The document summarizes health reforms in Mexico from 1943-2004, with a focus on the 2004 reform that established the Health Social Protection System. It overviews declining mortality rates and increasing life expectancy over time. Key aspects of the 2004 reform included establishing universal health care coverage, separating financing from service provision, defining an essential benefits package, and increasing accountability through performance measurement. The reform reorganized Mexico's health system to improve access, quality, and financial protection for all citizens.
Research done while in PwC Mexico. A short version was included as part of a PwC publication "Future of Pacific Alliance", that was presented at the presidental summit in Chile on July 2016.
The document summarizes the current state of universal health insurance in the United States. It discusses the fragmented nature of today's health care system and statistics on the uninsured. Research studies show that a universal single-payer system could cover all Americans for less money by reducing administrative costs. The document also briefly reviews universal health care systems in other countries like the UK, Germany, Japan, and Canada. It concludes by suggesting a universal system may be more achievable in the US than commonly believed.
Higher incomes are associated with longer life expectancy in the United States. This study analyzed tax and mortality data from 1999-2014 to examine the relationship between income and life expectancy. The key findings were:
1) The gap in life expectancy between the richest and poorest was 14.6 years for men and 10.1 years for women.
2) Income inequality in life expectancy increased over time, with those in the top 5% of incomes seeing larger gains in life expectancy than those in the bottom 5%.
3) Life expectancy varied substantially across local areas for low-income individuals, differing by up to 4.5 years between areas.
4) Differences in life expectancy across areas were correlated with
The document discusses Mexico's healthcare system and reforms to expand coverage. It notes that in 2003, Mexico passed legislation to establish universal healthcare coverage through the System of Social Protection in Health. This created Seguro Popular public insurance to cover the poor and informal sector workers. The goal was to achieve universal coverage by 2010. However, challenges remain around unequal access, financing, and health outcomes between states due to socioeconomic factors. Improving insurance programs and consolidating the system is needed to address these issues.
Single Payer Systems: Equity in Access to Caresoder145
Presentation by Lynn Blewett at "The True Workings of Single Payer Systems: Lessons or Warnings for U.S. Reform' conference sponsored by the Journal of Health Politics Policy and Law, May 10 2008.
The United States health care system is a multi-payer system with both private and public insurance plans. About 62% of Americans receive health insurance through their employers, while 18% are uninsured. Major public programs include Medicare for the elderly and disabled, Medicaid for low-income individuals, and the State Children's Health Insurance Program. These programs are financed through taxes and premiums paid by individuals, businesses, and various levels of government. While the U.S. spends more on health care than any other country, many Americans remain uninsured, costs are very high, and the system ranked 37th globally in 2000. Recent health reform aims to expand coverage and regulate insurers.
Used for Medical Grand Rounds at several hospitals, this is data based comprehensive review of the shortcomings of the American Medical System and dysfunctional political attempts at reform. Single payer, Medicare for all, with elimination of for profit insurance companies is the best answer.
This presentation discusses the history and key aspects of universal healthcare in the United States. It covers major healthcare programs and reforms over time like Medicare, Medicaid, and the Affordable Care Act. Key points of the ACA are explained, such as the individual mandate, health insurance exchanges, Medicaid expansion, and new regulations for insurance companies. The presentation also addresses criticisms around the cost of universal coverage and impacts on taxpayers, employers, and immigrants.
Research done while in PwC Mexico. A short version was included as part of a PwC publication "Future of Pacific Alliance", that was presented at the presidental summit in Chile on July 2016.
The document summarizes the current state of universal health insurance in the United States. It discusses the fragmented nature of today's health care system and statistics on the uninsured. Research studies show that a universal single-payer system could cover all Americans for less money by reducing administrative costs. The document also briefly reviews universal health care systems in other countries like the UK, Germany, Japan, and Canada. It concludes by suggesting a universal system may be more achievable in the US than commonly believed.
Higher incomes are associated with longer life expectancy in the United States. This study analyzed tax and mortality data from 1999-2014 to examine the relationship between income and life expectancy. The key findings were:
1) The gap in life expectancy between the richest and poorest was 14.6 years for men and 10.1 years for women.
2) Income inequality in life expectancy increased over time, with those in the top 5% of incomes seeing larger gains in life expectancy than those in the bottom 5%.
3) Life expectancy varied substantially across local areas for low-income individuals, differing by up to 4.5 years between areas.
4) Differences in life expectancy across areas were correlated with
The document discusses Mexico's healthcare system and reforms to expand coverage. It notes that in 2003, Mexico passed legislation to establish universal healthcare coverage through the System of Social Protection in Health. This created Seguro Popular public insurance to cover the poor and informal sector workers. The goal was to achieve universal coverage by 2010. However, challenges remain around unequal access, financing, and health outcomes between states due to socioeconomic factors. Improving insurance programs and consolidating the system is needed to address these issues.
Single Payer Systems: Equity in Access to Caresoder145
Presentation by Lynn Blewett at "The True Workings of Single Payer Systems: Lessons or Warnings for U.S. Reform' conference sponsored by the Journal of Health Politics Policy and Law, May 10 2008.
The United States health care system is a multi-payer system with both private and public insurance plans. About 62% of Americans receive health insurance through their employers, while 18% are uninsured. Major public programs include Medicare for the elderly and disabled, Medicaid for low-income individuals, and the State Children's Health Insurance Program. These programs are financed through taxes and premiums paid by individuals, businesses, and various levels of government. While the U.S. spends more on health care than any other country, many Americans remain uninsured, costs are very high, and the system ranked 37th globally in 2000. Recent health reform aims to expand coverage and regulate insurers.
Used for Medical Grand Rounds at several hospitals, this is data based comprehensive review of the shortcomings of the American Medical System and dysfunctional political attempts at reform. Single payer, Medicare for all, with elimination of for profit insurance companies is the best answer.
This presentation discusses the history and key aspects of universal healthcare in the United States. It covers major healthcare programs and reforms over time like Medicare, Medicaid, and the Affordable Care Act. Key points of the ACA are explained, such as the individual mandate, health insurance exchanges, Medicaid expansion, and new regulations for insurance companies. The presentation also addresses criticisms around the cost of universal coverage and impacts on taxpayers, employers, and immigrants.
The document summarizes a presentation on comparing the US healthcare system to other countries. It begins with defining terms like OECD, healthcare systems, and analytic methods. It then discusses the evolution of healthcare systems in OECD countries after World War II, with European nations adopting universal coverage through national systems while the US relied on employer subsidies. The presentation outlines different healthcare models - National Health Service, National Health Insurance, and mixed private/public systems - and provides examples from countries like the UK, which has a National Health Service funded mainly through taxes.
