility rate was 3.04
Slide159The role of insurance and private sector in health care system in Saudi Arabia
Slide160The role of insurance and private sector in health care system in Saudi Arabia
Saudi citizens comprise around 68.9% of the total population; 50.2% are males and 49.8% females.
67.1% of the population are under the age of 30 years and about 37.2% are under 15 years; the population over the age of 60 years is estimated at 5.2%According to United Nation projections, it is estimated that the population of Saudi Arabia will reach 39.8 million by 2025 and 54.7 million by 2050.
This is a natural outcome of the high birth rate (23.7 per 1000 population), increased life expectancy (72.5 years for men, 74.7 years for women)
Slide161The role of insurance and private sector in health care system in Saudi Arabia
Current Health System:
The Healthcare sector in the Kingdom of Saudi Arabia is primarily managed by the Government through the Ministry of Health (MOH) and number of semi public organization who specifically operate hospitals and medical services for their employees.In addition, private sector operators are also playing a key role in providing quality healthcare services in the Kingdom.
Slide162The role of insurance and private sector in health care system in Saudi Arabia
Current Health System:
KSA
Slide163WHO Data 2013
2
General Government Health Expenditure (GGHE) as% of Gross Domestic Product (GDP)
5
General Government Health Expenditure (GGHE) as % of General government expenditure (GGE)
64
General
Government
Health
Expenditure
(GGHE) as
% of Total
Health
Expenditure
55
Out of Pocket Expenditure (OOPS) as % of Private
Health Expenditure (
PvtHE)20Out of Pocket Expenditure (OOPS) as % of TotalHealth Expenditure (THE)36Private Health Expenditure (PvtHE
) as % of TotalHealth Expenditure (THE)22Private Insurance as % of Private Health Expenditure
Slide164WHO Data 2013
Slide165The role of insurance and private sector in health care system in Saudi Arabia
Main Health Providers:
Health Facilities
Slide166The role of insurance and private sector in health care system in Saudi Arabia
Health insurance in Saudi Arabia :
Funding health care services is a central challenge faced by the MOH.Since the total expenditure on public health services comes from the government and the services are free-of-charge.
This lead to considerable cost pressure on the government, particularly in view of the rapid growth in the population, the high price of new technology and the growing awareness about health and disease among the community.
Slide167The role of insurance and private sector in health care system in Saudi Arabia
Health insurance in Saudi Arabia
:To meet the growing population demands for health care and to ensure the quality of services provided, the Council for Cooperative Health Insurance was established by the government in 1999.
The main role of this Council is to introduce, regulate and supervise a health insurance strategy for the Saudi health care market.
The implementation of a cooperative health insurance scheme was planned over 3 stages
Slide168The role of insurance and private sector in health care system in Saudi Arabia
Health insurance in Saudi Arabia:
In the first stage, the cooperative health insurance was applied for non-Saudis and Saudis in the private sector, in which their employers have to pay for health cover costs.
In the second stage, the cooperative health insurance is to be applied for Saudis and non-Saudis working in the government sector.
The government will pay the cooperative health insurance costs for this category of employee.
Slide169The role of insurance and private sector in health care system in Saudi Arabia
Health insurance in Saudi Arabia:
In the final stage, the cooperative health insurance will be applied to other groups, such as pilgrims.Only the first stage has been implemented to date, with the cooperative health insurance being implemented gradually in a 3-phase programme to employees of the private sector and their dependants.
The first phase covered companies with 500 or more employees, while the second phase applied to employers with more than 100workers
Slide170The role of insurance and private sector in health care system in Saudi Arabia
Health insurance in Saudi Arabia:
The third phase included employees of all companies in Saudi Arabia as well as domestic workers.The government is now working systematically to apply the remaining 2 stages—for employees in the government sector and for pilgrims— before they privatize the state-owned health care facilities
While the market for cooperative health insurance in Saudi Arabia started with only one company in 2004.
It currently involves about 25 companies
Slide171The role of insurance and private sector in health care system in Saudi Arabia
Health insurance in Saudi Arabia:
The introduction of the scheme is intended to decrease the financial burden on Saudi Arabia due to the costs associated with providing health services free-of-charge.It will also give people more opportunity to choose the health services they require.
No information is available yet regarding the cooperative health insurance scheme for the population of Saudi Arabia other than employees and expatriates.
Slide172The role of insurance and private sector in health care system in Saudi Arabia
Health insurance in Saudi Arabia:
Backed by new regulations, the health insurance market in Saudi Arabia is expected to experience a healthy growth rate. Health insurance Gross Written Premium (GWP) stood at around SAR 8.7 Billion (US$ 2.35 Billion) in 2010. It is expected to reach SAR 21.1 Billion (US$ 5.70 Billion) by the end of 2015, growing at a CAGR of around 19% during 2011-2015.
In terms of health insurance premiums, the market is dominated by three companies: Tawuniya (22%), Medgulf (19%) and Bupa (22%) who are estimated to capture 63% of the total Gross Written Premium.
Slide173The role of insurance and private sector in health care system in Saudi Arabia
Health insurance in Saudi Arabia:
This indicates a potential threat to healthcare providers, i.e. it restricts their bargainingpower to set discount levels with the insurance companies.
Concurrently this provides an opportunity to healthcare providers to reduce administration costs rather than having to deal with a myriad of differing forms and administration systems from a large number of insurance companies.
Slide174The role of insurance and private sector in health care system in Saudi Arabia
Staging of Health Insurance:
Co-operative Health Insurance for non-Saudis
and
Saudis in Private Sector
National Health Insurance System for Saudis
And
Non-Saudis in the Governmental Sector
Other Groups e.g. Religious visitors
Slide175The role of insurance and private sector in health care system in Saudi Arabia
Types of Insurance In Saudi market:
Property and casualty 34%
Aviation
Marine
Medical Malpractice
Car 34%
Health 32%
Slide176The role of insurance and private sector in health care system in Saudi Arabia
Key Players of health care in Saudi Arabia:
Ministry of Health (“MOH”):Approximately 60% of all hospitals within the Kingdom are owned and operated by the MOH.These hospitals provide basic healthcare services, as well as, in certain cases, specialized facility centres.
