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Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
Health system models-an overview
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Health system models-an overview

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Health System Models- Health Models- International Health System - Health Care Levels- Health system financing

Health System Models- Health Models- International Health System - Health Care Levels- Health system financing

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  • May I have a copy please drmchall@gmail.com
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  • its really a very useful presentaion and I like to have a copy
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  • is this the same as health service delivery model?
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  • THANKS SO MUCH BUT I CAN'T OPEN ANY OF THE MODELS BUT I WILL TRY TO OPEN THEM. BE BLESSED.
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  • @beautykekana
    The following list of links may be of a value to you.....Best regards
    http://www.who.int/healthsystems/en/
    http://www.who.int/healthsystems/topics/en/
    ________________________________________
    WHO- 2012 : World Health Report التقرير الصحي العالمي 2012
    http://www.who.int/healthinfo/EN_WHS2012_Full.pdf

    The World health report 2000 : health systems : improving performance
    http://www.who.int/whr/2000/en/whr00_en.pdf

    ________________________________________
    WHO- Health System Performance
    http://www.who.int/health-systems-performance/

    ________________________________________
    Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. © World Health Organization 2010
    http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf
    ________________________________________

    THE HEALTH SYSTEM ASSESSMENT APPROACH: A HOW-TO MANUAL
    Version 2.0 September 2012
    http://www.healthsystems2020.org/content/resource/detail/528/

    USAID- Health system 2020
    http://www.healthsystems2020.org/
    ________________________________________
    World Bank: Health System
    http://wbi.worldbank.org/wbi/about/topics/health-systems
    ________________________________________

    International Healthcare Systems Primer Prepared By:
    Jessica A. Hohman Miami University - Washington University School of Medicine Class of 2007 jrf@www.amsa.org ________________________________________
    Primary Health Care:The basis for health systems strengthening Frequently asked questions( WHO ,2010)
    http://www.searo.who.int/LinkFiles/Primary_and_Community_Health_Care_SEA-HSD-338.pdf
    ________________________________________
    Pan American Health Organization “Integrated Health Service Delivery Networks: Concepts, Policy Options and a Road Map for Implementation in the Americas”
    Washington, D.C.: PAHO, © 2011________________________________________
    Monitoring and evaluation of health systems strengthening: 1 An operational framework WHO, Geneva. October 2010________________________________________
    Glossary for Health System- World Health Organization
    http://gis.emro.who.int/HealthSystemObservatory/PDF/Instruments%20And%20Tools/Glossary.pdf
    ________________________________________
    Health Systems Building Blocks: How to Build Strong Health Systems that Deliver Quality Services
    http://www.healthsystems2020.org/content/resource/detail/2593/
    ________________________________________
    Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies
    http://www.who.int/healthinfo/systems/monitoring/en/index.html
       Reply 
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  • 1. Health Models And Health System ModelsDr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Dr. Ahmed-Refat AG Refat Taibah University – Nov. 2012 1
  • 2. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat ContentsSection One : Health Models  Positive Vs Negative  Preventive Vs Curative  Biomedical Vs socialSection Two: Health Care systems  Private vs Public  Beveridge, Bismark,Private and Out-of-pocket models  Tired vs Diffuse Care Model  Outpatient Care and HospitalsGlobal Health Care Systems  UK – Canada, France, Germany, Japan & USA. 2
  • 3. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Health Models • Positive Health Model State • Negative Health Model • Biomedical Health ModelDeterminants • Social Health Model • Preventive Health Model Care • Curative Health Model 3
  • 4. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Health Models (I)The positive and negative models of health 4
  • 5. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat1- The positive model of healthOne of the best known of the positive definitions of health is thatof the World Health Organization. In defining health as: "a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity"the World Health Organization has sought to broaden our viewof the nature of health status and therefore the responsibilitiesof those who contribute in different ways to health care. 5
  • 6. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatMerits of The WHO definition of Health  Recognizes the various aspects of health (physical, mental and emotional)  Draws attention to the fact that health affects every sphere of life (work, rest and play)  Incorporates a subjective element – how we feel about our state of health. 6
  • 7. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatLimitations of the WHO definition  Too idealistic, in the sense that it conceptualizes good health in such a way that it is unattainable – no one would ever describe himself or herself as being in ‘a state of complete physical, mental and social well-being’  All-embracing and undifferentiated, since it seems to imply that every positive aspect of life is an element of good health  Too generalized, with too little account being taken of the  differences between individuals. 7
