Transcript Document

Globalization and Health Care
Systems Reform
Bernardo Ramirez MD, MBA
UCF Health Management and Informatics
April 2013
Globalization and Health Care Systems
Global Health Care
•Global Health Care Management Experience
Management
•Study
tour 2005 (US, Canada, Experience
Mexico,UK and Australia)
•All countries in the Americas
•Partnerships Europe, CEE and NIS
(Hospitals, Managed Care, Health Systems, Health Reform,
Education and training on health services management
[human resources development, institutional strengthening])
•Managerial and Health Services Research Perspectives
•Globalization impact in health and health care services and
management
•Health systems reform strategies with issues like
competitiveness, state regulations, insurance companies,
public private partnerships and patient empowerment
•Quality, safety and performance improvement
•Value and impact of heath care. Chronic Care
Physician Views of the Health System, 2009 and 2012:
“System Works Well, Only Minor Changes Needed”
Percent
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care
3
Physician Satisfaction with Practicing Medicine
Percent
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care
4
Examples of global issues in
healthcare include:
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Outsourcing of medical services (e.g. medical
transcribing, radiology, billing support – similar to other
businesses)
Acquisitions and consolidations in the pharmaceutical
industry
Movement of health professional labor across national
borders
Medical tourism; competition for international patients
Immigration and global workforce
Global health – pandemics (e.g. HIV/AIDS, Avian flu,
SARS)
Comparative Health Systems and Health Reforms
HEALTH AS A SYSTEM
STRUCTURE
PROCESS
OUTPUTS
OUTCOMES
PRODUCTIVITY
EFFICIENCY
RESOURCES
HEALTH SERVICES
POPULAT ION
UTILIZAT ION
HEALTH STATUS
EFFECTIVENESS
Adapted from Donabedian A. (2005) Evaluating the Quality of Medical Care. Milbank Quarterly Vol 83-No4, Reprinted from Vol44No3, 1966. And
From Bradbury R. (1992) Health Systems Analysis and Hospital Quality Improvement. ISQUA,9 th International Conference Mexico.
Health Services Elements

Population
 Access/utilization (Education, Health
Promotion, Options for Care, Legal
Aspects, Geographical and Cultural
Barriers)
 Epidemiology (Transition, Mortality,
Morbidity, Population, Life Expectancy)
 Life Styles and behaviors (Prevention and
chronic health, Patient & Family Centered)
Health Services Elements

Resources
 Physical Resources, (hospitals, clinics, privatepublic, Ambulatory services)
 Equipment/Technology, Medicines
 Human resources (Education, health
manpower, Incentives, training, continuing
education, Physicians, nurses, technicians and
emerging professions)
 Financial Resources (Resource allocation,
budgets, financial schemes, reimbursement,
insurance mechanisms)
Health Services Elements