MOH facilities are increasingly being made available mostly to Saudi Nationals only with accessibility to expatriates in majority of cases restricted to specialized treatments except in rural areas where private sector facilities are not present.
Slide177The role of insurance and private sector in health care system in Saudi Arabia
Key Players of health care in Saudi Arabia:
Other Governmental Organizations: Health treatment in other government and quasi organizations is effectively free for employees, typical organizations would include The National Guard, Ministries of Defence and Aviation and the Royal Commission.Private Sector: Historically most of the outpatient treatments were provided by the private sector. However, increasingly inpatient treatments are also being provided by the private sector due to the high demand and the restrictions placed on entry to MOH facilities.
Slide178The role of insurance and private sector in health care system in Saudi Arabia
Budget Allocations:
Between 2005 and 2008 Saudi Arabia allocated approximately SAR 23.5 billion per annum with a cumulative amount of SAR 94 billion investment in the healthcare sector.However, in 2010 and 2011 there was a substantial increase in the healthcare budget which increased from SAR 30 billion (6.3% of total Government Budget) in 2008 to SAR 52 billion in 2009 (11% of total Government Budget) and to SAR 61.2 billion in 2010 (11.3% of total Government Budget).
Slide179The role of insurance and private sector in health care system in Saudi Arabia
Budget Allocations:
The budget allocation was further increased to SAR 68.7 billion (11.8% of total Government Budget) in 2011, a cumulative allocation of SAR 113 billion in last two years compared to SAR 94 billion in the previous four years.
In order to maintain the network of healthcare facilities, the Saudi Government has implemented a two tier health service plan; Tier 1 includes a network of primary healthcare centres and clinics established throughout the Kingdom. These clinics and centres are backed by a network of secondary care hospitals and specialized treatment facilities.
Slide180The role of insurance and private sector in health care system in Saudi Arabia
Budget Allocations:
(Tier 2) located mainly in major urban areas across the country.Moreover, comparing the healthcare indicators of Saudi Arabia to other developed countries such as the US, UK and Germany demonstrates there is a shortage of doctors, nurses and beds in Saudi Arabia. The shortage is prevalent across all GCC countries, however, Saudi Arabia has the lowest number of beds, nurses and doctors per population within the GCC.
Slide181The role of insurance and private sector in health care system in Saudi Arabia
Sector Overview:
There are currently over 369 hospitals, both within the public and private sectors provide various healthcare facilities and treatment throughout the Kingdom. In 2009, the total number of doctors and nurses was approximately 62,805 with over 20% employed at hospitals in Riyadh.Bed Capacity: Total number of beds at MOH hospitals increased from 28,751 in 2002 to 33,277 in 2008 while the private sector and quasi government hospitals bed capacity increased from 10,133 and 10,300 in 2002 to 11,822 and 10,833 respectively for the same period.
Slide182The role of insurance and private sector in health care system in Saudi Arabia
Sector Overview:
The gradual increase in private hospital beds is also due to influx of expatriate patients seeking medical treatment who previously had access to MOH hospitals.total number of hospital beds in Saudi Arabia increased from 49,148 in 2002 to 55,932 beds in 2008, an increase of 13.7% over the six year period and the total number of hospitals increased from 350 in 2002 to 408 in 2008, an increase of 16.6% during the same period.
The bed capacity at MOH hospitals is by far the largest, accounting for 59% of cumulative hospital bed supply in Saudi Arabia.
Slide183The role of insurance and private sector in health care system in Saudi Arabia
Sector Overview:
inpatients and Outpatients: The number of outpatients is considerably higher than in-patients. This is in line with the nature of outpatient treatments which are less than a day long with a high percentage of cases consisting only of consultations.
On average residents of KSA visit healthcare facilities five times a year, from which 31% are to Private sector facilities.
Slide184The role of insurance and private sector in health care system in Saudi Arabia
Sector Overview:
Keeping abreast of the increasing healthcare demands and the limited supply of hospitals & specialized treatments, the Ministry of Health in Saudi Arabia has embarked on ambitious plans to establish 195 healthcare projects including thirty-three new hospitals with five hospitals having a bed capacity of over 500 beds.
These five hospitals are expected to be constructed in East Riyadh, North Jeddah, Makkah, Balijurashi and Tabuk.
Slide185The role of insurance and private sector in health care system in Saudi Arabia
Key Stakeholders view points:
Extracted and combined from questionnaires and interviews the following represents the views of key stakeholders (investors and operators) in Saudi Arabia relating to the healthcare sector.Market Structure: The current healthcare sector is dominated by insurance companies (25 companies listed on the Saudi Stock Exchange) and is hence driven by cost versus quality. Unless a set regulation is introduced to monitor pricing, healthcare access and quality of care in private hospitals will continue to face lower profit margins and collection delays which will result in lower quality of care.
Slide186The role of insurance and private sector in health care system in Saudi Arabia
Key Stakeholders view points:
Shortage of Hospital Beds: The present shortage of beds which is growing with time, can be overcome by funding from the public sector to establish new hospitals both in public and private sectors, as well as, improving and expanding existing facilities.
Lifestyle related Disease: There is a tremendous increase in lifestyle related diseases
such as diabetes, hypertension, obesity, heart and kidney Presently, the private sector plays an important the role in providing care for these diseases.
Slide187The role of insurance and private sector in health care system in Saudi Arabia
Key Stakeholders view points:However, government needs to take an active role in prevention through educating people and offering preventive services.