Syn cing chronic disease advocacy greewaldhealthhiv
The document discusses health care reform opportunities and challenges for people living with HIV/AIDS. It outlines the current access to care crisis, including high rates of uninsured individuals with HIV/AIDS and limited Medicaid access in most states. It then describes major opportunities created by health care reform, such as expanded Medicaid eligibility, enhanced Medicaid care coordination, increased access to Medicare prescription drugs, private insurance market reforms, and new investments in prevention and care delivery. Finally, it discusses key challenges in ensuring these opportunities translate into real benefits for people with HIV/AIDS.
The health care debate - up to date as of June 15, 2017
1) Health care troubles, 2) ACA accomplishments and problems, 3) 20 AHCA characteristics and problems, 4) Single payer as solution
The document discusses key concepts for measuring universal health coverage, including population coverage, service coverage, and financial risk protection. It provides an example of how benefit incidence analysis (BIA) and financing incidence analysis (FIA) were used in an empirical study in Ghana to assess how the benefits of health services and the financing of healthcare were distributed across socioeconomic groups. The study analyzed data from a national survey to examine progressivity and determine if the distribution of benefits and financing aligned with populations' needs.
This document summarizes several health issues in California presented by different students. It discusses food insecurity in San Francisco, including challenges like lack of grocery stores and transportation that contribute to the problem. It also covers genetically modified foods and debates around labeling in California. Additionally, it summarizes issues with the prison healthcare system in California like overcrowding and outdated resources that increase costs. Finally, it outlines conflicts between California and federal laws around medical marijuana.
Healthcare oligopoly is Affecting u.s. economy convertedRoyJMeidinger
The document provides an overview of rising healthcare costs and declining outcomes in the United States compared to other developed nations. It notes that while the US spends much more per capita on healthcare, it has lower life expectancy and rates of preventable deaths than peers. The high costs are driven by administrative waste, high prices, and lack of cost control. The document argues that healthcare costs are a major burden on the US economy and individuals, and that reforms are needed to reduce costs while improving access and outcomes for all Americans.
$10.58 $10.00
Licensed Nurse: $21.00 $19.10
Administrator: $41.00 $36.30
Sources: Janis O’Meara and Charlene Harrington, University of California, San Francisco. Calculations using the Office of
Statewide Health Planning and Development’s long-term care annual financial data for 2001 and 2003.
< R E T U R N T O C O N T E N T S
California’s Fragile
Nursing Home Industry
In 2001, only 5 percent of
California nursing homes
met or exceeded the national
average for quality of care
as measured by the federal
government’s five-
The document discusses the crisis facing California's nursing home system, including a rapidly aging population that will double the number of seniors over 65 by 2025. Many nursing homes already struggle with inadequate staffing and budgets. High staff turnover contributes to poor quality of care in most homes, as evidenced by weight loss, residents left in bed, and physical restraints used on some residents. Additionally, 78% of nursing homes had violations of federal regulations during inspections in 2002. The growing senior population will increase the demand for long-term care services that the current system is ill-equipped to handle.
A seminar with Walid Ammar, MD, PhD, Director General, Ministry of Public Health of Lebanon; Professor, The Lebanese University; Senior Lecturer, American University of Beirut.
Moderated by Melani Cammett, Professor of Government, Harvard University.
North Coast Breast Health Community Assessment: Needs, Assets and Opportunities Dolly England
This document provides a needs assessment of breast health resources in Oregon's North Coast counties, with a focus on Columbia County. It finds that Columbia County has limited breast cancer resources, including a single mammography site, no dedicated coordinator for a program assisting low-income women, and limited educational materials. However, the county also has access to Oregon's only mobile mammography van. The assessment provides data on demographics, poverty levels, driving times to mammography sites, and identifies organizations in the breast health network for each county. It aims to use these findings to improve outreach and reduce cancer disparities in these rural communities.
Describe rationale for free care in Providence Rhode Island, the mission and aims of the Clinica Esperanza / Hope Clinic, the current patient demographics, and plans for the future.
The document discusses challenges and opportunities for applying operations research (O.R.) principles to healthcare systems in emerging countries. It outlines several key issues facing healthcare delivery in these countries, including growing wealth and health disparities between urban and rural areas, increasing rates of non-communicable diseases, lack of health insurance coverage for most populations, and antiquated infrastructure. It then provides examples of how O.R. has been applied to healthcare projects in some low-income countries to improve monitoring, evaluation and resource allocation. Finally, it proposes a roadmap for applying O.R. in emerging country healthcare, focusing on improving access to medical supplies and products, hospital/clinic efficiency, disease prevention programs, public health emergencies, health
A single-payer healthcare system would cause further inefficiencies and be an economic burden for the United States. While increasing access to care, a single-payer system would lead to longer wait times like in Canada where 27% of people wait over 4 months for procedures compared to only 5% in the US. It would also decrease quality of care as seen in Canada where doctors are overworked and underpaid. Implementing such a system would require a tax increase of over 150% which would cripple the US economy, as seen when Vermont explored a single-payer plan. Competition in healthcare markets leads to lower costs and higher quality unlike a single-payer system, making it a step backwards for US healthcare.
The document discusses the problems with the current US healthcare system, including the large number of uninsured and underinsured Americans, high costs, and lower quality of care compared to other developed nations. It argues for a universal single-payer healthcare system that would provide comprehensive coverage to all Americans with no out-of-pocket costs, funded through taxes and savings from reduced administrative overhead. A single-payer system could save over $200 billion per year currently spent on private health insurance bureaucracy and lower drug and care costs through collective bargaining.
This document summarizes a research article that tested the hypothesis that HIV prevalence is not associated with governance. The researcher used governance data from the World Bank across six dimensions for 149 countries with UNAIDS HIV prevalence estimates from 2002. When countries were divided into three groups based on mean governance scores, the median HIV prevalence was lower (0.2%) for countries with higher mean governance compared to 0.7% and 0.75% for countries with lower and middle mean governance scores, despite improvements in other health and economic indicators. The results rejected the hypothesis and showed HIV prevalence is significantly associated with poor governance.
The document discusses health insurance rates and demographics in Pennsylvania counties. It analyzes data from the US Census Bureau and other sources, finding that while Latino populations increased substantially in some counties from 2000-2010, the change in uninsured rates for those counties was statistically insignificant. An analysis of various county health and demographic variables also found little correlation between Latino population percentages and uninsured rates at the county level in Pennsylvania.
This document discusses universal health care in the United States and its potential effects on society. It first defines universal health care as a system that provides health insurance to all citizens. It then compares the systems in other countries like Canada, Great Britain, and Germany. In the US, over 45 million people are uninsured despite health care being declared a basic right. The document outlines several potential effects of universal health care on employment, government spending, households, and the economy. Both pros and cons are discussed. In conclusion, it states that most cannot afford treatment without insurance and increasing costs may raise the uninsured population.