  • 8. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatHealth in terms of the capacityThe Ottawa Charter defined health as a resource for doingthings—a capacity, not a state of well-being. Accordingto this definition, health must be clearly differentiated fromhealth status, because health has a dynamic potential forincreasing or at least maintaining whatever health status(place on the spectrum) a person has. Health in this sense is ameans of moving toward the positive end of the healthstatus spectrum. 8
  • 9. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatProbably more than achieving some degree of health status,people want health as a resource for doing the things they wantto do. That view of health characterizes the new era of health.The goal is longevity with good function, and the challengeto health professionals is not only preventing disease andovercoming it when it occurs but also helping people toachieve that goal. 9
  • 10. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatThe new concept advanced in the Ottawa Charter—that healthis not a state of well-being but a resource for living—can bemeasured in its physical (e.g., body mass index [BMI]), mental(e.g., cognition), and social health dimensions (e.g., network offriends and relatives). It also can be measured in terms ofhealth-related practices (e.g., exercise), because there isevidence that, as a category of personal characteristics, health-related practices are important resources for living that carrygreat influence for future health 11
  • 11. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat2- The negative model of healthThe negative model is based on the idea that health is the polaropposite of disease. On the basis of this model, people aredeemed to be healthy if no trace of disease can be found,regardless of how they feel or behave. Conversely, if disease is detected, they are considered to beunhealthy to varying degrees, regardless of whether or not theyregard themselves as unhealthy. 11
  • 12. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatThus, unlike positive definitions of health, negative definitionsallow no room for subjectivity. They are essentially objective inthe sense that the presence or absence of disease isestablished by scientific investigation.With the advance of technology for the purposes of screeningand diagnosis, the detection of disease – and therefore theassessment of health status from the point of view of thenegative model – becomes more sophisticated and relies lessand less on patient reporting. 12
  • 13. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatWhich model predominates??Which model predominates will be determined by a number of factors,including: . the distribution of power between the various stakeholders, withacademics and some health care practitioners favoring positivedefinitions and doctors favoring negative definitions . the stage of development of a health care system, with lessdeveloped, simpler systems tending towards positive definitions andmore developed, complex systems tending towards negativedefinitions . the particular circumstances of an individual case, with positivedefinitions more likely to prevail in community settings and negativedefinitions more likely to prevail in hospital settings. 13
  • 14. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Health Models (II)The Biomedical and Social Models of Health 14
  • 15. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat1- The biomedical model of healthThere is a close affinity between the biomedical model and thenegative model of health. The basic idea is that the humanbody is a machine made up of a number of parts/organs . Assuch, any malfunction (such as disease) is an ‘engineering’problem which is capable of being tackled by technical means.The model has its origins in germ theory, which is particularlyassociated with the pioneering work of Pasteur and Koch in the 15
  • 16. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatnineteenth century. This, in turn, gave rise to the doctrine ofspecific aetiology: for every disease there is a single andobservable cause that can be isolated..Against this, however, must be set a number of weaknesses:-  Not everyone exposed to a causative agent will give in to the disease.  There appear to be many different causative agents rather than a single one. 16
  • 17. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat2-The Social Model of HealthThe social model can be seen, in part, as a reaction to thelimitations of the biomedical model. This model is closely linkedwith positive definitions of health. In the social model the healthof individuals and communities is seen as the result of complexand interacting social, economic, environmental and personalfactors.A person’s optimum state of health is equivalent to the state ofthe set of conditions which fulfill or enable a person to work tofulfill his or her realistic chosen and biological potentials. 17
  • 18. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatBecause of the range of its determinants, the potential forallocating responsibility for ill-health is much greater. In thecase of biomedicine it has been easier to regard ill-health as an‘act of God’ and therefore nobody’s fault.By contrast, the social model gives rise to many possibilities forapportioning blame and has resulted, on the one hand, in‘victim blaming’ and, on the other, in pointing the finger atdeficiencies in public policy and the behavior of business andindustry. 18
