The health system , also sometimes referred to as the healthcare system or as a health system , is the organization of people, institutions and resources that provide services health care to meet the health needs of the target population.
There are various health systems around the world, with a lot of history and organizational structure like there are countries. Implicitly, countries should design and develop health systems according to their needs and resources, although common elements in almost all health systems are primary health care and public health measures. In some countries, health system planning is distributed among market participants. In other countries, there is a joint effort between government, trade unions, charities, religious organizations or other coordinated bodies to provide planned health services targeted to the population they serve. However, health care planning has been described as something that is evolutionary rather than revolutionary.
Video Health system
Goal
The World Health Organization (WHO), the directive and coordinating authority for health in the United Nations system, promotes universal healthcare objectives: to ensure that everyone gets the healthcare they need without suffering financial difficulties when paying for them. According to WHO, the purpose of the health system is good health for citizens, responsive to the expectations of the population, and a means of fair funding operations. Progress toward them depends on how the system performs four vital functions: the provision of health care services, resource generation, financing, and stewardship. Other dimensions for health system evaluation include quality, efficiency, acceptability, and equity. They have also been described in the United States as "five C": Cost, Coverage, Consistency, Complexity, and Chronic Illness. Also, the continuity of health care is the main goal.
Maps Health system
Definition
Often the health system has been defined with a reductionist perspective, eg reducing it to a health system . In many publications, for example, both expressions are used interchangeably. Some authors have developed arguments to expand the concept of health systems, suggesting additional dimensions to be considered:
- The health system should not be expressed only in terms of its components, but also its linkages;
- The health system should cover not only the institutional side or the supply side of the health system, but also the population;
- The health system should be seen in terms of their goals, which include not only health improvement but also equity, responsiveness to legitimate expectations, respect for dignity, and fair financing, among others;
- The health system should also be defined on the basis of their function, including the provision of direct services, whether it is medical or public health services, but also other "support functions, such as stewardship, financing and resource generation, including perhaps the most complex of all challenges, health workforce. "
World Health Organization definition
The World Health Organization defines the health system as follows:
The health system consists of all organizations, people, and actions whose primary purpose is to promote, restore or maintain health. This includes efforts to influence health determinants as well as more direct health improvement activities. Therefore, the health system is more than a pyramid of publicly owned facilities that provide personal health services. This includes, for example, a mother caring for a sick child at home; private providers; behavior change program; vector control campaigns; organization of health insurance; health and safety laws. This includes inter-sectoral action by health staff, for example, encouraging the education ministries to promote women's education, known as better health determinants.
Provider
Healthcare providers are institutions or individuals that provide health care services. Individuals including health professionals and allied health professionals may work alone or work as employees in hospitals, clinics, or other health care agencies, whether government-operated, private for profit, or private non-profit (eg non-governmental organizations ). They may also work outside of direct patient care such as in government health departments or other institutions, medical laboratories, or health training institutions. Examples of health workers are doctors, nurses, midwives, nutritionists, paramedics, dentists, medical laboratory technologists, therapists, psychologists, pharmacists, chiropractors, ophthalmologists, community health workers, traditional medicine practitioners, and others.
Financial resources
There are generally five main methods for funding health systems:
- general taxation to states, districts or municipalities
- national health insurance
- voluntary or private health insurance
- payment out of payment
- donate to a charity
Most state systems display a mix of all five models. One study based on data from the OECD concluded that all types of health care financing are "compatible with" an efficient health system. The study also found no relationship between financing and cost control.
The term health insurance is generally used to describe a form of insurance that pays for medical expenses. Sometimes it is used more widely to include insurance covering disability or long-term care or custodial care needs. This can be provided through a social insurance program, or from a private insurance company. These can be obtained by group (for example, by the company to protect its employees) or purchased by individual consumers. In any case, premiums or taxes protect the insured from high or unexpected health care costs.
By estimating the overall cost of health care costs, routine financial structures (such as monthly premiums or annual taxes) can be developed, ensuring that money is available to pay for the health benefits specified in the insurance agreement. The benefits are usually managed by government agencies, nonprofit health funds or operating companies seeking profits.
Many forms of commercial health insurance control their costs by limiting the benefits paid through deductibles, co-payments, coinsurance, policy exclusion and total coverage limits and will severely limit or deny coverage of pre-existing conditions. Many government schemes also have a shared payment scheme but exceptions are rare due to political pressure. Larger insurance schemes can also negotiate fees with service providers.