The document explores implementing mandatory advance health care directives for Medicare beneficiaries as a strategy to reduce astronomical end-of-life medical costs. It notes that without changes, Medicare spending could grow to over 1/3 of GDP by 2030 as baby boomers age. Advance directives allow people to outline their end-of-life wishes in case they become incapacitated. The document argues this could help control costs by limiting unnecessary or unwanted intensive end-of-life treatments for the 5% of Medicare beneficiaries who account for 30-35% of total spending in their final year. It also examines the political and economic implications of making advance directives mandatory for all Medicare recipients.
Presentation Fam Med Masters Seminar Apr 25 07briefJanet2007
The document discusses the impact of poverty on health. It provides background on poverty and health indicators in Canada, showing that those in poverty experience higher rates of chronic disease, infant mortality, lower life expectancy, and worse mental and physical health overall. It suggests that poverty, through factors like inadequate income for nutrition and housing, is the main determinant of these health inequities. The document proposes ways for health providers to help address poverty, such as by expanding assessments of social/economic barriers patients face and connecting them to resources to improve their situations.
The document summarizes a presentation on comparing the US healthcare system to other countries. It begins with defining terms like OECD, healthcare systems, and analytic methods. It then discusses the evolution of healthcare systems in OECD countries after World War II, with European nations adopting universal coverage through national systems while the US relied on employer subsidies. The presentation outlines different healthcare models - National Health Service, National Health Insurance, and mixed private/public systems - and provides examples from countries like the UK, which has a National Health Service funded mainly through taxes.
Syn cing chronic disease advocacy greewaldhealthhiv
The document discusses health care reform opportunities and challenges for people living with HIV/AIDS. It outlines the current access to care crisis, including high rates of uninsured individuals with HIV/AIDS and limited Medicaid access in most states. It then describes major opportunities created by health care reform, such as expanded Medicaid eligibility, enhanced Medicaid care coordination, increased access to Medicare prescription drugs, private insurance market reforms, and new investments in prevention and care delivery. Finally, it discusses key challenges in ensuring these opportunities translate into real benefits for people with HIV/AIDS.
The health care debate - up to date as of June 15, 2017
1) Health care troubles, 2) ACA accomplishments and problems, 3) 20 AHCA characteristics and problems, 4) Single payer as solution
The document discusses key concepts for measuring universal health coverage, including population coverage, service coverage, and financial risk protection. It provides an example of how benefit incidence analysis (BIA) and financing incidence analysis (FIA) were used in an empirical study in Ghana to assess how the benefits of health services and the financing of healthcare were distributed across socioeconomic groups. The study analyzed data from a national survey to examine progressivity and determine if the distribution of benefits and financing aligned with populations' needs.
This document summarizes several health issues in California presented by different students. It discusses food insecurity in San Francisco, including challenges like lack of grocery stores and transportation that contribute to the problem. It also covers genetically modified foods and debates around labeling in California. Additionally, it summarizes issues with the prison healthcare system in California like overcrowding and outdated resources that increase costs. Finally, it outlines conflicts between California and federal laws around medical marijuana.
Healthcare oligopoly is Affecting u.s. economy convertedRoyJMeidinger
The document provides an overview of rising healthcare costs and declining outcomes in the United States compared to other developed nations. It notes that while the US spends much more per capita on healthcare, it has lower life expectancy and rates of preventable deaths than peers. The high costs are driven by administrative waste, high prices, and lack of cost control. The document argues that healthcare costs are a major burden on the US economy and individuals, and that reforms are needed to reduce costs while improving access and outcomes for all Americans.
$10.58 $10.00
Licensed Nurse: $21.00 $19.10
Administrator: $41.00 $36.30
Sources: Janis O’Meara and Charlene Harrington, University of California, San Francisco. Calculations using the Office of
Statewide Health Planning and Development’s long-term care annual financial data for 2001 and 2003.
< R E T U R N T O C O N T E N T S
California’s Fragile
Nursing Home Industry
In 2001, only 5 percent of
California nursing homes
met or exceeded the national
average for quality of care
as measured by the federal
government’s five-
The document discusses the crisis facing California's nursing home system, including a rapidly aging population that will double the number of seniors over 65 by 2025. Many nursing homes already struggle with inadequate staffing and budgets. High staff turnover contributes to poor quality of care in most homes, as evidenced by weight loss, residents left in bed, and physical restraints used on some residents. Additionally, 78% of nursing homes had violations of federal regulations during inspections in 2002. The growing senior population will increase the demand for long-term care services that the current system is ill-equipped to handle.
A seminar with Walid Ammar, MD, PhD, Director General, Ministry of Public Health of Lebanon; Professor, The Lebanese University; Senior Lecturer, American University of Beirut.
Moderated by Melani Cammett, Professor of Government, Harvard University.
North Coast Breast Health Community Assessment: Needs, Assets and Opportunities Dolly England
This document provides a needs assessment of breast health resources in Oregon's North Coast counties, with a focus on Columbia County. It finds that Columbia County has limited breast cancer resources, including a single mammography site, no dedicated coordinator for a program assisting low-income women, and limited educational materials. However, the county also has access to Oregon's only mobile mammography van. The assessment provides data on demographics, poverty levels, driving times to mammography sites, and identifies organizations in the breast health network for each county. It aims to use these findings to improve outreach and reduce cancer disparities in these rural communities.
Describe rationale for free care in Providence Rhode Island, the mission and aims of the Clinica Esperanza / Hope Clinic, the current patient demographics, and plans for the future.
The document discusses challenges and opportunities for applying operations research (O.R.) principles to healthcare systems in emerging countries. It outlines several key issues facing healthcare delivery in these countries, including growing wealth and health disparities between urban and rural areas, increasing rates of non-communicable diseases, lack of health insurance coverage for most populations, and antiquated infrastructure. It then provides examples of how O.R. has been applied to healthcare projects in some low-income countries to improve monitoring, evaluation and resource allocation. Finally, it proposes a roadmap for applying O.R. in emerging country healthcare, focusing on improving access to medical supplies and products, hospital/clinic efficiency, disease prevention programs, public health emergencies, health
A single-payer healthcare system would cause further inefficiencies and be an economic burden for the United States. While increasing access to care, a single-payer system would lead to longer wait times like in Canada where 27% of people wait over 4 months for procedures compared to only 5% in the US. It would also decrease quality of care as seen in Canada where doctors are overworked and underpaid. Implementing such a system would require a tax increase of over 150% which would cripple the US economy, as seen when Vermont explored a single-payer plan. Competition in healthcare markets leads to lower costs and higher quality unlike a single-payer system, making it a step backwards for US healthcare.
The document discusses the problems with the current US healthcare system, including the large number of uninsured and underinsured Americans, high costs, and lower quality of care compared to other developed nations. It argues for a universal single-payer healthcare system that would provide comprehensive coverage to all Americans with no out-of-pocket costs, funded through taxes and savings from reduced administrative overhead. A single-payer system could save over $200 billion per year currently spent on private health insurance bureaucracy and lower drug and care costs through collective bargaining.