  • 19. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatPeople are influenced and constrained by the social, economicand physical environment in which they live and theorganizational setting within which they work.Thus the failure of governments to provide adequate housingmay result in individual behaviour which is damaging to healthand can also lead directly to an increase in respiratory disease.In short, the social model sees health primarily as an issue for –and the responsibility of – society as a whole. Among otherthings, this means a collective responsibility for ensuring thatindividuals have every opportunity to adopt healthy lifestyles. 19
  • 20. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat By now it should be clear that the positive and social models of health are more likely to lead toan approach to health care in which top priority is given to prevention. Likewise, application of the principles of the negative and biomedical models will result in a curative approach. 21
  • 21. Health Models And Health System ModelsDr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatHealth Models (III)The Preventive and Curative Models of Health 21
  • 22. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatA- The Preventive Model of Health CareAdvocates of the preventive model:. Give pride of place to measures designed to reduce theincidence and prevalence of ill-health – for example,promotional campaigns, ensuring that people have access tothe prerequisites for health (adequate housing, satisfactory diet,etc.), screening, and vaccination and immunization. Argue for what has come to be called ‘healthy public policy’which means, in effect, making ‘healthy choices the easierchoices’ – for example, ensuring that healthy food is cheaper 22
  • 23. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatthan unhealthy, and creating environments in which it is difficultto smoke.. Emphasize the importance of mobilizing a wide range ofagencies such as academic institutions, voluntary organizationsand local authorities, and tapping as many different sources ofexpertise as possible, both professional and lay. See community settings, such as the home, schools andleisure centres, as the most significant locations for theprovision of health care 23
  • 24. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat. Stress the need for more epidemiological research, toenhance our understanding of the links between diseasepatterns and social factors in health and health care.There are a number of drawbacks, however.First, preventive strategies are more difficult to justify becauseof the long-term nature of the outcomes and uncertaintyregarding their effectiveness.For example, the effect of anti-smoking campaigns in primary schoolswill not be felt for several years, during which time many other factorswill play a part in influencing people’s smoking behavior 24
  • 25. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatSecond, the collaboration necessary when several professional groupsand agencies are involved in planning and implementing apreventive programme is extremely difficult to sustain inpractice and can easily lead to a dilution of responsibility.Last,prevention often raises people’s expectations to such an extentthat some will inevitably be disappointed. This is the case withpeople who, despite their healthy lifestyle, getting heartdisease. 25
  • 26. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatB-The curative model of health careThose who pledge the curative model take as their startingpoint the insights provided by the biomedical model andconcentrate on measures designed to cure disease.They:. Give pride of place to what are called, in the colourfullanguage sometimes used in this context, ‘magic bullets’(wonder drugs, heroic surgery, and other techniques). Focus on the treatment of individuals 26
  • 27. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat. Legitimize the central and dominant role played by cliniciansin the health care process. Regard hospitals as the principal delivery point for health careServices . place particular emphasis on research into thebiological causes of ill-health and methods for tackling themalfunctions referred to earlier.The overwhelming argument in favour of this approach is thatmany diseases and conditions can be successfully treatedthrough the application of science and technology. Moreover, inso doing, it has made a significant contribution to improving thehealth status and well-being of many people. 27
  • 28. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatNone the less, it is not without its drawbacks.For many conditions, particularly those which are currentlymajor causes of morbidity, such as lung cancer, cures haveremained vague.In addition, treatment is often very costly in financial terms andcarries with it risks, /‘iatrogenesis’ –At the same time, the curative approach has made only alimited contribution to improving the health status of thepopulation as a whole.This is reflected, in part, in the increasing demand for healthservices. 28
  • 29. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatModels of Health Care System According to According to Delivery Funding Methods Methods 29
  • 30. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Health System According to Funding Types All healthcare systems occupy a distinct place on the “publicversus private” continuum in terms of the financing and delivery ofhealthcare . Although distinctions blur, most systems tend topredominantly hold a (a) “national health service model,” (b)“entrepreneurial model,” or (c) “mandated insurance model.” 31
  • 31. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatA• Under a national health service (e.g. the United Kingdom and Spain), universal coverage is publicly financed through taxation. Healthcare delivery occurs via mostly public mechanisms; hospitals are publicly owned, and medical services are primarily delivered by government-salaried physicians .B• In an entrepreneurial model of healthcare (e.g. the United States), people voluntarily purchase employment-based or individual insurance, and the healthcare delivery mechanisms (providers and healthcare facilities) exist largely in the private sector. Financing can 31
