Health Care Systems of the Future: Sustainable, Faire. Equitable...?

1
Health Care Systems of the Future Sustainable,
Faire. Equitable...?

• Stipe Oreskovic
• Andrija Stampar School of Public Health
• University of Zagreb School of Medicine
• Rockefellerova 4, 10000 Zagreb
• Croatia
• Emial soreskov_at_snz.hr

2

• Delivering high quality health care to all
  citizens for a reasonable cost should be a simple
  thing
• But it is not
• Because of the special nature of the health
  care systems

3
Information Asymetry

• Patients
• Consumer
• Providers
• Physicians
• Payers
• Purchacers

4

• Horror stories about overcrowded emergency rooms,
  poor quality of care, inequitable access to
  resources, financial scandals, medical errors
  have been reported alongside news on the wonders
  of modern medicine and technology

5
Each group involved interprets the situation from
its own perspective

• The physicians are complaining about constraints
  imposed on them by the government or health
  insurance
• The nurses are demanding their work be more
  highly valued.
• The hospitals want more resources and equipment.
• The pharmaceutical industry is trying to ensure
  its share of the healthcare market continues to
  increase

6
The governments

• strongly support the underlying principles of
  public health insurance systems (universal access
  to quality service),
• The general public is almost absent from the
  debate, except when organized groups (people with
  HIV, families of children with leukemia,
  associations representing people with specific
  illnesses)

7
Health systems/services reforms

• in most of the countries arround the world aimed
  at
• improving overall health and client satisfaction,
  
• technical and allocative efficiency,
• and to provide more equitable access.

8

• The reforms included
• reorganization of national health agencies,
• user charges for publicly provided services,
• health insurance schemes,
• and service contracting.

9
Unsuccessful reforms

• can have long lasting and profound effects on
  society
• but fundamental changes in health systems are
  advocated and undertaken based on less evidence
  than it requires to license a new antibiotic.
• National and international forces behind reform
  often have little interest in policy research
• Rigorously measuring the impact of complex
  reforms is not easy.

10
What will make a health system "good

• Based on the what we want for the future
  Criteria.
• Efficiency ?
• Affordability ?
• Availability ?
• Effectiveness ?
• Sustainability ?

11
Characteristics of "Old Planning" and "New
Planning"

• Control disease
• Maintain control
• Reactive approach
• Top down policy flow

• Manage health

• Provide direction

• Proactive approach

• Bottom up policy flow

12
Characteristics of "Old Planning" and "New
Planning"

• Narrowly comprehensive
• Bureaucratic
• Locally initiated
• Politicized
• Narrowly-defined outcomes

• Broadly comprehensive
• Democratic
• Federally initiated
• Systematized
• Broadly-def'd-outcomes

13
Characteristics of "Old Planning" and "New
Planning"

• Isolation of health
• Facilities/services outcomes
• Utilization-based standards

• Integration of health
• Health status outcomes
• Needs-based standards