This document summarizes a research article that tested the hypothesis that HIV prevalence is not associated with governance. The researcher used governance data from the World Bank across six dimensions for 149 countries with UNAIDS HIV prevalence estimates from 2002. When countries were divided into three groups based on mean governance scores, the median HIV prevalence was lower (0.2%) for countries with higher mean governance compared to 0.7% and 0.75% for countries with lower and middle mean governance scores, despite improvements in other health and economic indicators. The results rejected the hypothesis and showed HIV prevalence is significantly associated with poor governance.
The document discusses health insurance rates and demographics in Pennsylvania counties. It analyzes data from the US Census Bureau and other sources, finding that while Latino populations increased substantially in some counties from 2000-2010, the change in uninsured rates for those counties was statistically insignificant. An analysis of various county health and demographic variables also found little correlation between Latino population percentages and uninsured rates at the county level in Pennsylvania.
This document discusses universal health care in the United States and its potential effects on society. It first defines universal health care as a system that provides health insurance to all citizens. It then compares the systems in other countries like Canada, Great Britain, and Germany. In the US, over 45 million people are uninsured despite health care being declared a basic right. The document outlines several potential effects of universal health care on employment, government spending, households, and the economy. Both pros and cons are discussed. In conclusion, it states that most cannot afford treatment without insurance and increasing costs may raise the uninsured population.
The document explores implementing mandatory advance health care directives for Medicare beneficiaries as a strategy to reduce astronomical end-of-life medical costs. It notes that without changes, Medicare spending could grow to over 1/3 of GDP by 2030 as baby boomers age. Advance directives allow people to outline their end-of-life wishes in case they become incapacitated. The document argues this could help control costs by limiting unnecessary or unwanted intensive end-of-life treatments for the 5% of Medicare beneficiaries who account for 30-35% of total spending in their final year. It also examines the political and economic implications of making advance directives mandatory for all Medicare recipients.
Presentation Fam Med Masters Seminar Apr 25 07briefJanet2007
The document discusses the impact of poverty on health. It provides background on poverty and health indicators in Canada, showing that those in poverty experience higher rates of chronic disease, infant mortality, lower life expectancy, and worse mental and physical health overall. It suggests that poverty, through factors like inadequate income for nutrition and housing, is the main determinant of these health inequities. The document proposes ways for health providers to help address poverty, such as by expanding assessments of social/economic barriers patients face and connecting them to resources to improve their situations.
Nicaragua identifying factors that affect childrens healthImelda Medina, MD
Children's growth up to age five is influenced more by nutrition, environment and health care than by genetics or ethnicity. The document states that factors like nutrition, environment and health care have a greater influence on children's development in the first five years than genetic or ethnic factors.
- The document discusses improving the measurement of maternal mortality rates (MMR) in Mexico by implementing a passive identification system to more accurately count maternal deaths.
- This led to the addition of over 1,000 previously uncounted maternal deaths being added to official statistics.
- While initially controversial, it empowered neglected health areas and improved transparency, credibility, and the culture of health information over the long-term.
Chapter 7Maternal, Infant, and Child HealthChapter ObjecJinElias52
Chapter 7
Maternal, Infant, and Child Health
Chapter Objectives (1 of 2)
After studying this chapter, you will be able to:
Define maternal, infant, and child health.
Explain the importance of maternal, infant, and child health as indicators of a society’s health.
Define family planning and explain why it is important.
Identify consequences of teenage pregnancies.
Define legalized abortion and discuss Roe v. Wade and the pro-life and pro-choice movements.
Define maternal mortality rate.
Define preconception and prenatal care and the influence this has on pregnancy outcome.
List the major factors that contribute to infant health and mortality.
Chapter Objectives (2 of 2)
Explain the differences among infant mortality, neonatal mortality, and postneonatal mortality.
Identify the leading causes of childhood morbidity and mortality.
List the immunizations required for a 2-year-old child to be considered fully immunized.
Explain how health insurance and healthcare services affect childhood health.
Identify important governmental programs developed to improve maternal and child health.
Briefly explain what WIC programs are and who they serve.
Identify the major groups that are recognized as advocates for children.
Introduction
Using age-related profiles helps identify risks and target interventions
Infants <1 year
Children 1-9 years
Maternal, infant, and child health (MIC) encompasses health of women of childbearing age from pre-pregnancy through pregnancy, labor and delivery, and the postpartum period, and the health of the child prior to birth through adolescence
MIC Health (1 of 4)
MIC statistics are important indicators of effectiveness of disease prevention and health promotion services in a community
Decline in US MIC mortality in recent decades, but challenges remain
Significant racial disparities
Modified from: Mathews T.J., M.F. MacDorman, and M.E. Thoma. (2015). "Infant Mortality Statistics from the 2013 Period Linked Birth/Infant Death Data Set." National Vital Statistics Reports, 64(9). Hyattsville, MD: National Centers for Health Statistics. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf. Accessed December 5, 2015.
MIC Health (2 of 4)
Infant mortality rates, by race and Hispanic origin of mother; United States, 2005and 2013.
Data from: Child Trends DataBank (2015). “Infant, Child, and Teen Mortality.”Available at http://www.childtrends.org/wp-content/uploads/2012/11/63_Child_Mortality.pdf Accessed December 6, 2015.
MIC Health (3 of 4)
Death rates for infants (deaths per 100,000): selected years, 1980–2013.
Data from: Child Trends DataBank (2015). “Infant, Child, and Teen -Mortality.”Available at http://www.childtrends.org/wp-content/uploads/2012/11/63_Child_Mortality.pdf
MIC Health (4 of 4)
Death rates among children ages 5 to 14 by race and Hispanic origin: 1980–2013.
Family and Reproductive Health
Families are the primary unit in which infants and children are nurtured and suppo ...
Paho social inequities in the americas 2001 engRamon Martinez
Dr. Roses, PAHO Director, presentation on Social Inequalities in health in the Region of the Americas.
PAHO's Regional Health Observatory (RHO
Pan American health Organization (PAHO)
Multidimensional Poverty For Monitoring Development ProgressUNDP Eurasia
This document discusses multidimensional poverty measurement and the Alkire Foster methodology. It provides an overview of why measuring multiple dimensions of poverty is important, describes the key aspects of the AF methodology including identification of poverty, aggregation of measures, and generation of the Multidimensional Poverty Index. It then illustrates the MPI results for over 100 countries, how the methodology can be applied at the national level, and ideas for further research using panel data to analyze dynamics of chronic and transient poverty over time.
This document presents a 5-year strategic health plan for Apati from 2018-2022. The key points are:
1. The plan aims to improve basic healthcare access and quality as well as lower maternal and child mortality rates.
2. Apati has a population of over 44 million people with high density in central regions. Health resources are concentrated in urban areas.
3. Objectives include strengthening the health system, improving quality of care, increasing equitable access and utilization, and decentralizing planning and resources.
