Health Care System

HEALTH POLICIES

Are expressed in a whole series of practices, statements , regulations and laws which are the results of

decisions about how we will do things. Policies can be:-

1. Laws

2. Documents

3. Procedures

4. Guiding principles

5. Working frameworks

6. Rules and regulations

7. The intention of the policies.ex:- the written vision , goals objectives and plan to develop activities

8. To whom policies is belong to:- Government , Institute , Organization , Department.

 Types of health policies
• 1. normative or empirical:-it monitors the practices of the present and the record of the past.

• Substantive:- it is concerned with the legislation , programs and practices that the govern the

substantive aspect of communities works, like provision of education , economic stabilization

law , orders enforcement , anti pollution law etc.

• Administrative :- this involve the collection of statistical information and evaluation of

complex community programs.

• Proactive:- are introduced and pursued through deliberate choice.

• Reactive :- it emerge in response to a concern or crisis that must be address.

• Vertical :- it is developed with in the organization that has responsibilities for its

implementation.
 Health care System

• It is the institution and organization wherein health care and services is delivered to the

patients. it includes full range of players engaged in provision and financing of health

services. It including the public , nonprofit and profit , private sectors and voluntary

organization involved in the funding or implementing health activities

Health System functions

Stewardship

Creating Delivering
resources , Services
investment
and training

Financing

( collecting ,
pooling and
purchasing)
 Stewardship

• Government play the role of steward because it spend revenue that people pay through

taxes , social and private insurances. Government makes many of the rules and

regulations that steward or govern the operation of health services.

• Government exercise their stewardship function by developing , implementing and

enforcing policies that affect the other health care system.

• The one of the primary role of the health ministry is to develop health sectors policies

with the aim of improving health system performance.

GOVERNMENT POLICIES RELEVANCE
Health System TO HEALTH PROGRAMS
1. The size of total government health budget. 1.It shows over all limits of the government spending
on health

2. Financing mechanism for health care 2. It shows the government flexibilities for financing
system. health care and identified financial barriers

3. Allocation of government health budgets 3. It reflects how government used its resources to
deliver health services.

4. Political support to raise awareness for 4. Can be powerful for polemic health initiation ( hand
specific health messages and behavior. washing).

5. Adoption of specific health standards and 5. Can improve the quality of care.
guidelines

6. Regulation on pharmaceutical 6. Can improve the quality of medicines and rational use
of medicines.

7. Business regulation and taxation 7. Can influence the degree to which the private sectors
participates in health care.
Ex:- limitation on advertising can limit the promotion on
branded health products.
 Tele Health

• The covid -19 situation has caused health care system around the world to rapidly and

some cases radically rethink the delivery of medical care.

• The global expansion of tele health is the solution of this health issue. Tele health refer

to the delivery of health where patients and health providers are separated by distances.
 Benefits of Tele Health

• Improving access to health care services.

• Risk mitigation

• Convincing and flexibility.

• Reduction of overhead cost.

 Disadvantages of tele health

• Its implementation and adoption can be time consuming.

• Additional care can be taken during the transfer of patients health information.

• Due to the covid-19 emergency each and every country government have to think about

the importance of tele health.

• Most of the countries has been adopted tele health but with the expiration date depend

on the duration of covid-19 pandemic.

 Australian Tele Health

• From 30 march 2020 , in the response of covid-19 pandemic ,tele health determination

came into force. Under tele health determination , a rage of health care services

delivered through tele health that previously not given by tele health..the services has

been delivered to the patients by telephone and video conferencing where patients are

distant from health care providers. It is not conformed that which types of health

services are being given to the patients , it only doctors will decide the types health

services will deliver to patients and it is provided through specific software like e-health

application which can be certified by TELEMED Australia.

 Belgium Tele Health

• Reimbursement of tele health applied only for such medical services like triage and

advice regarding covid-19 infections.

• The assignment of degree of

Occupational Disease
 Definition

• Occupational disease occur among workers exposed to a specific hazard. eg:- lead ,

pesticides. Occupational diseases occur as a result of exposure of physical , chemical ,

biological or psychosocial factors in the work places. Like:- silica in workplace cause

silicosis which is a lung disease.

 Majors categories of occupational illness by organ
system.
• Musculoskeletal disorder

• Respiratory disorders

• Neurologic disorders.

• Skin disorders

• Reproductive disorders

• Cardiovascular disorders

• Hematologic disorders.

