The document discusses health care reforms and the evolution of health care systems. It covers objectives of health care reforms such as expanding coverage and access to care. A major goal is providing better health care protection for more people at lower cost. Issues discussed include unequal distribution of health care resources between rural and urban areas, difficulties accessing care due to geographic, socioeconomic and gender factors, and how economic inequality affects health outcomes. The growth of the private health care sector is also addressed as adding to social inequities in access to affordable, quality care.

1. HEALTH CARE REFORMS

2. Health care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place.

3. OBJECTIVESBroaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies

4. Expand the array of health care providers

5. Improve the access to health care specialists

6. Improve the quality of health care

7. Give more care to citizens

8. Decrease the cost of health careMAJOR GOALGetting better/ more health care protection for as many people as possible at the lowest possible cost.

9. EVOLUTION OF HEALTH CARE CHANGES

10. MEDICINE IN ANTIQUITY.DAWN OF SCIENTIFIC MEDICINEMODERN MEDICINE

11. MEDICINE IN ANTIQUITY.In ancient times, health and illness were interpreted in a cosmological and anthropological perspective. Medicine was dominated by magical and religious beliefs which were an integral part of ancient cultures and civilizations.

12. 1. PRIMITIVE MEDICINEEvidence from cave art, daring back at least 30,000 years, suggests caves were used for magical ritual purposes. Shamans were considered as the head of conducting rituals

13. Primitive medicine frequently performed a type of brain surgery that we today call trephination. Trephination was done by using stone instruments to bore or grind holes in the skull

16. 2. TRIO INDIAN MEDICINE

17. AYURVEDA: The practicals fields of Ayurveda are divided into eight sections or branches. These sections are: internal medicinal, surgery, cranial organo medicine, pediatrics, toxicology, rejuvenating remedy, aprodisiac remedy and spiritual healing. These eight sections are called "AstangaAyurveda.

21. SIDDHA MEDICINE. The Siddha medicine is a form of south Indian Tamil traditional medicine and part of the trio Indian medicines - ayurveda, siddha and unani. This system of medicine was popular in ancient India. The system is believed to be developed by the 18 siddhas in the south called siddhar.

24. UNANI MEDICINE. Unani-tibb or Unani Medicine its origin to Greece. It was the Greek philosopher - Physician Hippocrates (460-377 BC) who freed Medicine from the realm of susperstition and magic, and gave it the status of Science. The theoretical framework of Unani Medicine is based on the teachings of Hippocrates

27. Chinese medicine

30. Egyptian medicine.

32. Mesopotamian medicine

34. Greek medicineThe Greeks taught men to think in terms of why and how. The medical historian, Douglas Guthrie has reminded us of the legend that Hygiea was worshipped as the goddess of health and Panacea as the goddess of medicine. Panacea and Hygiea gave rise to dynasties of healers (curative medicine) and hygienists (preventive medicine) with different philosophies. Greatest physician in Greek medicine was Hippocrates who is often called as the father of medicine.

35. Roman medicineII. DAWN OF SCIENTIFIC MEDICINE

36. Revival of medicine

37. Sanitary awakening

38. Rise of public health

39. Germ theory of disease

40. Birth of preventive medicineFlorence nightinagle.

41. GERM THEORY

42. GERM THEORY OF DISEASE-LOUIS PASTEUR

43. III. MODERN MEDICINECurative medicine

44. Preventive medicine

45. Social medicineCHANGING CONCEPTS IN PUBLIC HEALTH.Disease control phase(1880-1920)

46. Health promotional phase(1920-1960)

47. Social engineering phase.

48. Health for all phaseHEALTH CARE REFORMS IN INDIA

49. 1. COMPREHENSIVE CARE

50. The Bhore committee (1946)defined comprehensive health care as the following criteria. Provide adequate preventive, curative and promotive health services.Be as close to the beneficiaries as possible.Widest cooperation between the people, the service and the profession. Is available to all irrespective of their ability to payLook after specifically the vulnerable and weaker sections of the community.Create and maintain healthy environment both in home as well as working places.

51. 2. BASIC HEALTH SERVICES.

52. A basic health service is understood to be a network of coordinated, peripheral and intermediate health units capable of performing effectively a selected group of functions essential to the health of an area and assuring the availability of competent personnel and auxiliary personnel to perform these functions.

53. 3. PRIMARY HEALTH CARE

54. Before Alma Ata primary health care was regarded as synonymous with basic health services, first contact care, easily accessible care , services provided by generalist…

55. The Alma-Ata international conference gave primary health care a wider meaning Primary health care is essential health care made universally accessible to individuals and acceptable to them , through their full participation and at a cost the community and country can afford. Principles of Primary health care.Equitable distribution.

56. Community participation.

57. Inter sectoral coordination

58. Appropriate technologyHEALTH FOR ALLIn 1977, it was decided in the World Health Assembly to launch a movement known as health for all by the year 2000. The fundamental principle of HFA strategy is equity that is an equal health status for people and countries ensured by an equitable distribution of health resources. CONTI…

59. In 1978, Alma Ata international conference on Primary health care reaffirmed Health for all as the major social goals of the Governments and stated that the best approach to achieve the goal of HFA is by providing primary health care, especially to the vast majority of underserved rural areas.

60. In 1981, a global strategy for HFA was evolved by WHO. The global strategy provides a global framework that is broad enough to apply to all Member states MILLENIUM DEVELOPMENT GOALS.September 2000, representatives from 189 countries met at the millennium summit in Newyork, to adopt the United Nations Millenium Declaration.Goals :Area of development and eradication of poverty.

61. ISSUES IN HEALTH CARE REFORMS.

62. 1. UNEQUAL DISTRIBUTION OF HEALTHCARE RESOURCES INDIA.

63. The ratio of hospital beds to population in rural areas is fifteen times lower than that for urban areas.

64. The ratio of doctors to population in rural areas is almost six times lower than that in the urban population.

65. Per capita expenditure on public health is seven times lower in rural areas, compared to government health spending for urban areas. The most peripheral and most vital unit of India’s public health infrastructure is a primary health centre (PHC).

66. In a recent survey it was noticed that only 38% of all PHCs have all the essential manpower and only 31% have all the essential supplies (defined as 60% of critical inputs), with only 3% of PHCs having 80% of all critical inputs.Though the spending on healthcare is 6% of gross domestic product (GDP), the state expenditure is only 0.9% of the total spending. People using their own resources spend rest of it. This makes the Indian public health system grossly inadequate and under-funded.

67. Only five other countries in the world are worse off than India regarding public health spending (Burundi, Myanmar, Pakistan, Sudan, Cambodia). As a result of this dismal and unequal spending on public health, the infrastructure of health system itself is becoming ineffective. 2. ACCESS DIFFICULTIES TO HEALTH CARE.

68. Geographical distance

69. Socio-economic distance

70. Gender distanceSocioeconomic distanceA different aspect of healthcare access problem is noticed in cases of ‘urban poor’.

71. Urban residents are extremely vulnerable to macroeconomic shocks that undermine their earning capacity and lead to substitution towards less nutritious, cheaper foods.