Health Services
 Primary/Secondary health care. Systems.
 Management Information Systems
 Clinical Standards and Protocols. Safety Issues.
 Quality Assurance and Quality Improvement
 Legal aspects (malpractice)
 Incentives, Performance management.
 Cost or services
 Efficiency, clinical & Management efficiency
 Effectiveness, Health Impact and outcomes
Types of Health Care Services
Traditional, spiritual, empirical
 Charitable and altruistic organizations
 Entrepreneurial Private practice
 Welfare-oriented, social insurance
 Government and centrally planned
 Prepaid voluntary insurance
 Owned by industry for their workers
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Origins of Health Care Systems
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England. Chadwick report on laboring
conditions. Boards of Public Health (1850).
Mandatory Insurance for workers (1911)
Welfare State Beveridge Report (1942), NHS
(1948)
Germany. Bismarck, Mandatory insurance for
injury and illness (1883)
Central Planning Concept: Semashko. (1923)
Mixed Systems from tax-free health care in
Saudi Arabia to combination of public-private
Ward in a London Hospital 2003
Infant Mortality and Total Heath Spending (% GDP)
Total Health Spending (% GDP) & Body Mas Index
THE HEALTH TRIANGLE
ACCESS
EQUITY
COST
QUALITY &
PERFORMANCE
MANAGEMENT
Adapted from Cost, access, quality triangle. Harvard Medical International, 2002
Retrieved from the Internet December 20, 2006 http://www.hmiworld.org/hmi/issues/Sept_Oct_2002/features_health_systems.html
Average Health Care Spending per Capita, 1980–2010
16
Adjusted for Differences in Cost of Living
Dollars ($US)
* 2009
Source: OECD Health Data 2012.
THE
COMMONWEALTH
FUND
Health Care Spending as a Percentage of GDP, 1980–2010
17
Percent
* 2009
GDP refers to gross domestic product.
Source: OECD Health Data 2012.
THE
COMMONWEALTH
FUND
Health Care Spending per Capita by Source of Funding,
2010
18
Adjusted for Differences in Cost of Living
Dollars ($US)
8,233
5,269
4,463
* 2009.
Source: OECD Health Data 2012.
4,445
4,338
3,974
3,758
3,670 3,433
3,035
3,022
THE
COMMONWEALTH
FUND
Pharmaceutical Spending per Capita, 2010
19
Adjusted for Differences in Cost of Living
Dollars ($US)
* 2009.
** 2008.
Source: OECD Health Data 2012.
THE
COMMONWEALTH
FUND
Relation of Health with Physicians
Will problems be solved in developing
countries if there were more physicians?
More and other health professionals?
Different Health Personnel Ratios?
How about training, incentives, etc?
More hospitals and health centers?
More technology?
Number of Practicing Physicians per 1,000 Population, 2010
* 2009.
Source: OECD Health Data 2012.
21
THE
COMMONWEALTH
FUND
Average Annual Number of Physician Visits per Capita, 2010
* 2009.
** 2008.
Source: OECD Health Data 2012.
22
THE
COMMONWEALTH
FUND
Doctors’ Perception of Patient Access Barriers
Percent
reporting
their patients
OFTEN have:
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Difficulty paying
out-of-pocket
costs
25
26
29
21
42
26
4
6
16
13
59
Difficulty getting
diagnostic tests
16
38
41
27
7
59
10
15
3
14
23
Long waits to
see a specialist
60
73
59
68
21
75
60
49
10
28
28
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care
23
Practice Has Arrangement for Patients’ After-Hours Care
to See Doctor or Nurse
Percent
* In Norway, respondents were asked whether there practice has arrangements or if there are
regional
arrangements.
Source: 2012
Commonwealth Fund International Health Policy Survey of Primary Care
24
Practice Uses Nurse Case Managers or Navigators
for Patients with Serious Chronic Conditions
Percent
Note: Question asked differently in France.
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care
25
Primary Care Doctors’ Receipt of Information from Specialists
Percent said after
their patient visits
a specialist they
always receive:
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Report with all
relevant health
information
32
26
51
13
13
41
26
12
59
36
19
Information
about changes to
patient’s drugs or
care plan
30
24
47
12
5
44
22
13
44
41
16
Information that
is timely and
available when
needed
13
11
26
4
1
15
4
8
27
18
11
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care
26
Health Sector Reforms Around The World
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Balance the Iron Triangle (Access-Quality-Cost)
Reorient MOH (make them smaller or more
functional, performance, accountability,
modernization, separate provision from financing,
competition, Chronic-Acute Care)
Institute user charges-AccountabilityInstitute or expand health insurance schemes
Decentralize-Empowerment
Third party Contracts with private/public providers
Sustainability:
The capacity of health services to
function with efficiency, including
the financial, environment and
social interaction that guaranties an
effective service now and in the
future, with a minimum of external
intervention and without limiting
the capacity of future generations to
fulfill their needs.
Adapted from Gallopin Gilberto. A systems approach to sustainability and sustainable development. Sustainable Development
and Human settlements Division. ECLAC/Government of the Netherlands. Project “Sustainable Assessment in Latin America
and the Caribbean” Santiago de Chile, March 2003
Areas and Dimensions
Sustainability of Processes
 Sustainability of Organizations
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The dimensions of sustainability are
grouped in five areas:
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The environment
Socio-Cultural
Institutional Capacity Development
The Financial Dimension
The Political Dimension