  • 32. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat come from both private and public sources . Consumerist- commercial-capitalistC• Between these two extremes lies the mandated insurance model, in which compulsory universal coverage is publicly financed and health care is delivered by both public and private entities . Within this category, systems can be further classified as following a national health insurance/single-payer model (e.g. Sweden) or a multi-payer health insurance model that relies on sickness funds to provide universal health coverage (e.g. Germany and France) . 32
  • 33. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Another ClassificationHealth Systems Based on the Sources of Funding 33
  • 34. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatBased on the source of their funding, three main models of national healthcare systems can be distinguished: 1. the Beveridge model, 2. the Bismarck model 3. the Private Insurance model 34
  • 35. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 1-The Beveridge Model "Public Model" - “Socialized Medicine Model”The Beveridge "public" model was inspired by the William BeveridgeReport for social insurance presented in the English Parliament in 1942.Funding is based mainly on taxation and is characterized by a centrallyorganized National Health Service where the services are provided bymainly public health providers (hospitals, community GPs, specialists andpublic health services). 35
  • 36. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatIn this model, healthcare budgets compete with other spending priorities.The countries using this model, beside United Kingdom, are Ireland, Sweden,Norway, Finland, Denmark, Spain, Portugal, Italy, Greece, Canada andAustralia. Characteristics:  Healthcare is provided and financed by the government, through tax payments  There are no medical bills  Medical treatment is a public service  Providers can be government employees  Lows costs b/c the government controls costs as the sole payer 36
  • 37. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 2-The Bismarck Model "Mixed Model" - “Sickness Funds”The Bismarck „mixed” model was inspired by the 1883 GermanySocial Legislation and National Health Insurance Plan for workersintroduced by Otto von Bismark, the Chancellor of Germany. Fundsare provided mainly by premium-financed social/mandatory insuranceand, beside Germany, is found in countries such as France,Switzerland, Japan, Central and South East European (CSEE) 37
  • 38. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatcountries and Former Soviet Union (FSU) countries. Also Japan hasa premium-based mandatory insurance funds system. This modelresults in a mix of private and public providers, and allows moreflexible spending on healthcare. Characteristics:  Providers and payers are private  Private insurance plans – financed jointly by employers and employees through payroll deduction  The plans cover everyone and do not make a profit  Tight regulation of medical services and fees (cost control) 38
  • 39. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 3-The Private Insurance Model The „private” insurance model is also known as the model of„independent customer”. Funding of the system is based onpremiums, paid into private insurance companies, and in its pure formactually exists only in the USA. In this system, the funding is predominantly private, with theexception of social care through Medicare and Medicaid. The greatmajority of providers in this model belong to the private sector. 39
  • 40. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 4-(!) Out-of-Pocket Model There is also a 4 th type of health system ( No System !!!!) called" the out-of-pocket-model!!! Only the developed, industrialized countries -- perhaps 40 ofthe worlds 200 countries -- have established health care systems.Most of the nations on the planet are too poor and too disorganized toprovide any kind of mass medical care. The basic rule in suchcountries is that the rich get medical care; the poor stay sick or die. 41
  • 41. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatIn rural regions of Africa, India, China and South America, hundredsof millions of people go their whole lives without ever seeing a doctor.They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease. Characteristics:  Only the rich get medical care; the poor stay sick or die  Most medical care is paid for by the patient, out-of-pocket  No insurance or government plan 41
  • 42. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat What is the best System? All models of health care systems are imperfect and there isno a odel which is the best and broadly accepted andrecommended. There are big differences among countries inrelation to the goals, structure, organization, finance and theother characteristics of the health care systems. These differences are influenced by history, traditions,socio-cultural, economic, political and other factors. But,regardless of all present differences, there are same commoncharacteristics, typical for all organized health care systems 42
  • 43. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatHealth Care Delivery System There is no perfect healthcare delivery system for a country.Some models seem to work better than others but each has its own advantages and drawbacks. Broadly, healthcare delivery models could be classified under tiered system or diffuse system. 43