Shortage of Healthcare resources: One of the major costs for healthcare providers is
spending on qualified medical staff. A large number of doctors, nurses, pharmacists and paramedical staff in KSA migrate to Western Countries after a few years due to better opportunities and training facilities.
Slide188The role of insurance and private sector in health care system in Saudi Arabia
Key Stakeholders view points:In addition, the current Saudi regulations for recruitment and Saudization continue to further increase the staff cost due to limited available resources. Government role is extremely important in establishing career-focused educational institutions (such as medical, pharmacy and nursing colleges) to increase the supply of local medical professionals and to drive qualified Saudi talent into jobs.
Slide189The role of insurance and private sector in health care system in Saudi Arabia
Key Stakeholders view points:
Competition from Public Sector Hospitals: Public Sector Hospitals are not cost driven and therefore provide quality healthcare services to the population either free or at subsidized rates. However, with the current population growth, access has been a major issue in public sector hospitals.
This shortage has resulted in an increase in demand for private healthcare facilities. With increased healthcare costs and emergence of lifestyle related diseases, public and private players should form partnerships to create better provision of care.
Slide190The role of insurance and private sector in health care system in Saudi Arabia
Key Stakeholders view points:
implementation of “best practice”: Implementation of Information Technology should have greater prevalence in the sector similar to other developed countries in which medical files for patients are either unified or centrally maintained. Improvement in unified or centralized filing is expected to improve diagnosis and provision of healthcare services.
Private hospitals will continue to play an even more important and crucial role within the Kingdom..
Slide191The role of insurance and private sector in health care system in Saudi Arabia
The delivery of healthcare in the Kingdom and around the world continues to evolve as the needs of healthcare provider become increasingly complex.
Trends and industry changes requires investors and operators of healthcare facilities to make challenging decisions.Despite improvements in healthcare systems across the Kingdom, the healthcare sector still offers significant opportunities for investors / operators.
We believe that due to strong growth fundamentals coupled with the increasing population and regulatory changes the sector is expected to experience robust growth in the foreseeable future .
Slide192Medication use and distribution systems in Saudi Arabia
Slide193List of contents
Introduction to medicinesdefinition of drugsUse of medications in Saudi Arabia
Drug Distribution ModelsDrug distribution systems
(i)Individual Prescription Order System.
(ii) Complete Floor Stock System
(iii)Combination of (i) and (ii).
(iv) The unit dose method.
Slide194Introduction to medicines
A medication or medicine is a drug taken to cure and/or ameliorate any symptoms of an illness or medical condition, or may be used as preventive medicine that has future benefits but does not treat any existing or pre-existing diseases or symptoms.
Dispensing of medication is often regulated by government into three categories.
over-the-counter- (OTC)
behind-the-counter-(BTC)
prescription only medicine (POM)
Slide195Introduction to medicines
Over-the-counter (OTC) drugs are medicines that may be sold directly to a consumer without a prescription from a healthcare professional .As compared to prescription drugs , which may be sold only to consumers possessing a valid prescription.
in many countries, OTC drugs are selected by a regulatory agencies to ensure that they are ingredients that are safe and effective when used without a physicians 's care.
Slide196Introduction to medicines
Behind-the-counter (BTC)drugs : which are dispensed by a pharmacist without needing a doctor's prescription.prescription medication:
A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained.Medications are typically produced by pharmaceutical companies and are often patented to give the developer exclusive rights to produce them, but they can also be derived from naturally occurring substance in plants called herbal medicines .
Slide197Definition of drugs
A
drug
, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function.
In pharmacology a drug is "a chemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being.
According to Federal Food, Drug, and cosmetic Act definition of "drug" includes "articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals
Slide198Use of medication in Saudi Arabia
Drugs are the fastest rising cost in the health care system. All developed nations are seeking ways to cut down the budgets allocated for buying drugs.In Saudi Arabia and other countries, the cost of maintaining the health care system is escalating out of control.
Governments, health care providers and consumers have to find ways to reduce these escalating costs while maintaining the quality of care that these countries have grown to expect.
Two contributing factors to the increased costs of medicines are the marketing costs for pharmaceutical firms and the expenses incurred in the development of new drug products
Slide199Use of medication in Saudi Arabia
Among the major reason behind the increased expenditure on medication is medication waste which is an unnecessary burden on an already fiscally restrained health care system in these countries.
Medication wastage is defined as any drug product, either dispensed by a prescription or purchased over the counter (OTC), that is never fully consumed.
Medication wastage may be due to poor compliance of patients, excessive and irrational prescribing, 6or the lack of control of the sales of prescription medications in the community pharmacy.
Slide200Use of medication in Saudi Arabia
The problem of wastage is almost universal. In Great Britain, the scale of the problem of wastage is enormous, research suggests that as many as 50% of the patients fail to comply with the terms of their prescription.A survey of 111 households was performed in England to determine the quantity and types of medicines in the homes and to investigate the incidence of double prescribing, wastage and hoarding.
Slide201Use of medication in Saudi Arabia
The investigators found that 51% of the medicines were not in current use by the patients and of those 40% were considered out of date.In Canada, two studies have sorted through piles of discarded medications seeking reasons why the waste of drugs is of "mammoth proportions“.The top medicines wasted regarding their dollar value were antihypertensive drugs followed by analgesics and anti-inflammatory drugs.
Slide202Drug distribution system
Traditional methods of distributing drugs in hospitals are now undergoing reevaluation, and considerable thought and activity is being directed toward the development of new and improved drug distribution systems. Drug distribution system is a Manner in which medications are provided from the pharmacy to the clinical unit
It Includes the period of time from when the drug is “dispensed” until it is “administered”
Slide203Drug Distribution Models
Slide204Current Models for
Medication Distribution
Slide205Drug distribution system
Some of the newer concepts and ideas in connection with hospital drug distribution systems are centralized or decentralized (single, or unit-dose) dispending, automated (mechanical and/or electronic) processing of medication orders and inventory control, and automated (mechanical and/or electronic) storage and delivery devices.