4. Key targets by 2022 are reducing the maternal mortality ratio to 110 deaths per 100,000 births and infant mortality rate to 20 deaths per 1,000 births.
The document discusses the economic burden of cardiovascular disease in Mexico. It provides data showing obesity, hypertension, and diabetes are increasing causes of death. Treatment of these conditions places a large burden on Mexico's health system, with diabetes alone costing over $778 million in 2010. Initiatives like CASALUD and CODIGO INFARTO aim to better prevent, monitor, and treat non-communicable diseases, but Mexico invests a lower percentage of its GDP on healthcare than most OECD countries. More public-private partnerships will be needed to address the growing economic challenges.
Brief overview of group 2 final PowerPoint presentation pertaining to the affects of macro-trends on the U.S.Healthcare Systems and potential job growth/opportunities that will come from them.
Maternal & Child Health Among Detroit Michigan’s Lower Socio.docxandreecapon
Maternal & Child Health Among Detroit Michigan’s Lower Socioeconomic Group
Delroy Barnett
Christina Bergman
Maria Victoria Blanton
Veverly Brooks
Jennifer Castro
Ashford University
HCA415- Public and Community Health
Instructor: Tynan Mara
April 6, 2015
1
Target Population
Detroit Michigan Population:688,701
Percent of White American: 10.6%
Percent of Black American: 82.7%
Percentage of Women: 52.7%
Pregnancy Related Deaths 36.6 per 100,000 births.
Pregnancy Associates Deaths 75 pre 100,000 births.
Pregnancy Related deaths - 50.8 per 100,000 births in African Americans.
-3rd highest in nation
As of 2010, Detroit Michigan has a total population of 688,701 people. Of the 688,701 people, 10.6 % are White American and 82.7% are Black American. The community of Detroit is dealing with a rising concern with maternal health and pregnancy related mortality rates. Of the total population, 52.7% (or 362,945) are women. The cause of mortality among maternal mothers is obstetric causes, medical, accidents, suicide, assaults, and other causes. Per year on average, 6 women die from pregnancy issues, this amount is three times higher than that of the national average. These high mortality rates are more common in African American women than other races. Pregnancy related deaths among African Americans is 50.8 per 100,000 live births. This makes Detroit Michigan the third highest city of pregnancy related mortality in the nation. The high mortality rates in Detroit are due to health conditions, poverty, and proper health care. These numbers show that it is dangerous for a pregnant women to live and give birth in Detroit.
2
Thesis Statement
Thesis
The health disparities among women and children in Detroit are some of the worst in the nation. “The maternal mortality rate for black mothers in 2002 was almost 25 deaths per 100,000 live births, compared to nearly 6 deaths per 100,000 live births among white mothers and more than 7 deaths…among Hispanic mothers” (National Institute of Health, 2006, p.x). That is nearly four times the national average. More focus needs to be placed on maternal and child health in low socio-economic areas of Detroit.
Factors & Causes
Over 40% of population is living in poverty
Chronic Diseases
Limited access/ quality of health care
Obstetric, Medical, Accidents leading cause
While normally a major health concern in less developed countries, maternal and child health in the United States has become a major concern. “Child mortality is highly preventable and can be reduced greatly through improvement of environmental conditions and hygiene levels, as well as increased parental compliance with immunizations for vaccine preventable diseases…Many of these deaths were caused by preventable or easily treatable condition or by malnutrition (WHO, 2012c; WHO, 2012a)” (Friis, Bell, & Philibert, 2013). Poverty is a detrimental impact on the maternal health of women in Detroit. With the me ...
The macro trends in healthcare and the associated careershivani rana
This document discusses emerging macro trends in the US healthcare system and their impact on future healthcare jobs. It identifies trends like changes in the economy, demographics, lifestyles, technology and government policies. It notes that healthcare accounts for 18% of the US economy and that between 2010-2020 there will be over 5 million new healthcare jobs. It explores how trends like an aging population, increased chronic diseases, technology and policies like the Affordable Care Act are changing the system. Various career opportunities that may emerge like health economists, home healthcare workers, public health educators and health IT analysts are also outlined.
The document discusses Mexico's healthcare system, which comprises three subsystems: social security, the Social Protection System in Health (SPSS), and private insurance. The SPSS includes Seguro Popular, which aims to achieve universal healthcare coverage for Mexican citizens by 2010. However, Mexico's healthcare system still faces challenges like unequal access to care, a need for additional funding, and disparities between states. Improving insurance programs and consolidating the system could help address some of these challenges.
There are numerous changes taking place in South Africa, in the economy, politics and health. All these are interdependent and embedded in a social milieu which brings a number of pressures on health services and systems. The major event in the medium to long term is the impact of the National Health Insurance. Other contextual factors of importance include the range of social determinants of health and disease, with the provision of water, sanitation, electricity and housing being the key services. South Africa will also be influenced in the future by the major diseases it harbours at present. This seminar provided some insight into how these factors will impact on the South African Health Services.
Barriers to Reproductive Rights in MexicoDr Olga Lazin
Mexico faces significant barriers to reproductive health, with abortion illegal in many states and limited access to healthcare and education. Life expectancy and infant mortality rates vary greatly between rich and poor areas of the country. Advocacy efforts have helped reduce maternal mortality rates by over 23% since 2005, but disparities persist and improvements are still needed to reproductive health services and education across Mexico.
1. Five macro-trends that affect the US healthcare system are identified: economy, demographics, personal lifestyle and behavior, technology, and government policies.
2. These macro-trends impact factors like poverty rates, health issues, and job opportunities in the healthcare industry.
3. Recommendations are made to control issues in the US healthcare system by promoting safety, managing hazards, and facilitating environmental plans.
The document provides an overview of the Indian health system, including its political and economic context, organizational structure, health financing, coverage patterns, and current status of health and healthcare in India. It discusses the complex mixed public-private health system and describes the various levels of the government health system from the central and state ministries down to primary care facilities. It also outlines the principles of primary health care and highlights significant health inequities across economic classes, geographic areas, and gender in India.
The document discusses 5 macro-trends that will impact the future of the US healthcare system: 1) Economy, 2) Demographics, 3) Personal lifestyle and behavior, 4) Technology, and 5) Government policies. It analyzes factors within each trend, such as the aging population, rise of chronic diseases, development of new technologies, and laws/regulations. The document recommends developing policies, plans, and job opportunities to address issues related to these macro-trends and ensure access to quality healthcare. It emphasizes managing personal lifestyles and the need for healthcare professionals to navigate changes in the system.
The document summarizes preliminary data from a community health needs assessment of Latino/Hispanic populations in Mississippi, Louisiana, and Alabama. Key findings include:
1) Obesity is the most commonly diagnosed chronic condition, followed by hypertension and diabetes.
2) Major barriers to healthcare access are lack of health insurance, cost of services, extended time between appointments, and lack of interpreter services.
