Post on 22-Nov-2014
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Introduction to Health Systems & Health Services Systems
Borwornsom Leerapan, MD PhD
MGMG 548: Health Service Systems and Health Systems
CMMU, Mahidol University May 18, 2014
Pix source: ra.mahidol.ac.th
MGMG 548 • Major issues in the organization of a health services system • The role of values in the development of health care policy • Methods for assessing the health status of populations • Analysis of need for, access to and use of services; current supply
and distribution of health resources • Analysis of health care costs and expenditures • Sociopolitical, economic, and moral/ethical issues confronting the
public health and medical care system • Trends in service provision, human resources, financing and health
services organization, and implications for the public’s health.
Course Description
Source Prattana Punnakitikashem. PhD; Pix source: online.wsj.com
Format
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F/U
Mini-lecture
DiscussionQ&A
Wrapup
To-do list
Course Website
Course Calendar
Week Date Topic 1 May 18, 2014 Overview of health & health services
Systems 2 May 25, 2014 Systems thinking & the building blocks of
health systems 3 June 1, 2014 Healthcare quality 4 June 8, 2014 Healthcare efficiency 5 June 15, 2014 Health equity 6 June 22, 2014 Social determinants of health 7 June 29, 2014 Mid-term exam
Course Calendar
Week Date Topic 8 July 6, 2014 Ambulatory care and primary healthcare 9 July 13, 2014 Chronic care 10 July 20, 2014 Long-term care 11 July 27, 2014 Emergency care 12 August 3, 2014 Palliative care 13 August 10, 2014 Care for certain diseases and populations:
travel clinic 14 August 17, 2014 Student presentations of final papers
Required reading: • Selected readings available via the course website. • In addition, there is a recommended textbook for this course.
– The Institute of Medicine (2001). Crossing the quality chasm: a new health system for the 21st century. Committee on Quality Health Care in America, Institute of Medicine. Washington, D.C.: National Academy Press.
Learning Materials
Source: nap.edu
Optional textbook/resource: • Garwande, A. (2002). Complications: a surgeon's notes on an imperfect
science. New York, NY: Picador Press. • Roberts, M. J., Hsiao, W., Berman, P., & Reich, M. R. (2004). Getting health
reform right: a guide to improving performance and equity. New York, USA: Oxford University Press.
• Aday, L. A., Begley, C. E., Lairson, D. R., & Balkrishnan, R. (2013). Evaluating the healthcare system: effectiveness, efficiency, and equity. Chicago, IL: Health Administration Press.
• Wibulpolprasert, S., Sirilak, S., Ekachampaka, P., & Wattanamano, N. (2011). Thailand health profile 2008-2010. Bangkok; The War Veterans Organization of Thailand Press.
Learning Materials
Up and Down the Ladder of Abstraction
Abstract: • Concepts
• Theories • Principles
• Strategies
Concrete: • Case studies • Data, Evidence
• Analysis, Synthesis
• Presentations
1. Pre-test 2. Concepts of health and health determinants 3. Health systems vs. Health services systems 4. Desirable characteristics of health services systems 5. Case study and discussion – Healthcare managers vs. policy/systems analysts.
Outline for Today
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Pretest (in-class exam, no grade)
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Considering the provided VDO presentation, please give your best answers to these two following questions: 1. What “health systems issues” are dominated in the
provided VDO presentation? (Please describe.) 2. As a (future) administrators in your healthcare
organizations, what could you do to address such issues? (Elaborate more on what, why, and how.)
(30 min)
Pre-test Exam
Concepts of Health & Health Determinants
Pix source: online.wsj.com
WHO definition of Health:
“Heath”
Source: reamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Thailand’s Definition of Health:
“Heath”
Source: Statute on National Health System B.E. 2552 (2009)
Health & Health Determinants
Figure source: Thailand Health Profile 2012
Health Systems & Health Services Systems
Pix source: online.wsj.com
“System”
Source: Scheerens and Bosker 1997; Pix source: system humanrevod.wordpress.com
“CIPO” Model
“Health System”
Source: who’s World Health Report (2000)
“Health System”
Pix source: WHO’s framework for action. (2007)
• “The Six Building Blocks” and their interconnections
“Health System”
Pix source: WHO’s framework for action. (2007)
Social Determinants of Health
Pix source: greenpeace.org; twirlit.com; who.int/bulletin; cha-amcity.go.th
• Health is not merely the absence of disease or infirmity. • Health promotion and disease prevention • Health promotion strategies have to go beyond health services
sector.
