Slides - Issues and Perspectives Health Policy - Master Health

Issues and Perspectives
Health Policy
Policy in Health Services

Management
Tuesday, June 29, 2021 1

PERSPECTIVES ON HEALTH
POLICY
Major Problems in Health Care
Economic Perspective
Political Perspective
Sociological Perspective
Epidemiological And Public Health
Perspectives

Fragmented responsibility for health
financing
Continuing conflict between government
and health professionals
Conflict between various health
professional groups

A lack of consensus about and
coordination of, the roles of the Public and
Private Sector
Concern about the equity of the system
Large and often unexpected out of pocket

expenditure
A continuing heavy emphasis on

institutional care
Inefficiency in the provision of hospital

care
Lack of coordination of hospital services

A continuing relative lack of prevention,

health promotion and community health
services
A lack of information about the quality of

health care

The proliferation of untested and often

expensive medical technologies
Large differential in health status between

the various socio-economic groups

Increase in the use and cost of health care

services
Heavy reliance of high levels of labour
Shortages of staff

Marked variation in the rates of provision

of some hospital based medical and
surgical services between residents of
different geographical areas

Limited involvement of staff and

consumers in policy making, research and
service delivery
Perception that provider interests are

dominant

Frequent reorganisation of the health

authorities and innumerable reports on the
system - with little evidence of any
improvement in efficiency or health status

Considerable demoralisation among

doctors, nurses and other health services
professionals, and extensive distrust of
health bureaucrats and officials

PERSPECTIVES ON HEALTH
POLICY
PERSPECTIVE DOMAIN KEY ISSUE MAIN CONCEPTS
Economic The Economy Efficiency Demand /

Supply
Political Politics Policy Making Reform/ Stability
Sociological Society Equity Dominance/

Subordination
Epidemiological Disease Effectiveness Morbidity/

Mortality

Health economists are chiefly concerned

with examining the determinants of health
service utilisation and expenditure

Within a framework of scarce resources

and competing objectives economist
depend heavily on two basic concepts
Demand And Supply

A major difference between healthcare

and other commodities is that the former is
demanded by consumers because of the
expectation that it will promote health
status

A further important difference between

healthcare and other commodities is that
the customer is generally lacking in
knowledge of the relationship between
health service and desired outcome of
better health status

The provider of health care will have much

more knowledge than the consumer of the
likely impact on health standards

Healthcare also differs from most other

commodities because the onset of illness,
disability or trauma is unpredictable for
any individual.

At any point in time the prevalence of

disease and the risk of heavy financial
outlays are very unevenly distributed
across the community

Health-care utilisation is characterised by

the presence of effects external to the
individual consumer

The conceptualisations of health care as a

commodity, a perspective derived
principally from the work of economists
helps us understand the basis for many of
the distinctive aspects of health systems
and policies associated with them

The economic perspective casts serious

doubt about any attempt to explain the
workings of the health-care system by
reference to a simple demand and supply
model of the kind that many economists
and politicians find appealing

POLITICAL PERSPECTIVE
The distribution of health standards varies

widely between different groups
When these are defined by factors such

as socio-economic status and geographic
location

Policy is often the outcome of conflict
between 3 major groups
Professional Monopolies
Corporate Rationalisers
Community Interest

PROFESSIONAL MONOPOLIES
Principally the medical practitioners who

have been able to secure the exclusive
legal rights to undertake a range of
diagnostic and therapeutic activities

CORPORATE RATIONALISERS
Health planners, administrators, and other

health professionals including those with
medical qualifications whose interests are
served by the promotion of the greater
efficiency, effectiveness and equity in the
provision of health services

COMMUNITY INTEREST
A variety of organisations and agencies,

often representing single client groups,
who have in common their desire to
improve the health care available to the
community

