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Globalization and Health Care Systems

International Healthcare policy 1.1

Globalization and Health Care Systems


Global Health Care Management Experience Study tour 2005 (US, Canada, Mexico,UK and Australia) All countries in the Americas Partnerships Europe, CEE and NIS (Hospitals, Managed Care, Health Systems, Health Reform, Education and training on health services management [human resources development, institutional strengthening]) Managerial and Health Services Research Perspectives Globalization impact in health and health care services and management Health systems reform strategies with issues like competitiveness, state regulations, insurance companies, public private partnerships and patient empowerment Quality, safety and performance improvement Value and impact of heath care. Chronic Care

Examples of global issues in healthcare include:


Outsourcing of medical services (e.g. medical transcribing, radiology, billing support similar to other businesses) Acquisitions and consolidations in the pharmaceutical industry Movement of health professional labor across national borders Medical tourism; competition for international patients Immigration and global workforce Global health pandemics (e.g. HIV/AIDS, Avian flu, SARS) Comparative Health Systems and Health Reforms

Health Services Elements


Resources Physical Resources, (hospitals, clinics, privatepublic, Ambulatory services) Equipment/Technology, Medicines Human resources (Education, health manpower, Incentives, training, continuing education, Physicians, nurses, technicians and emerging professions) Financial Resources (Resource allocation, budgets, financial schemes, reimbursement, insurance mechanisms)

Health Services Elements


Health Services Primary/Secondary health care. Systems. Management Information Systems Clinical Standards and Protocols. Safety Issues. Quality Assurance and Quality Improvement Legal aspects (malpractice) Incentives, Performance management. Cost or services Efficiency, clinical & Management efficiency Effectiveness, Health Impact and outcomes

Types of Health Care Services


Traditional, spiritual, empirical Charitable and altruistic organizations Entrepreneurial Private practice Welfare-oriented, social insurance Government and centrally planned Prepaid voluntary insurance Owned by industry for their workers

Origins of Health Care Systems


England. Chadwick report on laboring conditions. Boards of Public Health (1850). Mandatory Insurance for workers (1911) Welfare State Beveridge Report (1942), NHS (1948) Germany. Bismarck, Mandatory insurance for injury and illness (1883) Central Planning Concept: Semashko. (1923) Mixed Systems from tax-free health care in Saudi Arabia to combination of public-private

Health Sector Reforms Around The World

Balance the Iron Triangle (Access-Quality-Cost) Reorient MOH (make them smaller or more functional, performance, accountability, modernization, separate provision from financing, competition, Chronic-Acute Care) Institute user charges-Accountability Institute or expand health insurance schemes Decentralize-Empowerment Third party Contracts with private/public providers

Sustainability:
The capacity of health services to function with efficiency, including the financial, environment and social interaction that guaranties an effective service now and in the future, with a minimum of external intervention and without limiting the capacity of future generations to fulfill their needs.