pna 2012 national convention lecture

7/30/2019 PNA 2012 National Convention Lecture

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PHILIPPINE NURSES ASSOCIATION

90th Foundation Anniversary

55th Nurses Week Celebration

and National Annual Convention 2012

Plenary Session III:

Models of Health Care

Theme: Inspiring the Filipino Nursing Workforce towards Equity and Access to Health

Care

Josephine D. Lorica, RN, DPA

Faculty, School of Health Sciences

St. Paul University Phils.Tuguegarao City


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Session Objectives

1. Describe the four basic models of health care

system relating this to equity and access to health

2. Discuss the social model of health and its goal of

preventing and reducing illness and addressing

inequalitites and disadvantage that exist within

the community.

3. Discuss challenges and opportunities of nurses in

the present model of health care system in the

Philippines.


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Health is a basic human right!

The Universal Declaration of Human Rights

The General Assembly of the United Nations

adopted and proclaimed these principles in 1948

Article 25

Constitution of the Philippines

Article 2 Section 15


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Health Care System

Consist of

individuals and

organizations

designed to meetthe health needs of

target populations


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.. the measure of a responsive and effective

health system is its ability to contribute togood health. (WHO, 2000)

- main function of the national health care

system is to promote health among the

countrys citizens (McKinsey & Company,2006)

Health Care System


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Each nations health care system is a reflection

of its: History

Politics

Economy

National values

They all vary to some degree

However, they all share common principles

There are four basic health care models

around the world

Health Care System(Sibu Saha)


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Almost 200 countries in the world but only

about 40 of those are organized, rich andindustrialized enough to have a developed

health care system

Health Care System


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four basic models of health care

system (Reid, 2009)

1. The Beveridge Model

2. The Bismarck Model

3. The National Health Insurance

Model

4. The Out-of-the Pocket Model


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Named for William

Beveridge Social reformer who

designed Britains

National Health Service

(NHS)

The Beveridge Model


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The Beveridge Model

Health care provided and financed by

government through tax payments

Most hospitals and clinics are owned by the

government

Some doctors are government employees;

some private doctors collect their fees from

the government


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The Beveridge Model

British people never get a doctor bill

Medical treatment is public service

Beveridge systems tend to have low cost per

capita because government controls whatdoctors can charge


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The Beveridge Model Countries using Beveridge Plan or variations

from it: Great Britain, Spain, Scandinavia, New Zealand

a. Hongkong has its own Beveridge style system

since populace refused to give it up when Chinatook over in 1997

b. Cuba represents extreme application of

Beveridge probably worlds purest example oftotal government control


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The Bismarck Model

System named for

Prussian ChancellorOtto von Bismarck

Invented welfare state

as part of Germanys

unification during 19th

century


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The Bismarck Model

System uses insurance system

Insurers are called sickness funds

Private insurance system usually financed

jointly by employees and employees through

payroll deductions


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The Bismarck Model

Providers and payers are private

Health insurance plans have to cover

everybody

a. Multi-payer modelb. Does not make a profit

Tight regulation of medical services and fees(cost control)


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The Bismarck Model

Countries using it:

Germany, France, Belgium, The Netherlands,

Japan, Switzerland, and to a degree Latin America


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The National Health Insurance Model

Single payer system has elements of both

Beveridge and Bismarck

Single payer systems tend to have more

market power to negotiate lower health care

prices

Uses private sector providers, but payments

come from a government-run insuranceprogram that every citizen pays into


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No need for marketing because there is no

financial motive to deny claims and profit

National insurance collects monthly premiums

and pays medical bills


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NHI plans also control costs by:

1. limiting medical services they will pay

for or2. by making patients wait to be treated


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Countries using it:

Canada, Taiwan, South Korea


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The Out-of-the-Pocket Model

plan used by most nations because they are

too poor and too disorganized to provide anymass medical care

no system countries


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Most medical care is paid for by the

patient, out-of-pocket

No insurance or government plan

The Out-of-the-Pocket Model


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In these poor countries, only rich can affordmedical care

a. Rural regions of Africa, India, China andSouth America, hundred of millions of peoplego their whole life without ever seeing adoctor

b. Tend to rely on village healers and home

remediesc. May pay a doctors bill with potatoes or

other produce

The Out-of-the Pocket Model


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COMMON PRINCIPLES OF ALL MODELS Coverage

Coverage for every resident (old or young, rich or

poor)

Moral principle of all developed countries

Every country rations care not everything is covered!

Quality

Other developed countries produce better quality

results.


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Cost

All other systems are cheaper except OOTP

Foreign employers pay far less for health coverage

Effect?

Choice

Many countries offer greater choice

COMMON PRINCIPLES OF ALL MODELS


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the health of individuals and communities is

seen as the result of complex and interactingsocial, economic, environmental and personal

factors

The SOCIAL MODEL of HEALTH


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The Social Model of Health

Carefully considers the wider determinantsof health i.e. the range of factor thatimpact on peoples health and well being.


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Social Model of Health

(Dahlgren & Whitehead, 1991)


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Dahlgren and Whitehead (1991) talk of thelayers of influence on health. They describe a

social ecological theory to health.




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The first layer is a personal behavior and ways

of living that can promote or damage health.

eg. Choice to smoke or not individuals are

affected by friendship patterns and the norms

of their community.




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The next layer is social and community inunfavorable conditions, but they can also

provide no support to have a negative effect.