3) Improved cultural competency training for healthcare providers and more effective outreach programs that address these barriers are needed to improve health outcomes in this population.
This document summarizes a needs assessment conducted in Bangkok, Thailand to inform diabetes prevention efforts. Surveys found exercise was the top perceived need, with 28.9% reporting no exercise. However, participants noted a lack of community spaces and access barriers to physical activity. While organizers were concerned about a lack of cooperation and commitment to community-centered programs. The needs assessment identifies structural and participation barriers to address to effectively promote diabetes prevention in the community.
This document summarizes strategies used to undermine public acceptance of climate change science and discusses ways to more effectively engage the public on this issue. It notes that corporate interests have funded front groups and think tanks to manufacture doubt about climate science and make lack of certainty a political issue. As a result, news media often portray climate science as a two-sided controversy when there is actually a scientific consensus. It suggests joining online networks for information and action, developing new communication strategies, and promoting a values-based debate around climate solutions rather than perpetuating manufactured controversies.
The document discusses accountability for global health efforts. It asks if governments of poor countries are accountable for not spending more on domestic health and if so, to whom. It also asks if international organizations like the IMF and World Bank are accountable for policies that discourage health spending and if rich country governments are accountable for not providing more international health aid. It notes challenges to mutual accountability given both national and international responsibilities for health.
Understanding the Effect of the GAVI Initiative on Reported Vaccination Cover...UWGlobalHealth
This document discusses the critical role of health metrics and evaluation in ensuring accountability, transparency and reducing corruption in global health. It provides two examples: tracking childhood immunization coverage shows investments have increased coverage gradually over 20 years but initiatives can lead to over-reporting; India's conditional cash transfer program for facility births increased coverage and likely reduced mortality, but quality issues remain. Overall, independent monitoring of health indicators and evaluation of programs is needed to show resources are having their intended impact.
Foreign funding to NGOs in Nicaragua has undermined their accountability to grassroots organizations and limited their ability to catalyze social change. Due to short-term funding cycles tied to donor priorities, NGOs are more accountable to foreign donors than the communities they are meant to serve. This has contributed to a façade of civil society dominated by urban NGO elites rather than empowered grassroots organizations. As a result, NGOs have had minimal policy impact and have demobilized, rather than empowered, the people. Long-term funding structures that strengthen accountability to local constituencies may help NGOs better support grassroots organizations and social movements.
The Power of Numbers- Communities Use Government Budget Data to Advocate for ...UWGlobalHealth
The International Budget Partnership provides concise summaries of documents in 3 sentences or less:
The document outlines the work of the International Budget Partnership (IBP), including building budget literacy, training on fiscal analysis, and monitoring government budgets and expenditures. IBP partners with civil society organizations around the world to increase budget transparency and hold governments accountable. The document also describes IBP's role in providing funding, capacity building, information sharing, and networking opportunities to support its partners' budget work.
Perspectives and Controversies surrounding human rightsUWGlobalHealth
This document discusses the right to health from a human rights perspective. It begins by defining key concepts like health, human rights, and the relationship between health and human rights. It then examines how the right to health is established under international law through conventions like the International Covenant on Economic, Social and Cultural Rights. The document also summarizes commentary on the right to health from the UN Committee on Economic, Social and Cultural Rights. Finally, it discusses some controversies and challenges regarding a human rights-based approach to health, such as issues of universality and developing appropriate indicators.
Politics and Health Reform:Lessons From a Year in Washington, D.C.UWGlobalHealth
This document summarizes the history of health reform efforts in the United States from the late 19th century to 2009. It discusses how a national health insurance system has been proposed since the 1880s but consistently opposed by groups like the AMA and insurance industry. The US now spends over twice as much per capita on healthcare as other OECD countries but has lower life expectancy and more administrative waste. Creating a universal, publicly financed system could reduce costs while improving access and outcomes.
"What Will It Take To Control TB?" Richard Chaisson, MDUWGlobalHealth
Dr. Richard Chaisson, Professor of Medicine, Epidemiology and International Health and Director of the Center for Tuberculosis Research at the Johns Hopkins University in Baltimore was the keynote Jan. 19 as part of the Washington Global Health Discovery Series. His talk was on ""What Will It Take To Control TB?"
This document discusses health as a societal right. It begins by discussing how health has traditionally been viewed as an individual responsibility but argues that there are no biological reasons why entire populations cannot be healthy. It then explores how health can be considered a societal or human right. The document examines how determinants of health are influenced by societal factors like inequality and poverty rather than just individual behaviors or access to healthcare. Overall, it promotes a view of health as a societal issue that governments should aim to improve and protect for entire populations, rather than just an individual concern.
"The Aid Enclave: Mapping and Emerging Geography of Global Health"UWGlobalHealth
The document discusses how global health initiatives have led to the emergence of "aid enclaves" - self-contained areas focused on health research and aid that become isolated from their surroundings. It describes how these enclaves develop through economic, political, and ethical processes. Economically, they exist as tax-free zones that offer higher pay and privileges to foreigners compared to locals. Politically, they represent a return to colonial-style projects. Ethically, they position themselves as spaces of biomedical and moral correctness but may marginalize local healing practices. The document critiques how enclaves can act as "parasites" detached from the communities they aim to serve.
1) The US ranks last among seven countries in overall health system performance and ranks last or near last on most measures of health care quality, access, efficiency, and equity.
2) While the US spends much more per capita on health care than other countries, it has poorer population health outcomes and shorter life expectancies.
3) Rising health care costs are consuming an increasing share of family budgets in the US. The percentage of families spending over 10% and over 25% of pre-tax income on health care doubled from 2000 to 2008.
"The Health System and Aid Effectives: Sudan's Experience"UWGlobalHealth
The document summarizes Sudan's health system and aid effectiveness. It provides background on Sudan's location and history as a 4000 year old civilization. It then discusses Sudan's socio-economic context, including its potentially rich natural resources and decentralization of services. The health delivery system is described as providing free healthcare, with increasing expenditures over time. Main health issues are outlined and data is given on international NGO presence and beneficiaries across regions. The document concludes with some of the challenges facing Sudan's health system.
The IHOP program allows medical students to spend 8 weeks in a developing country to learn about global health challenges. Students conduct a community health assessment and partner with local organizations to address health needs. The experience aims to provide cultural immersion and help students understand how to incorporate global health into their careers. Students are responsible for costs of $3,000-$5,000 and must complete assignments while abroad and after returning. Strong applicants have a genuine interest in global health and experience with underserved populations.
The document discusses health care systems and funding in Mozambique. It outlines the various sectors involved in health including public, private, NGOs, and traditional/alternative care. It also describes the types of funding for health care including vertical, horizontal, and diagonal funding. Vertical funding for specific diseases has increased from organizations like PEPFAR, Global Fund, and foundations. While this funding has increased dramatically, questions remain about whether NGOs effectively strengthen health systems or divert resources and can fragment services.