Many forms of social insurance schemes control their costs by using the bargaining power of their communities they represent to control costs in health care delivery systems. For example, by negotiating drug prices directly with pharmaceutical companies negotiating standard fees with the medical profession, or reducing unnecessary health care costs. Social schemes sometimes feature income-related contributions as part of a scheme to provide universal health care, which may or may not involve the use of commercial and non-commercial insurance. Basically, richer people pay more proportionately into schemes to cover the needs of relatively poor people who therefore contribute less proportionately. There is usually a limit on the contribution of the rich and minimum payments to be made by the insured (often in the form of minimum contributions, similar to deductibles in the commercial insurance model).
In addition to these traditional health-care financing methods, some low-income countries and development partners also implement non-traditional or innovative financing mechanisms to improve the delivery and sustainability of health services, such as micro-contributions, public-private partnerships, and markets. tax-based financial transactions. For example, in June 2011, UNITAID has collected more than one billion dollars from 29 member countries, including some from Africa, through a levy of air ticket solidarity to expand access to care and treatment for HIV/AIDS, tuberculosis and malaria in 94 countries.
Payment model
In most countries, wage costs for healthcare practitioners are estimated to represent between 65% and 80% of renewable health system expenditures. There are three ways to pay medical practitioners: the cost for services, capitation, and salary. There is a growing interest in integrating the elements of this system.
Cost-for-service
The cost-for-service arrangement pays the general practitioner (GP) based on the service. They are even more widely used for specialists working in outpatient care.
There are two ways to set the cost level:
- By each practitioner.
- Central negotiations (such as in Japan, Germany, Canada and in France) or hybrid models (such as in Australia, sector 2 in France and New Zealand) where general practitioners may impose additional charges above the standard patient replacement level.
Capitation
In the capitation payment system, doctors are paid for each patient on their "list", usually with adjustments for factors such as age and gender. According to the OECD, "the system is used in Italy (at some cost), in all four countries in the United Kingdom (with certain fees and benefits for certain services), Austria (with fees for certain services), Denmark (one third of revenues with the remaining cost for services), Ireland (since 1989), Netherlands (cost-for-service for privately insured patients and public employees) and Sweden (from 1994).Chapitation payments have become more frequent in "managed care" environments in the United States. "
According to the OECD, "The capitation system allows funders to control the overall level of primary health spending, and funding allocations among physicians are determined by patient enrollment, but under this approach doctors may enroll too many patients and serve them less, choose more risk good and refer to patients who may have been treated by a physician directly.The freedom of choosing a consumer over a doctor, coupled with the principle of "money following a patient" can moderate some of these risks.In addition to selection, the issue is likely to be less marked than under salary type arrangement. "
Payroll settings
In some OECD countries, general practitioners (general practitioners) work in salary for government. According to the OECD, "Salary arrangements allow funders to directly control primary care costs, but they can lead to a lack of service provision (to reduce workload), excessive referrals to secondary providers and a lack of attention to patient preferences." There has been a movement away from this system.
Resources information
Healthy information plays an increasingly important role in the delivery of modern health services and the efficiency of health systems. Health Informatics - the intersection of information science, medicine and health care - deals with the resources, tools and methods necessary to optimize the acquisition and use of information in health and biomedicine. The tools necessary for coding and management of good health information include clinical guidelines, official medical terminology, and computers and other information and communication technologies. The types of health data being processed may include patient medical records, hospital administration and clinical functions, and human resource information.
The use of health information lies at the root of evidence-based policies and evidence-based management in health care. Increasingly, information and communication technologies are being used to improve health systems in developing countries through: standardization of health information; computer-assisted diagnoses and care monitoring; inform the population group about health and medicine.
Management
The management of any health system is usually directed through a set of policies and plans adopted by governments, private sector businesses, and other groups in areas such as private healthcare and financing, pharmaceuticals, healthcare human resources, and public health.
Public health is concerned with threats to public health as a whole based on population health analysis. The population in question can be as small as a few people, or as large as all the inhabitants of some continents (for example, in the case of a pandemic). Public health is usually divided into epidemiology, biostatistics, and health services. Environmental, social, behavioral, and occupational health are also important sub-areas.