• Hepatic disorders

• Renal disorders
 Occupational diseases factors
Physical Heat , noise , radiation

Chemical Solvents , pesticides , heavy metal and dust

Biological Tuberculosis

Ergonomic Repetitive motion , improper designed tools at work areas.

Psychosocial stress Lack of control over work , inadequate personal support.

Mechanical mainly cause accidents and injuries.

 Types of Occupational Diseases
WORK RELATED DISEASES OCCUPATIONAL DISEASES

Occur largely in the communities Occur mainly in work places

Multifactorial in origin Cause specific

Exposure at work places may be a cause Exposure at work place is essential

Having low oxygen levels in blood is called hypoxemia and low oxygen levels in tissues called
hypoxia.
 Health System
Occupational Diseases

Asbestosis •Heat resistance silicate fibers used for fire proof insulating materials.
• affect parenchyma tissue of lungs.
•Symptoms:- dyspnea , reduction of lung volume , hypoxia , lung cancer.
•Diagnosis:- history, physical examination, x-ray , ct scan and lung biopsy.
•Treatment :- broncho-dilators , oxygen therapy , nebulization etc

Pneumoconiosis Occupational disease caused by inhalation of dust.

Types :- coal workers pneumoconiosis , asbestosis , silicosis , siderosis:-
lung disease caused by breathing in fine particles of irons. Byssinosis :-
lung disease caused by breathing in fine particles textile fibers dust.
Diagnosis :- x-ray , ct scan , lung biopsy etc.

Acute contact Your skin become dark , red , itchy etc

eczema

Chloracne A skin disease cause by the exposure of chlorinated chemical.

 Preventing occupational diseases

• Substitute of non – hazardous substances in place of hazardous substances in work

places.

• Installation of engineering controls :- eliminate or reduce exposure to a chemical or

physical hazard through the use of engineering tools and devices.

• Job redesign work organization changes.

• Education and advices to the workers related hazardous substances using at work places.

• Personal protective equipments.

 Three Levels Of Preventions
PRIMARY In design to avoid the occurrence of disease
or injury.

SECONDARY Is designed to identified and adequately

treat a disease or injury as early as possible.

TERTIARY Is designed to treat a disorders when it has

advanced beyond its early stages to avoid
complications and limits disability.
TYPES OF HEALTH INSURANCES IN
THE WORLD
 Health insurances delivered by countries

• United state of America health insurance

• Population :- 325.7 million

• Population at the age of 65+ :- 16%

• 2.6 practicing physician / 1000 population.

• 4 average physician visit s/ person

• 11.7 nurses / 1000 population

• $10,586 health care spending /capita

• $1122 out of pocket health spending / capita

• 78.6% life expectancy rate at birth

• 40% obesity and 28% adults with multiple chronic conditions.

 United state of America health insurance
• The federal government funding for national Medicare programme for adults with 65 and + , some
people with disability as well as for veterans and low income groups under Medicaid and children
health insurance programme( chip).
• Insurances coverage:- total :- 91.5%
• Public( Medicare , Medicaid , chip , military :- 34%
• Private ( employees plan , direct purchase:-67.5%
• HEALTH CARE DELIVERY AND PAYMENT
• Primary care practitioners works mostly in private and paid through private insurances, capitations
and some public insurances. 66% primary care practices revenue come from fee for services .
Specialists work in outpatients private practice or hospitals out patients specialists can choose
which form of insurances they can accepts because public health insurances have low
reimbursement rate set by Medicaid and Medicare.
 Direct Services Programme
• Federal , state and local government fund numerous programmes that direct

provide health services to vulnerable population. Many of these programmes

received private fund and donations to support their operation.

 Federal Qualified Health Center
• These health centers are located in medically underserved areas and provide primary

care services to individuals as a sliding fee scales means patients have to pay health

services on the basis of their incomes sources.

• HIV/AIDS Services:- the ryan HIV/AIDS program works with states , cities and local

organizations to provides health services who do not have health insurance coverage's.

• Family Planning Services:- title x of the public health services act provide federal funding

for families planning services offer to a women who do not qualified for Medicare or

Medicaid.
 Health system

• Around 40% populations do not have health insurances due to expensive and people

living under poverty line. Medicaid and CHIP provide extensive coverage to low income

children that by adults can not get access of it because young become uninsured when

they transfers from school to workplace.

 Three types of health insurances found in other countries

• 1. A national health insurance:- system which is public financed but in which care is

provided by private practitioners( Canada).