There are four systems in general use for dispensing drugs for inpatients. They may be classified as follows:
(i) Individual Prescription Order System.
(ii) Complete Floor Stock System.
Slide206Drug distribution system
(iii) Combination of (i) and (ii). (iv) The unit dose method.
Individual prescription order system:
This system is generally used by the small and/or private hospital because of the reduced manpower requirement and the desirability for individualized service.
Inherent in this system is the possible delay in obtaining the required medication and the increase in cost to the patient.
Slide207Drug distribution system
Advantages of this system:
(i) All medication orders are directly reviewed by the pharmacist.(ii) Provides for the interaction of pharmacist, doctor, nurse and patient.
(iii) Provides closer control of inventory.
Complete floor stock system:
Under this system, the nursing station pharmacy carries both “charge” and “non-charge” patient medications. Rarely used or particularly expensive drugs are omitted from floor stock but are dispensed upon the receipt of a prescription or medication order for the individual patient.
Slide208Drug distribution system
Although this system is used most often in governmental and other hospitals in which charges are not made to the patient or when the all inclusive rate is used for charging, it does have applicability to the general hospital.
Advantages of Complete floor stock system:
(i) Ready availability of the required drugs.
(ii) Elimination of drug returns.
(iii) Reduction in the number of drug order transcriptions for the pharmacy.
(iv) Reduction in the number of pharmacy personnel required.
Slide209Floor Stock Medications
Slide210Drug distribution system
Disadvantages of Complete floor stock system:
(i) Medication errors may increase because the review of medication orders is eliminated.(ii) Increased drug inventory on the pavilions.
(iii) Greater opportunity for pilferage.
(iv) Increased hazards associated with drug deterioration.
(v) Lack of proper storage facilities on the ward may require capital outlay to provide them.
(vi) Greater inroads are made upon the nurse's time.
Slide211Drug distribution system
complete floor stock system is successfully operated as a decentralized pharmacy under the direct supervision of a pharmacist.
Charge floor stock drugs and non-charge floor stock drugs:Each pavilion in the hospital, regardless of its size or specialty care, has a supply of drugs stored in the medicine cabinet even though the nursing unit is serviced by a unit dose system.
However, the use of floor stock medications should be minimized.
Slide212Drug distribution system
in addition, research has shown that the system of drug distribution has an effect upon the incidence of adverse drug reactions.
These medications may be classified under two separate headings, each of which serves a specific purpose.Drugs on the nursing station may be divided into “charge floor stock drugs” and “non-charge floor stock drugs”
Charge floor stock drugs may be defined as those medications that are stocked on the nursing station.
Slide213Drug distribution system
Charge floor stock drugs represent that group of medications that are placed at the nursing station.
It is the responsibility of the hospital pharmacist, working in cooperation with the nursing service, to develop ways and means whereby adequate supplies of each are always on hand and, in appropriate situation that proper charges are made to the patients account.
Combination of Individual prescription order system and complete floor stock system:
Falling into this category are those hospitals which use the individual prescription or medication order system as their primary means of dispensing, but also utilize a limited floor stock.
Slide214Drug distribution system
This combination system is probably the most commonly used in hospitals today and is modified to include the use of unit dose medications.
Unit dose system:Unit-dose medications have been defined as:
“Those medications which are ordered, packaged, handled, administered and charged in multiples of single dose units containing a predetermined amount of drugs or supply sufficient for one regular dose application or use.”
Slide215Drug distribution system
Advantages of unit dose system:
1. Patients receive improved pharmaceutical service 24 hours a day and are charged for only those doses, which are administered to them.2. All doses of medication required at the nursing station are prepared by the pharmacy thus allowing the nurse more time for direct patient care.
3. Allow the pharmacists to interpret or check a copy of the physician’s original order thus reducing medication errors.
4. Elimination excessive duplication of orders and paper work at the nursing station and pharmacy.
Slide216Drug distribution system
5. Eliminates credits.6. Transfers intravenous preparation and drug reconstitution procedures to the pharmacy.
7. Promotes more efficient utilization of professional and nonprofessional personnel.
8. Reduces revenue losses.
9. Conserves space in nursing units by eliminating bulky floor stock.
10. Eliminates pilferage and drug waste
11. Communication of medication orders and delivery systems are improved.
Slide217Drug distribution system
Unit dose dispensing procedure:
The characteristic features of centralized unit-dose dispending are that all in-patient drugs are dispensed in unit-doses and all the drugs are stored in a central area pharmacy and dispensed at the time the dose is due to be given to the patient.
To operate the system effectively, electronic data processing equipment is not required, however delivery, systems such as medication carts and dumbwaiters are needed to get the unit-doses to the patients; also suction tube system or other means are required to send a copy of the physician’s original medication order to the pharmacy for direct interpretation and filling.
Slide218Drug distribution system
The decentralized unit-dose system, unlike the centralized system, operates through small satellite pharmacies located on each floor of the hospital.
The main pharmacy in this system becomes a procurement, storage, manufacturing and packaging center serving all the satellites.The delivery system is accomplished by the use of medication carts. This type of system can be used for a hospital with separate buildings or old delivery systems.
Slide219Drug distribution system
Although each hospital introduces variations, the following is a step-by-step outline of the procedure entailed in a decentralized unit-dose system:
Upon admission to the hospital, the patient is entered into the system. Diagnosis, allergies and other pertinent data are entered on to the Patient Profile card.Direct copies of medication orders are sent to the pharmacist.
The medications ordered are entered on to the Patient Profile card.
4-Pharmacist chicks medication order for allergies, drug –interactions, drug-laboratory test effects and rationale of therapy.
Slide220Accreditation of health care system in Kingdom
of Saudi Arabia
Slide221Contents
IntroductionHistory of Accreditation?