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The third layer includes structuralfactors: housing, working conditions,

access to services and provisions of

essential facilities




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Individual and community

experience and knowledge becomes

relevant empowered

Health becomes a social

phenomenon




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PHILIPPINE HEALTH CARE SYSTEM

Health development effort have aimed to

address the problem of inequity for almost 4decades

1979 Selective PHC implementation

1992 Devolution of health services

2000 health sector reforms

2005-2010 National objectives for health 2011-2016 Kalusugang Pangkalahatan


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Stated Objectives of our Health System

2005-2010 (National Objectives for Health

2010 Monograph)1. Better health outcomes

2. More equitable financing3. Increased responsiveness and client

satisfaction


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2011 2016 Kalusugang Pangkalahatan

Main Goal:

Achieving Universal Health Care

Stated Objectives of our Health System


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Goal of the Health System the main function of the national health care

system is to promote health among thecountrys citizens (McKinsey & Company,

2006),

this does not remain to be just health; it has

to put at the end view the equity, efficiency,

effectiveness of the chosen paths (WHO,

2007).


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Extent of the Goals being Achieved?

(WHO, 2011)

Improvement in the delivery of public

health services -> improved overallhealth outcomes

BUT PROGRESS towards the health MDGsappears to have slowed


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Regulations of goods and services hasbeen strengthened

BUT commercial interests continue todominate regulatory processes


(WHO, 2011)


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(WHO, 2011)

DESPITE strong efforts in the

implementation of Philippine HealthInsurance Law, OUT-OF-THE POCKET

costs have continued to increase


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Reforms in the governance continue to

be stymied by a flawed Local

Government Code -> increasedfragmentation in the management of

health services


(WHO, 2011)


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Philippine Health Care SystemsEQUITY

ACCESS TO SERVICES is limited by

financial and social barriers

Low coverage rates found in poorestquintiles of the population, among rural

areas and among families with

uneducated mothers


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Disparities in the distribution of human

and physical resources

Utilization patterns are affected byfinancial barriers, negative perceptions

about quality of care and lack of

awareness of services

Philippine Health Care SystemsEQUITY


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Philippine Health Care SystemsCOST

Public financing levels have steadily increased,

however remain low in regional terms High and steadily increasing out of the pocket

spending exposes large financial risks from

illness

PhilHealth is only financing about a tenth of

the countrys total health expenditure


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Philippine Health Care SystemsALLOCATIVE AND TECHNICAL EFFICIENCY

More health resources are spent on personalcare than public health

Drug expenditure consume 70% of out-of the

pocket expenditures and are largely spent on

heavily marketed non-essential and mostlyineffective medicaions


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Health facilities and human resources areconcentrated relatively affluent areas

Devolution of health service widened the gap

in health resource allocation

Health workforce production is geared

towards a perceived lucrative international

market rather than national health needs



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National government facilities providing

expensive tertiary care have budgets that are

disproportionately high in relation to localprimary care programmes

NHIP also follows the trend by favoring

hospitalized care



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Philippine Health Care SystemQUALITY OF CARE

Efforts to improve quality are typically adhoc

and uncoordinated due to lack of data onquality and the lack of incentives for best

practice

Most hospitals and professional practitioners

meet the quality standards set by licensing

requirements and PhilHealth accreditation

standards

hili i l h


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Data on quality outcomes are few and

unreliable Primary care facilities and lower level hospitals are

bypassed perceptions of low quality

SOLUTION PERFORMANCE INCENTIVES INCREASING CLIENTS VOICE THROUGH

EFFECTIIVE CONSUMER PARTICIPATION

STRATEGIES

Philippine Health Care SystemQUALITY OF CARE

Phili i H l h C S


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Philippine Health Care System HEALTHIMPROVEMENTS

Noticeable health outcomes in communicable

disease control, and child health programsbecause of substantial participation of

national government and strong coordination

with LGUs while adverse health results wherenational policy is not directly supportive of

LGU action

Phili i H lth C S t


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Major weakness failure to address the

large disparities in health outcomesbetween the rich and the poor

Philippine Health Care System HEALTHIMPROVEMENTS


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The PHCS model is basically out of pocket for most

of the population except for theemployed which is similar to the

German(Bismarck) model.


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The coverage of Philippine HealthInsurance Corporation is too limited to

be considered as a national healthinsurance program as what exists in

Canada.

In the PHCS


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What nurses can do? - Opportunities

Personally, each registered nurse should workand save for his/her own health care needs

as one grows older, ones saving must also

grow.


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Call for A Nurse in every Barangay

- to implement primary health careconcepts and principles

Each registered nurse to implement and utilizethe social health model in their practice, make

each one or each family /community

empowered


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Empower the community through:

Community-based health care financing or comeup with a sustainable health care financing

health and wellness promotion action


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Conduct Researches consumer feedback of

stakeholders; quality data for utilization ofservices , evidence-based health promotion

strategies and or come up with a system that

is based on health needs of our country Participate in health systems analysis and

research


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All nurses need to do their social

responsibility from providing their basichealth skills to referral,to being actively

involved in the community (Barangay

Nutrition Committee, Community Health

Council etc.) , and to being advocates for

the community people


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Empower ourselves by:

Social marketing showing what we can do

Lobbying for a more innovative and

evidenced-based information models that

nurses can implement

Stronger nursing role in health policy

enter politics? Or become involved in policyand decision making



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So, CAN WE DO

SOMETHING FOR OURCOUNTRYS HEALTH CARE

EQUITY AND ACCESS?

pna 2012 national convention lecture

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