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Globalization and Health Care Systems Reform

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 Management Experience Study tour 2005 (US, Canada, Mexico,UK and Australia) All countries in the Americas

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Globalization and Health Care Systems Reform

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  1. Globalization and Health Care Systems Reform Bernardo Ramirez MD, MBA UCF Health Management and Informatics April 2013

  2. Globalization and Health Care Systems • Global Health Care Management Experience • Study tour 2005 (US, Canada, 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 Global Health Care Management Experience

  3. 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 Physicians.

  4. Physician Satisfaction with Practicing Medicine Percent Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

  5. Examples of global issues in healthcare include: • 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

  6. PROCESS OUTPUTS OUTCOMES PRODUCTIVITY EFFICIENCY RESOURCES HEALTH SERVICES HEALTH STATUS UTILIZAT ION POPULAT ION HEALTH AS A SYSTEM STRUCTURE 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,9th International Conference Mexico.

  7. 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)

  8. Health Services Elements • Resources • Physical Resources, (hospitals, clinics, private-public, 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)

  9. 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

  10. 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

  11. Origins of Health Care Systems • 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

  12. Ward in a London Hospital 2003

  13. Infant Mortality and Total Heath Spending (% GDP)

  14. Total Health Spending (% GDP) & Body Mas Index

  15. THE HEALTH TRIANGLE ACCESS EQUITY COST QUALITY & PERFORMANCEMANAGEMENT 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

  16. Average Health Care Spending per Capita, 1980–2010Adjusted for Differences in Cost of Living Dollars ($US) THE COMMONWEALTH FUND * 2009 Source: OECD Health Data 2012.

  17. Health Care Spending as a Percentage of GDP, 1980–2010 Percent THE COMMONWEALTH FUND * 2009 GDP refers to gross domestic product. Source: OECD Health Data 2012.

  18. Health Care Spending per Capita by Source of Funding, 2010Adjusted for Differences in Cost of Living Dollars ($US) 8,233 5,269 4,463 4,445 4,338 3,974 3,758 3,670 3,433 3,035 3,022 THE COMMONWEALTH FUND * 2009. Source: OECD Health Data 2012.

  19. Pharmaceutical Spending per Capita, 2010Adjusted for Differences in Cost of Living Dollars ($US) THE COMMONWEALTH FUND * 2009. ** 2008. Source: OECD Health Data 2012.

  20. 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?

  21. Number of Practicing Physicians per 1,000 Population, 2010 THE COMMONWEALTH FUND * 2009. Source: OECD Health Data 2012.

  22. Average Annual Number of Physician Visits per Capita, 2010 THE COMMONWEALTH FUND * 2009. ** 2008. Source: OECD Health Data 2012.

  23. Doctors’ Perception of Patient Access Barriers Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

  24. 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 Physicians.

  25. 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 Physicians.

  26. Primary Care Doctors’ Receipt of Information from Specialists Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

  27. Health Sector Reforms Around The World • 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-Accountability- • Institute or expand health insurance schemes • Decentralize-Empowerment • Third party Contracts with private/public providers

  28. 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

  29. Areas and Dimensions • Sustainability of Processes • Sustainability of Organizations The dimensions of sustainability are grouped in five areas: • The environment • Socio-Cultural • Institutional Capacity Development • The Financial Dimension • The Political Dimension

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