The role of government in health policy is

often to balance the demands and
expectations of these various groups

SOCIOLOGICAL PERSPECTIVE
Sociologists are concerned with equity,

that is, with fair and just treatment

The medical profession dominates

healthcare by enjoying professional
anonymity, that is, freedom from outside
scrutiny, through authority over other
health occupations and by sharing
societies belief about healthcare problems
and how they should be managed

The medical profession autonomy is

strengthened further by the fact that it has
traditionally enjoyed A legally supported
monopoly over clinical practice

Professional autonomy has important

implications for health policy because it
doctors who have the major influence on
the type of health care we receive

Increasingly health care policy analysts

will be involved with ethical considerations
on resource allocation

The power relationship between doctors

and patients be crucial in this debate

EPIDEMIOLOGICAL AND PUBLIC
HEALTH PERSPECTIVE
Epidemiologist study the determinants of

incidents and prevalence of disease.

HEALTH PERSPECTIVE
Their concern will be with the recurrence,

transmission, control and natural history of
diseases and risk factors

HEALTH PERSPECTIVE
Their policy debate will place emphasis

on a totality of endeavours including
those that impact on other systems such
as housing, and social welfare activities
that effect communities rather than
individuals

SUMMARY
These disciplines can be viewed as

cultural constructions produced by
different groups of individuals and
organisations rather than reflections of
distinct domains of social reality.

SUMMARY
A balanced approach to health policy

analysis must be multidisciplinary and
requires input from all of these
perspectives in order to accommodate the
complexities of the problems being
addressed.

SUMMARY

Economic Perspective
Political Perspective
Sociological Perspective
And Epidemiological And Public Health
Perspectives

SUMMARY
Perspective Domain Key Issues Main Concepts
Economic The Economy Efficiency Demand And

Supply
Political Politics Policy-making Reform/Stability
Sociological Society Equity Dominance /

Subordination
Epidemiological Disease Effectiveness Morbidity /

Mortality

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Issues and Perspectives

Policy in Health Services

Tuesday, June 29, 2021 1

Tuesday, June 29, 2021 2

Tuesday, June 29, 2021 3

Concern about the equity of the system

Large and often unexpected out of pocket

A continuing heavy emphasis on

Inefficiency in the provision of hospital

Lack of coordination of hospital services

A continuing relative lack of prevention,

A lack of information about the quality of

Tuesday, June 29, 2021 6

The proliferation of untested and often

Large differential in health status between

Tuesday, June 29, 2021 7

Increase in the use and cost of health care

Heavy reliance of high levels of labour

Tuesday, June 29, 2021 8

Marked variation in the rates of provision

Tuesday, June 29, 2021 9

Limited involvement of staff and

Perception that provider interests are

Tuesday, June 29, 2021 10

Frequent reorganisation of the health

Tuesday, June 29, 2021 11

Considerable demoralisation among

Tuesday, June 29, 2021 12

Economic The Economy Efficiency Demand /

Political Politics Policy Making Reform/ Stability

Sociological Society Equity Dominance/

Epidemiological Disease Effectiveness Morbidity/

Tuesday, June 29, 2021 13

Health economists are chiefly concerned

Tuesday, June 29, 2021 14

Within a framework of scarce resources

Demand And Supply

Tuesday, June 29, 2021 15

A major difference between healthcare

Tuesday, June 29, 2021 16

A further important difference between

Tuesday, June 29, 2021 17

The provider of health care will have much

Tuesday, June 29, 2021 18

Healthcare also differs from most other

Tuesday, June 29, 2021 19

At any point in time the prevalence of

Tuesday, June 29, 2021 20

Health-care utilisation is characterised by

Tuesday, June 29, 2021 21

The conceptualisations of health care as a

Tuesday, June 29, 2021 22

The economic perspective casts serious

Tuesday, June 29, 2021 23

The distribution of health standards varies

When these are defined by factors such

Tuesday, June 29, 2021 24

Tuesday, June 29, 2021 25

Principally the medical practitioners who

Tuesday, June 29, 2021 26

Health planners, administrators, and other

Tuesday, June 29, 2021 27