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1. Explain and evaluate the main mechanisms for financing health services world-wide, especially
Health insurance, Social Insurance and Tax
2. List the stewardship roles of government 3. Provide criteria for evaluating national health systems performance using examples
1 and 2 aim are considered progressive, access to care based on need * See Thomas et al 2006 in Readings
b) Risk assessors (actuaries) assess risk that s/he will fall ill c) Company determines premium level based on risk assessment
Principle
Risk-sharing: the assumption that some people will not require treatment during the year who will subsidise those whose treatment will cost more than the level of premiums they paid
Problem
1. Less likely to be cared for by a fully trained doctor (consultant) 2. Longer waiting lists (slower access to hospital) often leading to deterioration in health
Financing mechanisms(3)
4. Health Maintenance Organisations (US) 5. Private medical savings (Singapore) 6. Out of pocket / fee for service (India and Africa)
Risks of catastrophic illness* In practice many countries use combinations of the above financing mechanisms, with different ones for different population subgroups Public Private mix in a country (% of doctors public and/or private) is both a consequence and a determinant of privatisation strong pressures in Ireland towards privatisation in the 2000s Choice of financing mechanism is fundamentally about ideology (see health care reform in USA) 46 million (15%) of US population have no insurance
Readings
Thomas S, Normand C. Smith S. Social Health Insurance: Options for Ireland . Trinity College Dublin. 2006 (esp pp 5-9)
http://www.adelaide.ie/cms/cms/uploads/files/full_report.pdf
Health Equity
There are often differences across populations
in health status, presence of disease, or quality of health; and in access to health care and in health outcomes
Horizontal Equity equal treatment because of equal need Vertical equity unequal treatment for unequal need, e.g.:
greater risk of TB in poor urban populations Greater risk of HIV in poor adolescent girls in Africa
Responsiveness to service users needs Health of the Population morbidity and mortality data
Health system performance comparison: an agenda for policy, information and research. European Observatory on Health Systems and Policies. 2012
10
Govt. Expenditure on Health (% of total) 2000 2010 67.5 70.4 75.1 59.0 43.2 90.8 51.3 71.1 71.1 69.2 55.5 48.2 95.2 60.8
Per capita Expend on Health ($) 2000 2010 497 2089 1561 125 4703 166 18 748 5257 4242 368 8233 583 74
98 98 100 81 98 100 42
97 99 100 99 99 100 47
21 8 9 17 11 13 193
13
10 6 4 7 8 6 83
94 88 65 90 90 92 91
99 95 95 99 94 96 81
73 77 75 71 75 74 45
79 82 81 74 79 78 55