Health Policy and System
Financing
Accessibility
funding policy
service capacity
structure
management
Financial Accessibility
able to care pay via community-based willingness and ability to pay survey
Geographic accessibility
local transportation; distribution of infrastructure;
cultural accessibility
can women use reproductive health services if all the physicians in facility are male?
can ethnic minority use services that are staffed by majority population?
will persons use health services for processes that are considered natural, that is without the need for health intervention such as pregnancy
UHC
coverage: the extend to which a basket of defined services is available to people through cost sharing and cross-subsidisation
efficiency: the extent to which objectives are achieved by minimising the use of resources
Technical: producing the minimum possible sustained output from a given set of inputs
productive - health outcomes (outputs) cannot be produced at a lower cost without compromising on quality gains
social: no person can be made better off without making someone else worse off
marco-economic: containment of rising cost of care
mirco-economic:in the production of care
equity:fairness and justice in distribution of costs, benefits and opportunities in the health sector
everyone should have equal opportunities to maximise their health status
in resource allocation (clinics, human resources, hospitals, budgets)
the incidence of health care financing should be distributed according to ability to pay,
benefits should be distributed according to need
horizontal equity: equal treatment for equal needs: health care system should deal with two individuals with the same health needs in the same way
vertical: unequal but equitable treatment of unequals: those with different needs for health care should be treated differently, according to extend of need
quality in health care: the degree to which heath services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
delivery/provision
current medical knowledge
customer-specific values and expectations
responsiveness: reflects the individual's actual experience with a health system therefore can be expected to improve health outcomes and respond to the legitimate expectation of a population
financial resources, staff, facilities, equipment, pharmaceuticals
allocation and utilisation of resources
regulatory framework ensuring stakeholder participation, and relationship management
infrastracture for continuous monitoring and evaluation
sustainability: the ability of the health system to change with the changing needs of the population that is served
financing function
funding available
to ensure access
revenue collection; pooling of resources; purchasing of resources and purchasing of interventions from healthcare providers
revenue collection
general taxation; mandated social health insurance contributions (usually salary-related and almost never risk-related); voluntary private health insurance contributions (risk-related); out-of-pocket payments and donations
poooling
accumulation and management of revenues in risk sharing
health insurance: distribution of financial risk, variation of health care expenditure by pooling cost over time (pre-payment) for different individuals (pooling)
purchasing:pooled funds are paid to providers in order to deliver a specified or unspecified set of health interventions on behalf of a particular population for which the funds have been pooled
passive: predetermined budget or simply paying bills when presented
strategic: use of selective contracting and incentive schemes
out-of-pocket payments: the point of use; co-payments, deductibles, benefits limits or exclusion; use of medical saving account;
private health insurance (phi): funding through non-income related premiums, paid usually on a contract between a private party and an insurance entity, as opposed to taxes or social security security payroll contributions
reimbursement of healthcare providers
fee-for-service
capitation
per diem: a set rate per day
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How far such groups can participate in policy making is dependent on the political system and how open or closed it is
Health Policy
independency
bureaucrates (force to consider international agenda)
international actors
donor agencies
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world bank
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minstry of health
national level: the basis of the rational approach is a belief that policy makers can make rational choices by a judicious use of information and options approasial
political system: to build up a picture of the complexities of how societies allow people within to express demands and wishes and how these are translated into policy by their governments. How problems are recognised, and turned into issues that get on to the policy agenda. How are policies formulate, implemented and evaluated?
how is policy change a best solution to the problems?
what and to what extend of participation allowed direct/indirect participation;the machenism of people are encouraged or discouraged to participate in the political systems2. what are people's beliefs about , and attitudes to policies and the goverment? How far do these attiitudes to politics and the government? How far do those attitudes affect the particiaption in public policy making?
mass national movement
voting
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how the political system perceive 'health' 1. who is involved in the political system? who makes the decisions? that is, how democratic is the system? 2. how are a decision taken and disseminated? Is there much discussions of alternatives? that is, is the system liberal or authoritarian? 3. what is the substantive aim of policy> ti distribute good and services equally or maintain inequalities? That is, is the system egalitarian or inegalitarian? Refer to Healey and Robinson (1992: 38):typology about political system in Africa
problem identification
problem evaluation
different actors involved
policy agenda setting
policy formation
policy implementation
a right?
universal health coverage?
the impact of private sector; think about the economic policy;increase the role of market forces, the reality; government determination
private sector (interests groups such as health insurance or social security companies; professional organisations;private organisations; private hospitals; the pharmaceuticals industry, political parties, and individual vectors
structural adjustment
inputs: demands, support, resources
institutions of government
Outputs - goods and services
pay attention to:
1.little account of conflict and the imperfect balance of power and influence
- is state handling different demand neutrually
3.some goverment is persistent, and force to repress or create demands to coerce compliance.
Exogenous factors that affect policy (Leichter 1979)
situational factors : wars; political leadership;crisis situation;
structural factors : aagriculture; technology; labour market; social and demographic factors
enviromental factors: trade agreement;
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the distinction between policy making and decision making: they cannot be simply be differentiated as macro and micro levels of reality. policy makers never start with blank sheets of infinite possibilities - previous decisions affect present policies. Goverment's ad hoc decisions (on maternity level, nurserly schools, school hours) may together add up to forceful implicit policy (discouraging women to join the labour force)
Policy is the selection of non-contradictory means to achieve non-contradictory ends over medium to long term. Policy is the thread of conviction that keeps a goverment from being the prison of event
public policies are those policies developed by goverment bodies and officials, and thus focus on purposive actions by or for the governments. policy involves the decision to act on some particular problem, but includes subsequent decisions relating to its implementation and enforcement. policy shoould involve more than intention or statement of intent - it should represent what governments actually do. However, given that goverment's choice not to do something may respresent a policy. policy must decide what goverment say they will do, what they actually do, and what they decided to do. In looking at public policy, we are concerned with the formal insittuions of government; they provide the structure with which the public policies takes place
Health policy embraces courses of action that addect the set of insitutions, organizations, services, and funding arrangments of the health care system. It goes beyond health services, however, and includes actions or intended actions by public, private and voluntary organizations that have an impact on health. Health policy is concerned with enviromental and socio-economic effects on health as well as with health care provision.
policies addressing issues a systematic or macro policies. These policies are ususally the