Process of Accreditation What is Joint Commission International (JCI) accreditation
Accreditation, Licensure and Certification
The main purposes of accreditation?
Rising interest in accreditation in the KSA
Accreditation system suitable for KSA
Comparison of Accreditation systems
The Canadian system
Slide222Contents
Saudi Council for Healthcare Accreditation (SCHA)
Steps for implementation of National Accreditation Program
List of healthcare accreditation organizations in the United State
Slide223Introduction
Introduction
introductionnnnn
Accreditation is a self-assessment and external peer review process used by healthcare organizations to accurately assess their level of performance in relation to established standards and to improve the Healthcare Systems
During the past years, healthcare organizations have been faced with challenges how to improve safety and quality healthcare services which they are serve to patients.
The voice for healthcare quality improvements comes from key stakeholder groups, such as government, Ministry of Health, health care insurance fund, healthcare associations, healthcare professionals, patients and their families, public, etc.
Also, international agencies, World Health Organization (WHO) and World Bank clearly promote improvement of quality and safety of healthcare services
Slide224Introduction
Investments and simply adding more resources does not always achieve the desired improvements in healthcare services
Accreditation standard for hospitals present an attractive methodology for significant improvements in areas of healthcare
Achieving accreditation standards is very important to improve quality of healthcare services and processes, ensure a safe environment, and prevent or reduce risk to patients and staff; it helps healthcare providers to identify their own organizations strengths and weaknesses.
Slide225History OF Accreditation
The process of accreditation originates from the United States.The American College of Surgeons set up a program of standards to define suitable hospitals for surgical training in 1917.This developed into a multidisciplinary program of standardization and in 1951 led to the formation of the independent Joint Commission on Hospital accreditation, now the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), from which all subsequent national programs have been directly or indirectly derived.
To identify national accreditation programs, WHO has undertaken worldwide survey in late 2000, and findings showed that there are 36 national accredited programs
Slide226History OF Accreditation
To promote development and compatibility in world, the International Society for Quality in Health Care (ISQua) launched Agenda for Leadership in Programs in Healthcare Accreditation (ALPHA) in 1999.ALPHA offers services for healthcare standards and accreditation bodies: survey and accreditation in accordance with international standards for national healthcare accreditation bodies and standards assessment against international principles for national healthcare .
Accreditation standards are available for different types of healthcare organization, such as hospitals, clinical laboratories, homecare, and nursing care, ambulatory care providers, transport care providers, etc.
Slide227History OF Accreditation
These standards are applicable in public healthcare organization as well as in private healthcare sectors.Many benefits of accreditation, such as establishment of uniform polices, procedures and records, measurement of indicators of performances, management system and clinical system, etc., attract healthcare decision makers to adopt this program.
Slide228History OF Accreditation
Accreditation is a process in which organization outside the health care organization, usually non-govenmental, assesses the organization to determine if it meets a set of standards designed to improve quality of care .When accreditation standards are implemented, healthcare organizations are required to continually monitor structures, processes, and outcomes, measure indicators, evaluate, and improve the quality of healthcare services.
Slide229Process of Accreditation
Accreditations bodies are independent, non-profit organizations with main role to help healthcare organizations to examine and improve the quality and safety of services they provide to their patients.They offer healthcare organizations a voluntary, external peer review to assess quality by developing standards, assessing compliance with those standards.
The main stages in process of accreditation including: 1.creation of team project, 2.choosing a model of standard, 3.training of staff members, 4.self-assessment, 5.selection of priority 6.improving areas, and 7.survey visit.
Slide230Process of Accreditation
Usually, accreditation process comprises a self-assessment, on site survey carried out by a multidisciplinary team of healthcare professionals, a detailed report of findings, and periodic review.
Accreditation is awarded when it has been demonstrated that a healthcare organization meets agreed standards. But the accreditation process does not end with the completion of the on-site survey; monitoring by accredited body continues during limited accredited period.
Slide231What is Joint Commission International (JCI) accreditation
JCI is a division of Joint Commission Resources, Inc., a wholly owned subsidiary of JCAHO. The mission of JCI is to improve the quality of health care in the international community through the provision of worldwide accreditation services.
For more than 75 years, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ad its predecessor organization have been dedicated to improving the quality of health care services.
Slide232Focus of the Accreditation
R
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Q
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A
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Strategic Directions
Support Services
Providers
Clients
Providers
Support Services
Strategic Directions
Slide233Accreditation, Licensure and Certification, What Are The Differences
It is important to understand what the difference is between licensure, certification and accreditation. Accreditation : Public recognition by a national healthcare accreditation body of the achievement of accreditation standards by a healthcare organization, demonstrated through an independent external peer assessment of that organization’s level of performance in relation to the standards .
Certification Formal recognition of compliance with set standards (e.g. ISO 9000 series for quality systems) validated by external evaluation by an authorized auditor.
Slide234The Role and Benefits of Accreditation
Licensure : Process by which a government authority grants permission, usually following inspection against minimal statutory standards, to an individual practitioner or healthcare organization to operate or to engage in an occupation or profession .As above difference accreditation is much more than licensure or certification; it signifies the achievement of high quality service delivery and a certain level of performance
Slide235The Role and Benefits of Accreditation
Accreditation does not only indicate compliance with a set of minimum standards or regulatory requirements, it focuses on continuous improvement and achievement of specific quality goals.The accreditation (or external peer assessment) of healthcare facilities is vitally important to the overall operation of a health system. It is the backbone of service provision in this sector, foundational to its credibility and continued quality improvement
Slide236The Role and Benefits of Accreditation
Accreditation usually provides information on (i) the structure of hospitals or clinics and the type of services that are offered at each facility (ii) information is given on the processes followed at the specific institution, and (iii) information on the expected outcomes of care is also supplied in some cases .Additional positive externalities and purposes of accreditation include the following:
1. Improve the quality of healthcare by establishing optimal achievement goals in meeting standards for healthcare organizations.
