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Evolution and Transformation of the Health System

Evolution and Transformation of the Health System. PA 574: Health Systems Organization Session 2 – January 13, 2011. What is a Health System?. Includes all the activities whose primary purpose is to promote, restore or maintain health

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Evolution and Transformation of the Health System

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  1. Evolution and Transformationof the Health System PA 574: Health Systems Organization Session 2 – January 13, 2011

  2. What is a Health System? • Includes all the activities whose primary purpose is to promote, restore or maintain health • Formal health services, traditional services, public health, alternatives • Health systems: • Improve health of populations • Respond to people’s expectations • Provide financial protection against costs of ill health

  3. Functional Components Shi & Singh, Figure 1-1, p. 6 • Financing • To obtain health services • Insurance • Protection against risks • Delivery • Providers of services • Payment • Reimbursement

  4. External Forces Affecting Health Services Shi & Singh, Figure 1-2, p. 10 • Social values and cultures • Population characteristics • Political climate • Economic conditions • Physical environment • Technology development • Global influences

  5. Institute of Medicine Six Aims/Ten Rules • Six Aims • Safe • Effective • Patient-centered • Timely • Efficient • Equitable • Ten Rules for System Redesign…

  6. Institute of Medicine Ten Rules for System Redesign • Care is based on continuous healing relationships; • Care is customized according to patient needs/values; • The patient is the source of control; • Knowledge is shared and information flows freely; • Decision making is evidence-based; • Safety is a system property; • Transparency is necessary; • Needs are anticipated; • Waste is continuously decreased; and, • Cooperation among clinicians is a priority.

  7. Levels of the Health Care System (Berwick, 2002) • Level 1: Patient and Community • Experience of patients • Level 2: Microsystem • Functioning of small units of care delivery • Level 3: Organization • Functioning of organizations that house microsystems • Level 4: Environment • Policy, payment, regulation, accreditation • Shapes behavior, interests and opportunities of Level 3 organizations

  8. Historical Forces of Transformation Brainstorm: What has transformed health services delivery over past few decades?

  9. Transformation • Professional sovereignty • Urbanization • Science and technology • Growth of institutions • Dependency • Cohesion among medical professionals • Licensing and regulation • Health professions education

  10. Transformation Growth in public health Consumer advocacy Increase in chronic conditions and longevity Services to special interest groups (veterans, disease, racial/ethnic) New forms of coverage

  11. Evolution and Transformation of the Health Care Delivery System Shi & Singh: Figure 3.1; p. 113 Science & Technology Mid 18th to late 19th Late 19th to late 20th Late 20th to 21st Consumer Professional Corporate Sovereignty Dominance Dominance Beliefs and Values Social, Economic & Political Constraints

  12. Break Please be back in 10 minutes…

  13. Beliefs, Values and Health Market Commodity or Public Good?

  14. Beliefs, Values and Health Care: Market Commodity or Public Good? • Market justice and social justice (Table 2-4; p. 59) • Belief in advancement of science • Capitalist orientation leads to health care viewed as a market commodity, not as public resource • Culture of capitalism consistent with entrepreneurial spirit, self-determination and personal responsibility • Some concern for underprivileged based on underlying values of equity and fairness • Principles of free enterprise dominate

  15. Market Commodity or Public Good? • Consideration of critical human concerns • Protection of society • Application to health care delivery • Health insurance • Health services organization • Equality/inequality • Distributional (in)efficiency

  16. Integration of Individual and Community Health • Attempt to integrate medical care, preventive services, health promotion, health education in community (see Fig. 2-5, p. 65) • Healthy People 2010 (see Fig. 2-6, p. 66) • Improve systems • Increase quality and years of healthy life • Eliminate health disparities • 28 focus areas (Ex. 2-1, p. 67)

  17. Shift in Health System Reform Preferences

  18. Fixing Health Care: Wyden & Bennett • New developments in health care reform -- political forces, alliances, federal/state roles • Emphasis on accessibility • Proposed Healthy Americans Act • Guarantees market-driven choices • Administrative savings • Feasibility?

  19. Performance of US Health Care System (2006/2008) • Scorecard using national and international data to identify performance benchmarks • Ratio scores of US average to benchmark • Healthy lives score: 75/72 / 100 • Quality score: 72/71 /100 • Access score: 67/58 /100 • Equity score: 70/71 /100 • Efficiency score: 52/53 /100 • Overall score: 67/65 /100 • Importance of policies to take coherent, whole-system approach to change and address interaction of access, quality, and cost

  20. Recommendations for a High-Performance U.S. Health System • Affordable coverage for all • Align incentives with value and effective cost control • Accountable, accessible, patient-centered and coordinated care • Aim high to improve quality, health outcomes, and efficiency • Accountable leadership and collaboration to set and achieve national goals

  21. Measures of Utilization • Extent to which health services are consumed • Critical assessment necessary to assess capacity • Types of Measures: • Access to primary care • Utilization of primary care • Utilization of targeted services • Average daily census • Occupancy rate • Average length of stay

  22. Health Status Measures • Self-perception of health and well-being • Life expectancy - longevity • Morbidity – disease • Disability – dysfunction • Mortality - death rates • Demographic – population • Other kinds of health status

  23. Making Sense of It All … • How do you untangle this mess of ideas and proposals? • Implications for first paper vis a vishow to improve the system

  24. Next Week • Health system resources • Redesign of primary care to enhance health services delivery • Group presentation #1: Lewis, Ch.1 • Shi & Singh, Ch. 5 • World Health Report 2008, Ch. 4 • Review Oregon Health Information website • Friedberg et al. (2010): “Primary Care” • Kilo and Wasson (2010): “Practice Redesign” • Margolius and Bodenheimer (2010): “Transforming Primary Care” • Bodenheimer and Pham (2010): “Primary Care: Current Problems …” • Grundy et al. (2010): “Multi-Stakeholder Movement for Primary Care Renewal…” • Lewis, Chapter 1

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