• 2. A national health system:- which is publically financed where health care is provided

to the government employees or contractors( Britain).

• 3. A social insurance systems:- that is financed through mandatory contribution by

employees and employers and in which care is provided by private

practitioners( Germany).
 Social Health Insurance System

• Canada health system called Medicare, it is decentralized with Canada provinces and
territories responsible for setting up their own delivery systems. The provinces and
territories set their own policies regarding many healthcare and social insurances.
Reimbursement directly through regional health authorities. The federal government has
responsibility for specifies health areas such as prescription drugs , public health , health
research and providing care to certain population( veterans and indigenous people).

• Medicare Health Insurance:- to qualified this insurance , salaries should not be higher
than $1357 to $1823 for a married couple. Age should be 65 or + , younger people with
disabilities and end stage of renal disease. Medicare are divided by two:- A hospital
insurances B Medicare insurance.
Government roles in health care
 Indian Social Health System

Out of pocket health expenditures( %)

2000 71 2001 74
2002 73 2003 73
2004 72.4 2005 73.1
2006 72.2 2007 70.8
2008 69.1 2009 66.7
2010 65.1 2011 62.2
2012 62 2013 69
2014 67 2015 64.1
2016 63 2017 62
2018 62.6
 Characteristics of Social Health Insurances

• Targets the formal sectors.

• Is provided by a compulsory pay roll tax.

• The premium is usually income related .ex:- the lower employees contributes a smaller

premium than higher employees.

• the classical example of social insurances in the German and Belgium health insurances

systems where employees and employers contributes to a mutual fund and used it to

finance health care for the entire population. Citizen have to enroll one of the mutual

fund . The government provide help to those who are not able to contribute. Vietnam ,

Philipines have been stated SHI in their countries. Philipines covered almost 50% of their

populations.
 Indian Social Health System

• Social health insurances are as follows:-

• 1. employees state insurance scheme:- it stated in 1948 and it provides both cash and

medical benefits.

• Low paid workers of the formal sectors specially industrial.

• Salary less than 10,000 ($200).

• Both employees(1.75%) and employers(4.75%) of their payroll.

• It covers outpatients and inpatients and rehabilitation.

• Managed by employees state insurance committee.

• Covered 47 million population.

 Indian Social Health System

• 2. Central Government Health Scheme:-

• Introduced in 1954.

• Covered central government employees and their families.

• Beneficiaries included both current as well as formers government employees.

• Government staff have to contributes nominal amount($5 per month).

• Benefits in both out patients and hospitalization.

• It covered 4 million populations.

• 18% of govt. budgets used for government servants who contribution is only 0.4% of

population.
 Indian Social Health System

• 3. Community Health Insurance:- it divide into three parts:-

• 1. providers models:-Money directly collected from the communities and provided to

the hospitals for health care delivery to the communities.

• 2. Insurer Model:- wherein NGO collect money from the societies and that money use to

provide health care treatments for those who can not afford health expenses in the

communities.

• Linked Model:- wherein fund collect from industries and communities by NGO and it

used to provide health care services for those who can not afford health treatments

expenses.
 Indian Social Health System

• Rashtriya Swasthya Bima Yojana:- it provide $7000 health insurance for those who are

under low poverty line. This scheme provide smart card with the assistance, card holder

can avail health insurance once in a years.

• 30 million families are covered by the rashtriya swasthya bima yojana.

• Total 85 million are having health treatments benefits under social health insurances

scheme in India and it is on increasing trend.

 Social Health Insurance System

• It is the form of financing health care. It considered as prospective financing where

funds are pooled or collected in advanced , mainly in the form of monthly contribution ,

from insurance fund managers . Employees , employers and the government. it address

inequalities in health financing wherein healthy pays for the sick and those who can not

afford medical care.

• ADVANTAGES:- can improve equality , mobilize financial resources for health care , low

administration cost , can control health expenditures inflations.

• DISADVANTAGES:-require knowledge and organization to handle it properly , can not

provide universal coverages.

 Implementing SHI for universal health coverage

• Governance:- enact adequate laws and other legal provisions.

• Membership management:-bring alll population groups with in the fold of SHI.

• Fund management:- determine needed fund and set contribution to insure

sustainability.

• Benefits Design:- define benefits packages and identify who pay for what.

• Providers managements:- accredit providers to ensure quality and contract with them

using adequate payment mechanism.

• Information management:- established HMIS , organize providers reporting and

institutionalize monitoring.