Slide237The Role and Benefits of Accreditation
2. Stimulate and improve the integration and management of health services .3. Establish a comparative database of healthcare organizations able to meet selected structure, process, and outcome standards or criteria.4. Reduce healthcare costs by focusing on increased efficiency and effectiveness of services .5. Provide education and consultation to healthcare organizations, managers, and health professionals on quality improvement strategies and “best practices” in healthcare.
Slide238The Role and Benefits of Accreditation
6. Strengthen the public’s confidence in the quality of healthcare; and 7. Reduce risks associated with injury and infections for patients and staff.8. Hospitals or clinics may want to be accredited for any of the above reasons, but also because it increases the public image and accountability of the facility.
For this reason, accreditation is voluntary in most countries, but there are a few examples of mandatory accreditation .
Slide239KSA- Main features of the
required Accreditation system
A system that enhances continuous improvement
A system that respects and fit within local culture
A system that enhance Saudi citizen participation
A system that is to be built into the existing working environment
Slide240Comparison of Existing Hospital Accreditation Organizations
Country
Accrediting Body
Standards Manual Format
Types of Standards
Using Step-Wise Approach
United States
Joint Commission on the Accreditation of Health Care Organizations
Functional
Outcomes
No
Canada
Canadian Council on Health Services Accreditation
Functional + Departmental
Structure, Process, and Outcomes
Yes
United Kingdom
Health Services Accreditation
Functional
Structure, Process, and Outcomes
No
Australia
Australian Council on Healthcare Standards
Departmental
Structure, & Process
No
Slide241The Canadian system
Canadian and Saudi Health care systems are similarMany of Saudi medical staff are specialized in Canada
Canadian System is flexible as the organization cultureThere is a gradation in standards in accordance with the current status of the organization
1992: Structural Standards
1995: Process Standards
2000: Outcomes Standards
Slide242The Canadian system
CCHSA program is one of the most effective tools to improve quality of care.by developing capabilities and systems that ensure continuous measurement and improvement
Self assessment Team approach
Canadian council provides a range of Technical assistance for hospitals.
Cost of accreditation is reasonable in comparison with others
Slide243Current Accreditation in South Africa
Accreditation is completely voluntary in South Africa at the moment .The Council for Health Services Accreditation of Southern Africa (COHSASA) is the only local accreditation organization .COHSASA is a non-profit, independent organization which accredits both private and public facilities .
Healthcare facilities are assessed in terms of the International Society for Quality in Health Care25 (ISQua) standards which have been modified for South Africa and comprise of two sections
namely (1) healthcare organization management, and (2) patient care.
Slide244Current Accreditation in South Africa
Some of the private hospitals in South Africa are accredited by the International Organization for Standardization (ISO) rather than COHSASA.ISO develops and publishes international standards for many different product and service delivery areas .The aim is to facilitate international standardisation
across countries and also between private and public sectors in manufacturing and service delivery. ISO accreditation has been very useful in the South African context in terms of setting standards and ensuring high quality service delivery in this sector.
Slide245Saudi Council for Healthcare Accreditation (SCHA)
The aims of (SCHA)1. To develop an accreditation program which could be used to help guide Healthcare organization
2. To improve the quality of patient care3. To ensure on safe environment and
4. To reduce risks to patients and staff
Slide246What is SCHA?
SCHA is a national accrediting body for organizations across all health sectors in KSAMission is to help organizations improve the services they provide to their communities
An independentSemi-government
Non-profit organization
Accreditation program voluntarily
Slide247Why Accreditation?
It stimulates the improvement of care delivered to patientsIt strengthens community confidence in accredited hospitalsIt reduces unnecessary costsIt increases efficiency of staffIt provides credentials for continuous education
It can protect against lawsuitsIt facilitates acceptance by third-party payers
Slide248List of healthcare accreditation organizations in the United State
The following organizations survey and accredit hospitals and healthcare organizations in the USA.A number have deeming power for Medicare and Medicaid .Healthcare Facilities Accreditation program (HFAP)
The joint commission (TJC)National committee for quality Assurance(NCQA)community health accreditation program (CHAP)
Slide249List of healthcare accreditation organizations in the United State
Accreditation com(mission for Healthcare (ACHC)The compliance team “Exemplary provider programs”Healthcare quality association on accreditation(HQAA)
DNV health care Accreditation Association For ambulatory care
Slide250The IOM report, Crossing the Quality Chasm: A New Health System for the 21st Century, identifies six aims for health care system improvement: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.
With these objectives in mind, we have developed three broad goals related to medication access and use that should be an integral part of the health reform discussion .
Recognizing the role of pharmacists to help ensure that medication therapy is safe, effective, equitable, patient-centered, and results in quality outcomes;
Ensuring that all people have timely access to prescription medications that are provided accurately and efficiently;
Pharmacy principles for health care reform
Slide251Slide2523. the use of health information technology to support full integration of pharmacists as part of the health care delivery team.
These recommendations are critical to helping patients make the most effective and safe use of their prescription medications and to maintaining a critical pharmacy delivery infrastructure.
Pharmacy principles for health care reform
Slide253Pharmacy and health care system
Slide254Major definitions
Introduction to pharmacyTypes of pharmacy practiceClinical pharmacy practice Community pharmacy practice Hospital pharmacy Goals and standards of hospital pharmacy Role of pharmacist in health care system
Table of content
Slide255Organizational structure of pharmacy
Introduction to health care system Components of health care systemOverview of health care system in Saudi Arabia Overview of healthcare in CanadaPharmacy principles for health care reform
Table of content
Slide256Pharmacy:
the health profession that links the health science with the chemical science and it is charged with ensuring the safe and effective use of pharmaceutical drugs.
the branch of the health sciences dealing with the preparation, dispensing, and proper utilization of drugs.The word derives from the Greek :pharmakon meaning "drug" or "medicine
Pharmacy is inversely related to health care system
Definitions
Slide257Pharmacist:
health care professionals with specialized education and training who perform various roles to ensure optimal health outcomes for their patients through proper medication use.Since pharmacists know about the chemical synthesis mode of action of a particular drug, and its metabolism and physiological effects on the human body in great detail, they play an important role in optimization of a drug treatment for an individual.