  • 44. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefata- The Tiered SystemThe tiered system is made up of regionalized systems of healthcaredelivery divided into Primary care, Secondary care and Tertiarycare. Such a pyramidal system is more common in UK and in HMOs(Health Maintenance Organizations) in US.a- Primary care Refers to the activities concerned with prevention and treatment ofcommon medical problems in outpatient setting. Care is delivered byprimary care practitioners (PCPs) in the US or general practitioners 44
  • 45. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat(GPs) in the UK. A PCP could be responsible for 2000-3000 patientsand is responsible for managing patient’s overall care.b- Secondary care Concerns with treatment of disorders requiring specialist opinion or hospitalization. The patients are usually referred from Primary care and the physicians are affiliated to a hospital or a group practice.c- Tertiary care Provides medical and/or surgical management of complex disorders in an inpatient setting and usually requiring collaboration between multiple specialties. These are super- specialized standalone hospitals or specialty departments in a multi-specialty hospital. 45
  • 46. Health Models And Health System ModelsDr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 46
  • 47. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatSelf Care ( Nonprofessional care ): Self care is nonprofessional care. It is performed within thefamily, and the population group counts from one to 10 persons. Self-care implies largely unorganized health activities and health-related decision-making carried out by individuals, families,neighbors, friends and workmates. These include the maintenance ofhealth, prevention of disease, self-diagnosis, self-treatment, includingself-medication, and self-applied follow- up care and social support tothe sick and weak members of the family after contact with the healthservices 47
  • 48. Health Models And Health System ModelsDr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 48
  • 49. Health Models And Health System ModelsDr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 49
  • 50. Health Models And Health System ModelsDr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 51
  • 51. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatb- Diffuse SystemIn the diffuse system there is no such division. In this system patientscan directly approach specialists without consulting GPs or PCPsfirst. The boundaries between GPs, internists, family practitioners andpediatricians are blurred. Many internal medicine specialists provideprimary care, many family practitioners provide secondary care.The diffuse system is the relatively more common in United States. Itis a diamond type of system with most hospitals providing a mix ofmulti-specialty secondary and tertiary services. The stress is ongetting the latest technology and advanced clinical care closer tohome. 51
  • 52. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Outpatient CareOutpatient care is very important part of the health care systemrepresenting the first contact of the consumer with theprofessional health care and the first step of a continuoushealth care.Such kind of services and institutions might be a part of thehospital, community health center or certain polyclinic 52
  • 53. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatand dispensaries In-patient care and institutionsIn-patient/hospital care means admission into hospital or otherstationary health organization, including diagnosis, treatmentand rehabilitation, with in-patient care and treatment of the mostseverely ill patients who cannot be treated in ambulatory-polyclinic institutions or at home.Hospitals are institutions whose primary function is to providediagnostic and therapeutic medical, nursing, and other 53
  • 54. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatprofessional services for patients in need of care for medicalconditions. Hospitals have at least six beds, an organized staffof physicians, and continuing nursing services under thedirection of registered nurses. The WHO considers anestablishment a hospital if it is permanently staffed by at leastone physician, can offer in-patientaccommodation, and can provide active medical and nursingcare . 54
  • 55. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatClassification of hospitalsHospitals are classified in several ways: length of stay, type ofservice, and type of control or ownership, as well as size of thehospitalLength of stay is divided into acute care (short term) andchronic care (long term). Acute care (of short duration orepisodic) is a synonym for short term. Chronic care (or longduration) is a synonym for long term hospitals. 55
  • 56. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatTypes of service denote whether the hospital is „general” or„special”.A third classification divides hospitals by type of control orownership: for profit (investor owned), or not for profit,governmental (federal, state, local, or hospital authority),religious or voluntary organizations. 56
  • 57. Health Models And Health System ModelsDr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat International Health Care Systems 57
  • 58. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat GREAT BRITAIN Insured :100% of population insured Spending:7.5% of GDP Funding —Single payer system funded by general revenues (National Health System); operates on huge deficit Private Insurance —10% of Britons have private health insurance —Similar to coverage by NHS, but gives patients access to higher quality of care and reduce waiting times Physician Compensations —Most providers are government employees 58
  • 59. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Physician Choice —Patients have very little provider choice Copayment/Deductibles —No deductibles —Almost no copayments (prescription drugs) Waiting Times —Huge problem Benefits Covered —Offers comprehensive coverage —Terminally ill patients may be denied treatment 59