The document summarizes research into how NGOs are implementing a voluntary Code of Conduct for Health Systems Strengthening. Interviews found that while most signatories are aware of the Code and value its principles, they still face challenges adhering to provisions around hiring health workers from ministries of health and matching government salaries. Some promising practices discussed include building workforce capacity through training, advocating for improved public sector opportunities, and coordinating hiring and compensation policies among NGOs. Overall, signatories are committed to the Code's goals but continuing to test practical solutions for balancing them with operational needs.
The document discusses the erosion of public sector health systems and increased privatization. It argues that without strong public sectors, healthcare will be inequitable and exclude the poor, rural communities, and marginalized groups. Public health measures also risk being neglected. It examines factors driving privatization like international financial institutions and private sector interests, and argues the private sector did not compensate for declines in public investment as hoped.
The document discusses PATH's approach to collaborating with private sector partners to advance global health technologies. It focuses on PATH bringing expertise in developing country health systems and strategic relationships, while partners contribute product development expertise, intellectual property, and distribution systems. The collaboration aims to improve availability, accessibility, and affordability of important health products for public health programs.
King Holmes, MD, PhD. University Consortium for Global Health. Sept. 15, 2009.UWGlobalHealth
The document discusses the state of global health in 2009 and opportunities for universities to help address global health challenges through collaboration. It outlines five major global health agendas, including communicable diseases, maternal and child health, injuries and violence, chronic diseases, and environmental health issues related to climate change. There are many workforce and infrastructure needs in developing countries that universities could help meet by training skilled professionals. New opportunities exist through partnerships, technologies, and increased resources and interest from different sectors. The Consortium of Universities for Global Health aims to leverage these opportunities by promoting effective interdisciplinary collaboration between universities and other institutions.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
1. Health Reform in Mexico in 2004: the origin of the Health Social Protection System Rafael Lozano MD MSc Global Health Seminar, “Aid and Health” November 13 2009
2. Outline Background Current Mexican´s facts Health reforms in Mexico 1943-2004 How evidence did help in the design of the 2004 Health Reform in Mexico? Empowerment and action Ethical component Legal process to get approval Democratizing the health System in Mexico : Innovations Stewardship Financing Services delivery Lessons Learned
20. Predicted Infant Mortality by Municipality and Level of Marginality, 2005 90.0 Very Low Low Medium High Very High 80.0 70.0 Infantl mortality per 1000 lb 60.0 4.5 50.0 4.0 Diarrheas 40.0 3.5 Low resp Infec Under nutrition 30.0 3.0 20.0 2.5 8.0 2.0 10.0 Source: CONAPO, 2008 TM < 5 años x 1000 nv 7.0 1.5 0.0 6.0 -3.0 -2.0 -1.0 0.0 1.0 2.0 3.0 Birth Asphyxia Marginality 1.0 Congenital Anomalies 5.0 0.5 Prematurity 0.0 4.0 Very Low Very High Hugh Median low TM < 5 años x 1000 nv 3.0 2.0 1.0 0.0 Very High High Media Low Very low Source: Lozano R,2008
21. Mexican Health System (before reform) 30% 15% 55% 40% 30% 30% 45% 45% 10% Source: Frenk J. et al 2003
22. Outline Background Current Mexican´s facts Health reforms in Mexico 1943-2004 How evidence did help in the design of the 2004 Health Reform in Mexico? Empowerment and action Ethical component Legal process to get approval Democratizing the health System in Mexico : Innovations Stewardship Financing Services delivery Lessons Learned
23. Reform From Latin “reformare” … “form or shape again” (re-form) “…make changes in (something) in order to improve it…” to remove abuse and injustices reclaim, regenerate, rectify Synonymous: better, improve, amend, ameliorate, meliorate, innovation, transform, modification, etc. Can we put adjectives to the word “Reform”? Radical, minimalist, moderate, progressive For Public Policy, Public Health and Social Analysis Purposes aim to improve the system describe changes to public services reform may be: no more than fine tuning Redressing serious wrongs without altering the fundamentals of the system Reform seeks to improve the system as it stands, never to overthrow it wholesale
24. Health reform typically attempts to Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies Expand the array of health care providers consumers Improve the access to health care facilities Improve the quality of health care Decrease the cost of health care Increase the financial resources for health etc., etc.,
25. Three generations of Health Reform in Mexico 14 2004 1982 1943 Million of population 1943 Foundation of the Modern Health System 1982 Toward a National Health System 2004 Health Social Protection Source: Frenk J. et al 2003
26. Health Reforms in Mexico: three generations 1943 Foundation of the Modern Health System Ministry of Health Social Security for all workers 1982 Toward a National Health System Change of the Mexican Constitution Article 4: Health protection is a right of the population and an obligation of the government General Health Law Decentralization of the health system (state level) Coordination and Integration of health providers Administrative Modernization 2004 Health Social Protection Separation of financing from the provision of services to stimulate competition and accountability; Evaluation of health interventions with the goal of designing cost-effective benefit packages; Programs for the continuous improvement of quality of care; and Increased participation of citizens in their care. Source: Frenk J. et al 2003
27. Outline Background Current Mexican´s facts Health reforms in Mexico 1943-2004 How evidence did help in the design of the 2004 Health Reform in Mexico? Empowerment and action Ethical component Legal process to get approval Democratizing the health System in Mexico : Innovations Stewardship Financing Services delivery Lessons Learned
28. Priorities for research and development (the intelligence) National Health Accounts (the means) National Burden of Disease (the problem) Universal package of health services (the solutions) Proposals for reform (the vehicle) Cost- effectiveness analysis Financing (the require- ments) Analysis of system performance (the capacity) Building the evidence Frenk J., Lozano R., González MA, et al 1994
29. Public Politics Political Ethical Technical Evidence andInformation The Pillars of Public Politics on Health Source: Frenk, J. 2005
30. The challenges of the Mexican Health System Equity: change in the health pattern with more social and regional inequalities Quality: heterogeneous performance by provider and lack of responsiveness Financial Protection: the uncertainty risk to have catastrophic expenditures
31. Financial Protection Motivation Almost half the families have no health insurance, which leads to postpone care and to be incurred in catastrophic expenditures, as well as generating a deep injustice
32. Financial Unbalances Level: investment: 5.8% of GDP Source of funds: the predominance out of pocket payments (55%) Distribution 3.1 Among populations: 1.5 times between insured and uninsured 3.2. Between states: 8 to 1 in the state with the highest per capita federal spending and the state with the lowest per capita federal spending State effort on health expenses: 119 to 1 between higher and lower Destination: increasing the payroll, with a fall in infrastructure investment
33. Financial imbalances Underinvestment Health expenditure as percentage of GDP 16 13.9 14 12 10.9 Latin America average: 10 9.3 $ 36,948 mills. de USD $ 356 USD per capita Percent 8 7.2 6.9 5.8 6 5.3 4 2 0 Bolivia Mexico USA Uruguay Colombia Costa Rica
34. Financial imbalances Source of funds Social Security 61% States 7% Federal 32% Private Insurances 3% Public Expenses 42% Out of Pocket 55%
35. Financial imbalances Unequal effort from the states Federal States Percentage of federal and state expenses on health for uninsured population 100% 80% 60% 40% 20% 0% AGS. B.C. B.C.S. COL. D.F. HGO. JAL. MICH. NAY. PUE. QRO. S.L.P. SON. VER. TLAX. YUC. ZAC. CAM. COAH. CHIS. CHIH. DGO. GTO. GRO. MEX. MOR. N.L. OAX. Q.ROO SIN. TAB. TAMPS.