Definitions
Slide258Pharmacy technician:
Support the work of pharmacists and other health professionals by performing a variety of pharmacy related functions, including dispensing prescription drugs and other medical devices to patients and instructing on their use.Pharmacy Practice : The discipline within Pharmacy that involves developing the professional roles of the pharmacist
Definitions
Slide259Health is more than the absence of disease, and care is more than the provision of diagnostic and treatment services
According to world health organization (WHO) Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
health care system:
an organized plan of health services. The term usually is used to refer to the system or program by which health care is made available to the population and financed by government, private enterprise, or both
.
Definitions
Slide260Acute care :
hospital provide care for serious illnesses that require the continuous and ongoing attention of physicians, nurses, pharmacist , and other health care providers . Emergency care intensive care provided hearLong term care: these facilities may be used to provide care to patients after discharge from the acute care hospital
Immediate care :Type of care a patient would receive at the physicians office but have extended hours of operation and do not require an appointment
Definitions
Slide261Introduction to Pharmacy
Introduction to pharmacy
Slide262The practice of pharmacy is a vital part of a complete health care system.
The number of people requiring health care services has steadily increased, and this trend will likely continue. pharmacy will face new challenges, expanded responsibilities, and an ever-increasing growth in opportunities. The traditional role of pharmacists is to manufacture and supply medicines.
pharmacists have been faced with increasing health demands which change their direction and focus to PATIENTS instead of the Product.
Introduction
Slide2631-Clinical pharmacy
: is defined as a pharmacy concerned with the science and practice of rational medication use.
The actual definition of clinical pharmacy is much more involved than that and entails several aspects.
Pharmacists often collaborate with physician and other healthcare professionals to improve pharmaceutical care.
Pharmacists are now an integral part of the interdisciplinary approach to patient care.
Clinical Pharmacist
:
Assume responsibility and are accountable for managing medication therapy for patients, whether acting alone or in collaboration with other health care professionals
Types of pharmacy practice
Slide264Clinical pharmacists are scientists as well as researchers.
They must be knowledgeable in medication and nontraditional therapies. They are responsible for regular consultations with patients and their health care professionals.They are employed in virtually all health care settings, such as hospitals, clinics and educational facilities.
Types of pharmacy practice
Slide2652-Community pharmacy
: are the health professionals most accessible to the public .
they supply medicines in accordance with a prescription or when legally permitted, sell them without prescription.Their professional activities also cover
counseling of patients at the time of dispensing of prescription and non-prescription drugs ,
drug information to health care professionals , patients and public ,
participation in health promotion programmes
Types of pharmacy practice
Slide266The main activities of community pharmacist :
Processing of prescription ,Care of patient, Monitoring of drug utilization, Educational policy ,Professional registration authorities, International agencies and professional bodies
Types of pharmacy practice
Slide267Hospital Pharmacy
:The department or service in a hospital which is under the direction of a professionally competent, legally qualified pharmacist, and from which all medications are supplied to the nursing units and other services.
Hospital pharmacies can usually be found within the premises of a hospitals
Types of pharmacy practice
Slide268long-range goals toward which its daily activities are directed, so must a profession, its members, and their representative societies.
the American Society of Hospital Pharmacists, in its Constitution and Bylaws, sets forth the following objectives:To assist in providing an adequate supply of such qualified hospital pharmacists.To assure a high quality of professional practice through the establishment and maintenance of standards of professional ethics, education, and attainments and through the promotion of economic welfare.
GOALS FOR HOSPITAL PHARMACY
Slide269To provide the benefits of a qualified hospital pharmacist to patients and health car institutions, to the allied health professions, and to the profession of pharmacy.
To promote research in hospital pharmacy practices and in the pharmaceutical sciences in general.To disseminate pharmaceutical knowledge by providing for interchange of information among hospital pharmacists and with members of allied specialties and professions.
More broadly, the Society's primary purpose is the advancement of rational, patient-oriented drug therapy in hospitals and other organized health care settings
GOALS FOR HOSPITAL PHARMACY
Slide270Pharmaceutical services in institutions have numerous components, the most prominent being
(1) The procurement, distribution, and control of all pharmaceuticals used within the facility.(2) The evaluation and dissemination of comprehensive information about drugs and their use to the institution's staff and patients.(3) The monitoring, evaluation, and assurance of the quality of drug use.
Minimum Standards For Hospital Pharmacy
Slide271Standard 1:
Administration: The pharmaceutical service shall be directed by a professionally competent, legally qualified pharmacistHe or she must be on the same level within the institution's administrative structure as directors of other clinical services.
Minimum Standards For Hospital Pharmacy
Slide272Standard 1:
The director of pharmaceutical services is responsible for:(1) Setting the long- and short-range goals of the pharmacy based on developments and trends in health care and institutional pharmacy practice and the specific needs of the institution(2) Developing a plan and schedule for achieving these goals.
Minimum Standards For Hospital Pharmacy
Slide273(3) Supervising the implementation of the plan and the day-to-day activities associated with it.
(4) Determining if the goals and schedule are being met and instituting corrective actions where necessary.The director of pharmaceutical services, in carrying out these tasks, shall employ an adequate number of competent and qualified personnel
Minimum standards for hospital pharmacy
Slide274Standard II: Facilities:
There shall be adequate space, equipment, and supplies for the professional and administrative functions of the pharmacy.The pharmacy shall be located in an area (or areas) that facilitate (s) the provision of services to patients. It must be integrated with the facility's communication and transportation systems
Minimum standards for hospital pharmacy
Slide275Space and equipment, in an amount and type to provide secure, environmentally controlled storage of drugs, shall be available.