Stakeholders in Thai Health System
Pix source: www.nationalhealth.or.th
Desirable Characteristics of Health Services Systems
Pix source: online.wsj.com
Goals of Health Services System
Source: Modified from WHO (2000) and Marc J Roberts et al. (2003)
Health
• A great health services system should be: 1. Equitable 2. Efficient 3. Safe 4. Timely 5. Effective 6. Patient-centered
Desirable Health Services System
Source: Adapted from IOM (2001)
“STEEEP”
Quality
• Equity: – Equality of opportunity to access to healthcare
services, regardless of race, gender, age, religion, geographic location, socioeconomic status
– “Equal services for equal needs, and unequal services for unequal needs”
1. Equitable Health Services
Pix source: www.stephenharrington-online.com
What is Your Theory of Justice?
Pix source: hp-lexicon.org/wizards; helenicproducts.com
• How would you fairly cut this cake into two pieces for each of the twins?
Theory of Justice
Source: John Rawls. The Theory of Justice (1971, 2001): Pix source: irwinbartlet.wordpress.com
– Fair decisions should be made from “the original position” where no one knows what burdens or benefits he or she might receive once “the veil of ignorance” is lifted.
• John Rawls: “Justice as Fairness”
Equity vs. Equality
Pix source: twicsy.com/i/TwC76c
• Equity means equality of opportunity (“justice as fairness”). • Equality is not always justice.
Equality Equity
• It is very difficult to measure “health equity”. • Equitable health services could be used as its proxy
measures, particularly measures of the “accessibility to health services”: – Physical accessibility – Psychological accessibility – Financial accessibility – Information accessibility
Equitable Health Services
Source: WHO/Europe (2007)
• Efficiency: – Efficient health services means a system that utilize
health resources (drugs, human resources, budgets) in a cost-effective fashion, with utility maximization and waste reduction.
2. Efficient Health Services
Source: Modified from IOM (2001)
Efficiency of Thai Healthcare?
“31.2% of diabetes patients and 50.3% of hypertension patients are not diagnosed. Only 28.5% and 20.9% of cases have been diagnosed, treated and brought under control.”
Figure source: Kanchanachitra .et al. (2010)
• Two approaches to improve efficiency: 1. Technical efficiency 2. Allocative efficiency
Technical vs. Allocative Efficiency
• Quality: – “Quality is in the eye of the beholder.” – Nonetheless, all health services should be “safe,
timely, effective, patient-centered”.
3. Quality Health Services
Source: Adapted from IOM (2001)
• Safety: – By design, a system that prevents medical error and
avoid iatrogenic injuries.
Quality as Safety
Source: Modified from IOM (2001); Pix source: thieme-connect.de/ejournals; tumblr.com
Quality as Safety
Source: amazon.com, matichonbook.com
(Disclaimer: Obviously, this is partly my self-advertisement!)
• Timeliness: – Reducing waiting time of both health providers and
consumers, which sometimes lead to injuries and harms.
Quality as Timeliness
Source: Modified from IOM (2001); Pix source: toonpool.com/cartoons.jpg
• Effectiveness:
– Delivery of evidence-based health services to all people who likely will benefit from such services (“avoid underuse”) and provide no services that have no evidence of benefits or that could be harmful (“avoid overuse and misuse”).
Quality as Effectiveness
Source: Modified from IOM (2001); Pix source: www.rch.org.au/clinicalguide
• Patient-centeredness: – A system that respects the patient’s rights. – Be responsive to personal beliefs ่ and value of individuals. – Open an opportunity for patients (and families) and
clinicians to make mutual decisions on their health interventions
– Not a disease-centered system – Not a provider-centered system
Quality as Patient-Centeredness
Source: Modified from IOM (2001); Pix source: blog.skylight.com/patient-centric
Ø Learning about health systems: “Experience, not explanation.”
Picture source: commonsenseatheism.com; variety.thaiza.com
Adult Learning
EXPERIENCE
What Level of Our Learning?
• Why Wisdom
• How Knowledge
• What, Who, When, Where Information
• Number, Text, Picture, Sound, etc. Data
Q& A Discussions
Pix source: online.wsj.com