  • 60. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat CANADA Insured —Single payer system – 100% insured —Each province must make insurance:  Universal (available to all)  Comprehensive (covers all necessary hospital visits)  Portable (individuals remain covered when moving to another province)  Accessible (no financial barriers, such as deductible or copayments)  61
  • 61. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Funding —Federal government uses revenue to provide a block grant to the provinces (finances 16% of healthcare) —The remainder is funded by provincial taxes (personal and corporate income taxes) Spending —9% of GDP Private Insurance —At one time all private insurance was prohibited; changed in 2005 —Many private clinics now offer services on the black market Physician Compensation 61
  • 62. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat —Physicians work in private practice —Paid on a fee-for-service basis —These fees are set by a centralized agency; makes wages fairly low Physician Choice —Referrals are required for all specialist services except the ED Copayment/Deductibles —Generally no copayments or deductibles —Some provinces do charge insurance premiums Waiting Times —Long waiting lists —Many travel to the U.S. for healthcare 62
  • 63. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat FRANCE• Insured – About 99% of population covered• Cost rd – 3 most expensive health care system – 11% of GDP• Funding – 13.55% payroll tax (employers pay 12.8%, individuals pay 0.75%) – 5.25% general social contribution tax on income – Taxes on tobacco, alcohol and pharmaceutical company revenues 63
  • 64. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat• Private Insurance – “more than 92% of French residents have complementary private insurance” – These funds are loosely regulated (less than U.S.); the only requirement is renewability – These benefits are not equally distributed (creates a two- tiered system)• Physician Compensation – Providers paid by national health insurance system based on a centrally planned fee schedule – fees are based on an upfront treatment lump sum (similar to DRGs in US) 64
  • 65. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat – However, doctors can charge whatever they want – The patient or the private insurance makes up the difference – Medical school is free – Legal system is fairly tort averse• Physician Choice – Fair amount of choice in the doctors they choose• Copayment/Deductible – 10% to 40% copayments• 65
  • 66. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat• Waiting Times – Very little waiting lists/times• Technology – Government does not reimburse new technologies very generously – Little incentive to make capital investments in medical technology 66
  • 67. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat GERMANY• Insured – 99.6% of population – sickness funds – Those with higher incomes can buy private insurance – The federal gov. decides the global budget and which procedures to include in the benefit package• Funding – Sickness funds are financed through a payroll tax (avg. 15% of income) – The tax is split between the employer and employee• Private insurance – 67
  • 68. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat – 9% of Germans have supplemental insurance; covers items not paid for by the sickness funds – Only middle- and upper-class can opt out of sickness funds• Physician Compensation – Reimbursement set through negotiation with the sickness funds – Providers have little negotiating power – Very low compensation – Significant reimbursement caps and budget restrictions Copayment/Deductibles —Almost no copayments or deductibles 68
  • 69. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Technology —Low technology compared to U.S. Waiting Times —WHO reported that “waiting lists and explicit rationing decisions are virtually unknown” Benefits Covered —There is an extensive benefit package which even includes sick pay (70% to 90% of pay) for up to 78 weeks 69
  • 70. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat JAPAN Insured —Universal health insurance based around a mandatory, employment-based insurance —“The Employee Health Insurance Program” requires that all companies with 700 or more employees to provide workers with health insurance —Small business workers join a government-run small business national health insurance plan —The self-employed and the retired are covered by Citizens Insurance Program administered by municipal governments 71
  • 71. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Costs —Not as high as U.S.; average household spends $2300 per year on out-of-pocket costs —Japans have a healthy lifestyle – lower incidence of disease Funding —8.5% (large business) or an 8.2% (small business) payroll tax —Payroll taxes are split almost evenly between employer and employee —Those who are self-employed or retired must pay a self- employment tax 71
  • 72. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Private Insurance —Very rare for Japanese to use this; less than 1% JAPAN Physician Compensation —Hospital physicians are salaried —Non-hospital physicians are paid on a fee-for-service basis —Hospitals and clinics are privately owned but the government sets the fee schedule Physician Choice —No restrictions on physician or hospital choice —No referral requirements Copayment/Deductibles 72
  • 73. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat —Copayments are 10% to 30% —Capped at $677 per month for the average family Technology —High levels of technology; comparable to U.S. Waiting Times —Significant problem at the best hospitals b/c they cannot charge higher prices  Comparison of Global Healthcare by Rand Corporation UNIVERSAL LAWS OF HEALTHCARE SYSTEMS No matter how good the healthcare in a particular country people will complain about it No matter how much money is spent on healthcare, the doctors and hospitals will argue that it is not enough 73