There shall be designated space and equipment suitable for the preparation of sterile products and other drug compounding and packaging operations.
Minimum standards for hospital pharmacy
Slide276The pharmacy should have a private area for pharmacist-patient consultations.
The director of pharmaceutical services should also have a private office or area.Current drug information resources must be available. These should include appropriate pharmacy and medical journals and texts and drug literature search and retrieval resources.
Minimum standards for hospital pharmacy
Slide277Standard III: Drug Distribution and Control:
The pharmacy shall be responsible for the procurement, distribution, and control of all drugs used within the institution. This responsibility extends to drugs and related services provided to ambulatory patients
Policies and procedures governing these functions shall be developed by the pharmacist with input from other involved hospital staff (e.g. nurses) and committees (pharmacy and therapeutics committee, patient-care committee, etc.).
Minimum standards for hospital pharmacy
Slide278Standard IV:
Drug Information: The pharmacy is responsible for providing the institution's staff and patients with accurate, comprehensive information about drugs and their use and shall serve as its center for drug information
Minimum standards for hospital pharmacy
Slide279Standard V:
Assuring Rational Drug Therapy: An important aspect of pharmaceutical services is that of maximizing rational drug use. In this regard, the pharmacist, in concert with the medical staff, must develop policies and procedures for assuring the quality of drug therapy
.
Minimum standards for hospital pharmacy
Slide280Standard VI:
Research : The pharmacist should conduct, participate in, and support medical and pharmaceutical research appropriate to the goals, objectives, and resources of the pharmacy and the institution.
Minimum standards for hospital pharmacy
Slide281How do you become a Pharmacist in Saudi Arabia
Slide282Pharmacist are health professionals who practice the science of pharmacy
The fundamental role of pharmacists is to distribute drugs that have been prescribed by a healthcare practitioner to patientsOne of the most important roles that pharmacists are currently taking on is one of pharmaceutical care. Pharmaceutical care involves taking direct responsibility for patients and their disease states, medications, and the management of each in order to improve the outcome for each individual patient.
Role of pharmacist in health care
Slide283ROLE OF PHARMACIST IN GLOBAL HEALTH :
Pharmacist should adequately inform patients and the general public about unwanted effects of medicines, and should monitor such unwanted effects and their consequences in collaboration with other health care professionals and the appropriate authorities.Role in Transmitted Diseases Pharmacist can educate people by giving information that explain disease, its transmission, risk reduction and prevention against disease. Patient counseling is one of the important role that a community Pharmacist can provide.
Role
of pharmacist in health care
Slide284Role in Epidemiology : Epidemiology is the study of the distribution and prevention of health related events in specific population
Role of pharmacist to Provide up-to-date information about New Guidelines, New Medications , News reports about medications Provide answers to patient questions before They are asked to medical staff , Drug-drug interactions, Drug-food interactions , Drug-disease interactions
Role of pharmacist in health care
Slide285With the selection and categorizing of the employees, it now becomes essential to develop a chart showing the flow of administrative authority.
Obviously, in the very small departments, this is usually generally understood and no problems arise. However, in the large units with assistant chief pharmacists, supervisors, and lay personnel, authority must be delegated by the chief pharmacist.In large hospitals, departments of pharmacy have a more complex organization
Organizational structure of pharmacy
Slide286Administrative Services Division
1. Plan and coordinate departmental activities.2. Develop policies.3. Schedule personnel and provide supervision.
4. Coordinate administrative needs of the Pharmacy and Therapeutics Committee.
5. Supervise departmental office staff.
Organizational structure of pharmacy
Slide287Education and Training Division
1. Coordinate programs of undergraduate and graduate pharmacystudents.2. Participate in hospital-wide educational programs involving nurses, doctors etc.
3. Train newly employed pharmacy department personnel
Organizational structure of pharmacy
Slide288Pharmaceutical Research Division
1. Develop new formulations of drugs, especially dosage forms notcommercially available, and of research drugs.2. Improve formulations of existing products.3. Cooperate with the medical research staff of projects involving drugs
.
Organizational structure of pharmacy
Slide289In-Patient Services Division
1. Provide medications for all in-patients of the hospital on a 24-hour per day basis.2. Inspection and control of drugs on all treatment areas.3. Cooperate with medical drug research.
Out-Patient Services Division1. Compound and dispense out-patient prescriptions.
2. Inspect and control all clinic and emergency service medication stations.
3. Maintain prescription records.
4. Provide drug consultation services to staff and medical students
Organizational structure of pharmacy
Slide290Drug Information Services Division
1. Provide drug information on drugs and drug therapy to doctors, nurses, medical and nursing students and the house staff.2. Maintain the drug information center.3. Prepare the hospital's pharmacy newsletter.
4. Maintain literature files.Departmental Services Division
1. Control and dispense intravenous fluids.
2. Control and dispense controlled substances.
3. Coordinate and control all drug delivery and distribution systems.
Organizational structure of pharmacy
Slide291Purchasing and Inventory Control Division
1. Maintain drug inventory control.2. Purchase all drugs.3. Receive, store and distribute drugs.
4. Interview medical service representatives.Central Supply Services Division
1. Develop and coordinate distribution of medical supplies and irrigating fluids.
Assay and Quality Control Division
1. Perform analyses on products manufacturered and purchased.
2. Develop and revise assay procedures.
Organizational structure of pharmacy
Slide292Sterile Products Division
1. Produce small volume parenterals.2. Manufacture sterile ophthalmologic, irrigating solutions etc.3. Prepare aseptic dilution of lyophylizal and other "unstable" sterile injections for administration to patients.
Radiopharmaceutical Services division1. Centralize the procurement, storage and dispensing of radioisotopes used in clinical practice.
Organizational structure of pharmacy
Slide293Thank you