Currently, most governments recognize the importance of public health programs in reducing disease incidence, disability, the effects of aging and health injustice, although public health generally receives much less government funding than drugs. For example, most countries have a vaccination policy, supporting public health programs in providing vaccinations to improve health. Vaccinations are voluntary in some countries and are mandatory in some countries. Some governments pay all or part of the cost for vaccines in national vaccination schedules.
The rapid emergence of many chronic diseases, which require expensive long-term care and treatment, has led many health managers and policy-makers to reexamine their health care delivery practices. The critical health problem facing the world today is HIV/AIDS. Another major public health issue is diabetes. In 2006, according to the World Health Organization, at least 171 million people worldwide suffered from diabetes. The incidence is rising rapidly, and it is estimated that by 2030, this figure will double. The controversial aspect of public health is the control of tobacco smoking, linked to cancer and other chronic diseases.
Antibiotic resistance is another major concern, leading to the re-emergence of diseases such as tuberculosis. The World Health Organization, for the 2011 World Health Day campaign, called for a global commitment to protect antibiotics and other antimicrobial drugs for future generations.
System health performance
Since 2000, more initiatives have been taken at the international and national levels to strengthen the national health system as a core component of the global health system. Taking into account this scope, it is important to have a clear, and unlimited, vision of a national health system that may result in further advances in global health. The elaboration and selection of performance indicators does rely heavily on the conceptual framework adopted for the evaluation of the health system's performance. Like most social systems, the health system is a complex adaptive system in which change does not always follow a rigid epidemiological model. In complex systems of dependence, emerging traits and other non-linear patterns are less explored and immeasurable, which may lead to the development of inappropriate guidelines for developing responsive health systems.
More and more tools and guidelines published by international agencies and development partners to assist health system decision-makers to monitor and assess the strengthening of health systems including human resource development using standard definitions, indicators and standards. In response to a series of papers published in 2012 by members of the World Health Organization Task Force on Developing a Health System Guide, researchers from the Consortium of the Future Health System argue that there is not enough focus on 'policy implementation gaps'. Recognizing the diversity of stakeholders and the complexity of the health system is essential to ensure that evidence-based guidelines are tested with the required humility and without strict adherence to models dominated by a limited number of disciplines. Health services often implement Quality Improvement Initiatives to address this policy implementation gap. Although many provide better health services, most fail to survive. Many tools and frameworks have been created to respond to these challenges and improve longevity improvements. One tool highlights the need for these tools to respond to user preferences and settings to optimize impact.
The Health Policy and Systems Research (HPSR) is an emerging multidisciplinary field that challenges 'disciplinary capture' by the dominant health research tradition, arguing that this tradition produces inadequate, improperly inappropriate definitions rather than improving the strengthening of the health system. HPSR focuses on low- and middle-income countries and refers to a relativist social science paradigm that recognizes that all phenomena are built through human behavior and interpretation. In using this approach, HPSR offers insights into the health system by generating complex understanding of the context to improve health policy learning. HPSR calls for greater involvement of local actors, including policymakers, civil society and researchers, in decisions made around funding health policy research and strengthening health systems.
International comparison
The health system may vary substantially from one country to another, and in recent years, comparisons have been made internationally. The World Health Organization, in World Health Report 2000 , assigns a worldwide healthcare system according to the overall criteria and health distribution in the population, and the fair response and financing of health care services. The goals for the health system, according to WHO World Health Report 2000 - Health system: performance improvement (WHO, 2000), are good health, responsive to population expectations, and fair financial contributions. There is some debate surrounding the outcome of this WHO exercise, and especially based on the country ratings associated with it, so far it seems to depend largely on the choice of preserved indicators.
The direct comparison of health statistics between countries is complex. The Commonwealth Fund, in its annual survey, "Mirror, Mirror on the Wall", compares health system performance in Australia, New Zealand, the UK, Germany, Canada and the United States. The 2007 study found that, although the US System is the most expensive, it consistently performs poorly compared to other countries. The main difference between the United States and other countries in the study is that the United States is the only country without universal health care. The OECD also collects comparative statistics, and has published short state profiles. Health Consumer Powerhouse makes comparisons between the two national health care systems in the Euro health consumer index and specific areas of health care such as diabetes or hepatitis.
Doctors and hospital beds per 1,000 residents vs. Health Care Expenditures in 2008 for OECD Countries. The data source is http://www.oecd.org.
See also
References
Further reading
Source of the article : Wikipedia
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