36. Financial imbalances Imbalance destination of the expenditure Federal expenses by chapter 100% 80% 60% 40% 20% 0% 1995 1996 1997 1998 1999 2000 2001 2002 2003 Health care Administrative Investment on Infrastruc
37. Financial imbalances Impoverishment due to health spending 2 millions: Catastrophic expenses (more of 30% of income available) 1.5 millions of families .5 millions of families 1.8 millions of families 2.3 millions: immiserizing spending ( "Medical indigence") Source: Encuesta Nacional de Ingresos y Gastos de los Hogares, 2000. Estimaciones CASESALUD
38. Universality Social Inclusion NationalPortability Equal opportunities Explicit Priorization Fair Finance Free of Charge in the moment of use Financial Solidarity Co-respon-sability Subsidiarity Democratic Budgeting Individual Autonomy Accountability Ethical foundations of the reform Principles Key Concept Values Democratization of Health
39. Democratizing the health System in Mexico Empower people making them aware about their entitlements Transparency and accountability Objectives of the Reform Ordering the health financing and increasing public budget gradually, fiscally responsible and financially sustainable To protect investments in prevention and health services to the community To provide financial protection in health care to the population, especially the poorest To transform the Incentives in order to achieve a democratic budgeting, which allows to increase the satisfaction of population's expectations
40. More than a Legal process to get the change in the Law Foundation of The National Institute of Public Health, January 1987 The Health and the Economy 1994, Frenk et al. Beginning of the administrative period, Dec 2000 Release of the National Health Program 2000-2006, July 2001 Initiative sent to the congress, Nov 2002 Approval in the Congress, April 2003 (92% of votes in the senate house and 79% in the representatives house) The Official Gazette published the decree that reforms and adds the General Health Law, May 2003 Started the System of Social Protection in Health, January 2004 29
41.
42. Two level of government were involved (state and national)
43.
44. Structural reform of the health systemfinancing Innovations Universalization of social security on health Establishment of the System on Social Protection in Health Master Plan for Health infrastructure Protection against catastrophic expenses Budget priority for public health New plan for democratic budgeting Affiliation with explicit rights for all people
46. Stewardship Key function, mother function “…To do that others do what they must do…” Tools and rules Coordination, regulation, monitoring and evaluation Create instruments with explicit rules for financial transfers Priority setting to a package Certification of health infrastructure Orient financial flows Demand instead supply Accountability
47.
48. New structure to provide universal financial protection Contributors Public Insurances Co-responsible contributor Federal Government Beneficiary IMSS salaried employees in the private sector Private Employer employee taxes Social contribution Public Employer Social contribution Employee taxes ISSSTE salaried employees in the public sector Seguro Popular non-salaried workers,self-employees, families outside of the formal labour force Family Solidarity contribution Social contribution State Federal Gov
49. Service Delivery Master plans Investment in infrastructure Medical equipment Human resources Universal Coverage Essential package (249) Catastrophic expenses (17) Improving the Quality of care Accreditation of health facilities
50.
51. Seguro Popular Accelerated Vertical Coverage New vaccines Equal start of life New vaccines Children & adolescents Cancer Cervix Cancer Children Cancer Cataracts HIV/AIDS < 9 months 2 years 5 years 18 years 60 years Life line
52. Outline Background Current Mexican´s facts Health reforms in Mexico 1943-2004 How evidence did help in the design of the 2004 Health Reform in Mexico? Empowerment and action Ethical component Legal process to get approval Democratizing the health System in Mexico: Innovations Stewardship Financing Services delivery Lessons Learned
53. Lessons Learned The ABCDE of the successful reform Agenda Budget Capacity Deliverables Evidence Healthy Policies National Commission for Risk Protection Global Public Goods for local decision-making
54. Report 2009 1stsem(NCSPH) Affiliation 9.6 millions of families (28.5 millions of people) Almost all Municipalities Increase in the number of people of the first and second deciles (including indigenous population) New generation program (2.2 million) Healthy pregnancy (380 K) 90.9% of re-affiliation Services Delivery 39 million of visits Half a million of hospital discharges (245 K of deliveries) Waiting time 58 min (?) 78% of patients have received all drugs from doctor prescription (?) Financial imbalances follow up Source: Frenk J., et.al. 2006
60. The use of funds for purposes other than those for which they were intendedThe poor are affiliating to Seguro Popular More resources are available for the uninsured and the distribution of resources across states is more equal Mixed results for utilization of health services among SP affiliates Composite coverage has increased for the country and for the uninsured Inequalities in coverage have decreased across states and across wealth deciles Catastrophic spending is lower among SP affiliates than the uninsured, especially within subgroup that use health services
61. 46 National Health System (2007) Physicians % Beds % Population Affiliated % Health Expenses per capita USD Hospitals % 87.9 34.5 33.3 42.4 No Medical Insurance 26.8 325.6 36.0 36.5 27.9 Medical Insurance 73.2 324.8 25.0 27.6 16.3 IMSS 35.8 231.9 7.7 5.9 6.4 ISSSTE 7.5 216.8 Seguro Popular (Health Reform) 25.5 910.0 3.2 3.2 5.0 Others 1.5 1,000.0 29.5 30.2 29.7*** Private 2.9 534.2 218** 115** 1,664 Total (absolute) 106* * Millions ** thousands *** Includes Hospitals over 15 beds. Private Sector has more than 2.5 thousand small hospitals
62. Lesson Learned Money matters. More money better result, but just at the beginning, after, strong management is needed Health reform is more complicate that a change of the law. Besides the need of lobby is necessary to build good stakeholders How do get ownership of the reform? More that the inner circle Institutionalization of the change How do get the achieved the goals offered? Affiliation Increase the budget Change the predominance of private money Increase the quality of care Decrease inequalities
63. Daniel Cosio Villegas Those that are inside of the government know what is going on, but they don't have time to write anything; however who is out the government write many things, but they don't have any idea of what is going on 48
Editor's Notes
Wise words from someone who knew what he was saying and because he said it. In Mexico we consider that Daniel Cosio Villegas is one of the greatest minds of the twentieth century and a wise man.