  • 74. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat The last reform always failed - Tsung-mei Cheng, an American economist  5 MYTHS ABOUT HEALTH CARE AROUND THE WORLD 1. It’s all socialized medicine out there  Many countries provide universal coverage using private providers, hospitals and insurance plans 2. Overseas, care is rationed through limited choices or long lines – some truth. 3. Foreign health systems are inefficient, bloated bureaucracies 74
  • 75. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 4. Cost control stifles innovation  False. This pressure to control cost can generate innovation 5. Health insurance companies have to be cruel  Insurance plans in other countries accept all applicants  Cannot deny on the presence of a preexisting condition  Cannot cancel as long as you pay your premium  U.S. HEALTHCARE: COST DRIVERS Drugs and devices Defensive medicine 75
  • 76. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Demands —Patient related —Physician related---? Fee for service! Administrative costs Market driven healthcare COST MANAGEMENT Evidence based medicine Use of protocol and guidelines Reduction of administrative costs Managing demand Management of chronic diseases Promotion of healthier living Tort Reform 76
  • 77. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat U.S.A In United States, the healthcare administration is largelyoutside the governmental control. This leaves hospitalcapacity regulation, residency seat allocation andcoordination of care in the hands of private entities. The physician groups control the policy, occupationalstandards and entry requirements for licensing. So theirprofessional interests and favor for technology and inpatientcapacity also led to expansion of hospital facilities. 77
  • 78. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Over the last few decades, the healthcare hasincreasingly been delivered at hospitals rather than physicianoffices. With emerging consumer driven healthcare modelsand advanced surgical techniques, there is a gradual shifttowards Ambulatory Clinics. This will introduce newer modelsof healthcare delivery.  The United States has a unique system of health care delivery.  The US health care delivery system is complex and massive. 78
  • 79. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat In contrast to the United States, most developed countries have national health insurance programs  referred to as “universal access” • provide routine and basic health care • run by the government and financed through general taxes. All Americans are not “entitled” to routine and basic health care services. 79
  • 80. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat 187.4 million Americans have private healthinsurance coverage,  Health insurance can be bought from:  1,000 health insurance companies  70 BlueCross/BlueShield plans  The managed care sector includes approximately: 540 licensed health maintenance organizations (HMOs) 925 preferred provider organizations (PPOs) 81
  • 81. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefatVulnerable Populations  Particularly the poor, uninsured, minorities and immigrants  live in disadvantaged communities and receive care from “safety net” providers.Vulnerable Populations  Safety nets are not secure  Provider type and availability vary  Some individuals give up care and seek hospital emergency services if nearby 81
  • 82. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Characteristics Of The U.S. Health Care System No Central Governing Agency;  Little Integration and Coordination  Technology-Driven and Focuses on Acute Care High on cost, Unequal in Access, and Average in Outcomes Imperfect Market Conditions Government as Subsidiary to the Private Sector No Central Governing Agency;  Little Integration and Coordination 82
  • 83. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat The US system is different from other developed countries  It is not centrally-controlled • Central systems are less complex, less costly  Has different payment, insurance, and delivery mechanisms  Health care is financed both publicly and privately Technology-Driven and Focuses on Acute Care 83
  • 84. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat What is good about USA system? US is responsible for more than 53% of Drug Research Dollars Best Medical Education and Training in the World Eight of the top 10 medical Advances in the past 20 years was developed in the US Nobel Prizes in Medicine have been awarded to more Americans than to researchers in all other countries combined Eight of the 10 top-selling drugs are made in the US We have the highest breast, colon, and prostate cancer survival rates in the world 84
  • 85. Health Models And Health System Models Dr. Ahmed-Refat AG Refat (Nov. 2012) www.SlideShare.net/AhmedRefat Cited References1. WHO. Measurement of Levels of Health. Geneva, Switzerland: WHO; 1957.2. World Health Organization (WHO), European Regional Office. Ottawa Charter for Health Promotion. Copenhagen, Denmark: WHO; 1986.3. Lester Breslow, Health Measurement in the Third Era of Health. Am J Public Health. January; 96(1): 17–19. 20064. Elizabeth A. www.ololcollege.edu5. HEALTH SYSTEMS AND THEIR EVIDENCE BASED DEVELOPMENT. VESNA BJEGOVI] AND DON^O DONEV(editor). Hans Jacobs Publishing Comany20046. Roger Ottewill and Ann Wall . Models of health and health care. Crwon 20047. Sibu Saha, HEALTHCARE MODELS ACROSS THE GLOBE A COMPARATIVE ANALYSIS. Harvard University 85

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