Introduction to Comparative Health Care Systems

Lecture 3Tracey Lynn Koehlmoos, PhD, MHA

HSCI 609 Comparative International Health Systems

Overview

• Define Health

• Define Health Services System

• How can we compare?

• Why should we compare?

Defining Health

• WHO:– Health is not merely the absence of disease,

but the state of physical, mental and social well-being.

Fundamental conditions for health:

Peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice, equity

Determinants of Health

Physical Environment Social Environment

Access to Health Services

Physical and Mental Well-Being

The Iron Triangle or the Holy Grail?

All nations struggle tobalance access to healthcarewith quality and cost efficiency.

Is there one perfect solution for all nations?

Health Care in General

• Health status is central to quality of life• In every advanced country, healthcare is

the largest economic activity—consuming between 5% and 16% of the GDP.

• Health services workforce >10 % of all workers in most OECD nations.

• All countries are engaging major healthcare reform with an emphasis on cost efficiency.

Common Challenges of Developed Nations

• Aging population—Europe, USA, Japan– 30-40% of consumption in some countries– Need for long term care

• Indigent citizens—how to include everyone

• Incorporating technology– Rationing expensive procedures– Overuse in some countries

• Rising costs—What GDP % is too high?

Defining a Healthcare System

The combination of health care institutions, supporting human resources, financing mechanisms, information systems, organizational structures that link institutions and resources, and management structures that collectively culminate in the delivery of health services to patients. (Anderson, 1989a)

DELIVERYOF

SERVICES

ORGANIZATION OF

PROGRAMS

MANAGEMENT

ECONOMICSUPPORT

RESOURCEPRODUCTION

Roemer ModelOur definition of a

healthcare system lends itself to the use of the Roemer Model

Components to Compare

• Organization of the Program• Management of Health Services System• Economic Support of Health Services• Production of Health Services Resources• Delivery of Health Services

• Not in the Roemer Model—but look for the use of Information Systems and advanced technology!

Paradigms for Comparison• National Health Service Model (Beveridge):

– Universal coverage, tax-based financing– National ownership of production

• Social Insurance Model: (Bismarck Model)– Universal social security (employer, employee

taxes)– Public/Private ownership of production

• Private Insurance Model:– Employment-based private insurance– Private ownership of productionNO ABSOLUTES, VARIATIONS IN ALL APPLICATIONS!

Major Influences on Systems

• Environmental Influences• Historical Record• Demographic Influences• Economic Influences• More: Cultural, Political, Social Influences

• Public Health and Disease Prevention—What makes the population need health services? (Lifestyle, pollution, unsafe?)

Health Outcomes to Compare

Infant Mortality

Life Expect

Male

Life Expect

Female

Canada 5.3 76.3 81.7

Japan 3.6 77.6 84.6

UK 5.8 75.0 79.8

US 7.2 73.9 79.4(1997-2000)

Value of International Comparison

• Understand and appreciate common healthcare problems

• Understand how characteristics of the delivery system impact population outcomes

• Impact of mental illness on culture

• Comparative strategies for reform and increasing quality and containing costs

Conclusion• There is no “Gold Standard” for health

services systems just the ability to adapt, reform and learn.

• Werner Christie (Norwegian MoH) said, “The whole healthcare system is futile, as the average death rate is still 100%”

• This course should teach you about the range of possibilities and give you tools to apply in your own life and work.