1 / 21

International Health Leadership Program

International Health Leadership Program. Policy Context for Reform Pam Garside University of Cambridge. Values Evidence Based Medicine/Policy Accountability. International Health Leadership Program. VALUES AND ACCOUNTABILTY

braima
Download Presentation

International Health Leadership Program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. International HealthLeadership Program Policy Context for Reform Pam Garside University of Cambridge

  2. Values Evidence Based Medicine/PolicyAccountability

  3. International Health Leadership Program • VALUES AND ACCOUNTABILTY • What are the values to guide design and implementation of the health care system? • What is the model of accountability for performance?

  4. Policy Challenges and Core Competencies Needed • Making explicit the basic values • Management • Evidence-based medicine -reasonable? • Accountability

  5. Need for Reform of Health Systems • Arguments • Humanitarian argument - health care is public good • Economic advantage/vitality • Issues • Resource constraints • Inequity of access • Mal-distribution of resources • Uneven quality of care • Political problem

  6. Increasing Complexity Inadequate capacity to plan and manage Weakened resource base (financial and human capital) Declining System Performance Health worker stress Reduced public confidence Disparities/ Inequities Gaps between science and practice Dramatic shifts in organization and financing Unstable Health Care Systems

  7. Core Competencies of SustainableHealth Care Systems • Policy/Planning • Making explicit the basic value framework • Environment assessment/strategic planning/forecasting • Legislative and regulatory • Developing essential infrastructure; workforce, IT, etc. • Management • Resource allocation and management • Integrate • Intersectoral • Public and private • Prudent use of technologies • Develop/organize human resources • Generate public good will • Evaluation • Monitor performance • Foster accountability • Implement change

  8. WHO Health-For-All in the 21st Century (HFA) Policy “Value Positions” • Health is a prerequisite for human development • A notion of equity or fairness should be at the core of all health system development • Health systems need to adapt and respect the local context and respond to the needs of the population • New mechanisms for transparent policy dialogue priority setting accountability need to be established • Aggregate population based need better expresses societies priorities in health than patient based demand • Health systems must be conceived as an operationally linked to other elements of a countries social and economic development • Health interventions should have a strong evidence base • Case for the individual must be integrated within public health functions that address population needs

  9. Values • Solidarity • Equity • Fairness • Autonomy (Personal) • Autonomy (Professional) • Efficiency • Effectiveness • Choice (Individual)

  10. Values: Discussion • What if any values are missing? • What are three most important for design and management of health care systems? • What values are inherently inconsistent or trade-offs?

  11. Evidence-Based Medicine(and Policy?...)

  12. Evidence-Based Medicine(and Policy?...) The application of science and related knowledge to: • Medical decision making at the individual level • Organization of/and delivery of health care at the population level

  13. Evidence-Based Medicine: Limitations/Risks • Financial/affordability • Knowledge gap • Cultural insensitivity • Equity/fairness

  14. Evidence-Based Medicine: Merits • Science-based/logical • Effective: achieves desired outcomes • Rational: for distribution/ management of resources • Inclusive/transparent

  15. Evidence-Based Medicine What is reasonable?

  16. Accountability The obligation to provide a justification and to be held responsible for its actions by another interested party.

  17. Accountability - For What? • Medical decision-making • Financial • Individual respect • Patient vulnerability • Confidentiality • Cultural uniqueness • Practitioner/Institutional behavior • Equity/fairness • Procedure for resolving dilemmas

  18. Regulation and Accountability: Methods • Professionalism • Market competition/choice • Disclosure • Accreditation/Licensure • Legal (individual and institutional litigation) • Legislation/regulation

  19. Accountability: Models Conception Domain Methods of patients of accountability Professional Recipient of Patient, physician Licensure, Certification prof. services Prof. Association Malpractice suit Economic Consumer of Marketplace and Choice and “exit” health care regulation commodity Political Citizen Government “Voice” and receiving reforms and government pressure public good actions Adapted from Emanuel and Emanuel Annals of Internal Medicine, Jan 15, 1996

  20. Accountability • What are pros and cons of 3 models? • Which model is most predictable to serve public interest? • What are implementation issues?

  21. Characteristics of Optimal Health Care Systems • Sustainable financing • Prudent resource management • Attention to quality of care • Respect for individual needs/choices • Accountability

More Related