1 Health system.pptx.................................

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1. Health management IV study year Study program : Medicine Health system

2. "[ As a doctor] people will trust you, confide in you, and appreciate your efforts. You can do amazing things for people if you don’t let the system get you down." ― Wes Fischer, MD via Kevin MD

3. The health system is one of the few subsystems that works to protect people's health from birth to death. It is important and responsible for the health of individuals, families and communities. The health system as a part of the general social system developed following the general social and economic development, the development of thoughts and knowledge. If we look at all the social and environmental factors that can contribute to or affect the state of health, we can find a strong connection between the health system and many other systems - agriculture, industry, education, etc. Health systems are systems that include all organizations, institutions and resources that are committed to undertaking health actions (WHO, 2000). Health action is defined as any effort, whether in personal health care, community health service, or through a cross-sectoral initiative, whose primary intent is to improve health. Health system

4. The structure and functional connection of the health system of any country can be analyzed from the aspect of the existence of 5 components that are directly or indirectly connected to each other. Five main components of a simplified model of a health system: Development of health resources (staff, capacities, equipment) Organized arrangement of resources (national authorities, insurance) Provision of health care (levels of health care) Economic aid (funding sources) Management (leadership, decision-making, regulation). Components of Health system

5. The three main goals of the health system are: Improvement and preservation of people's health Responsibility for people's expectations and demands for health care Fair financial contribution - people's contribution. The healthcare system can do more harm than good if: Poorly structured, Poorly managed, Inefficiently organized, Inadequately funded. Goals of Health system

6. Primary/peripheral level The health system is usually organized at different levels: it starts at the (most) peripheral level, also known as the community level, communal level or primary health care level, which extends through the intermediate level (county, canton, region, province), all the way to the central level. At the same time, the peripheral level includes individuals and families who have an active interest and participate in solving their health problems, thus becoming equal members of the health care team. Levels of Health system

7. Secondary and tertiary Intermediate and central levels implement those elements, activities and services of the health system that are approved by the administration of the respective country. Both of these levels also provide progressively more complex and specialized support. Primary health care, which consists of at least basic elements, should be implemented at the point of first contact between individuals and the health system. Other levels of the health system (often called referral) should help the first contact (primary health care level) to implement all these basic elements continuously. Levels of Health system

8. Graph. Levels of health system

9. The higher referral system (of patients and problems) must be developed so that the first referral level is not overloaded with problems that could be dealt with in primary health care in the community so that patients are returned to their senders, with notification on the measures taken, with suggestions for further procedure (treatment). Mechanisms and procedures should be developed and evaluated so that the referral system can function effectively. Levels of Health system

10. Considering that the countries in the world developed differently and had their own development characteristics, this affected the fact that the health systems in the world also developed differently. It can almost be said that there are no identical health systems in the world and that each has its own specificities and characteristics . If one wanted to group health systems by some common characteristics and determine their types, then it could be done in the following ways: D ivision and characteristics of health systems

11. According to the level of economic development of the country (d eveloped countries, developing countries, underdeveloped countries, countries in transition ) According to the organization of the health system (m odestly organized, m edium organized, w ell organized ) According to the application of management and its main functions (planning, organizing, monitoring, decision-making, leadership, coordination, implementation laws and regulations ) According to the characteristics of the socio-political system According to functioning/performance According to types of health insurance (s ocial /national (fund, contributions, fees), p rivate , c ombined ) According to periods of development D ivision and characteristics of health systems

12. National Health Service System – Beveridge Model, Social security system – Bismarck's model, Semashko's model (1918) of the national health system Private insurance system – model of “independent” or “ sovereign “ users. Mixed systems. Models of the health care system according to the OECD (Organization for Economic Cooperation and Development)

13. Bismarck's model Mandatory or social health insurance, insurance of the entire population. Otto Eduard Lepold von Bismarck – Chancellor of Prussia, in 1883 was the first to apply such a system. This health insurance financing model is based on the payment of contribution funds based on work, employers (1/3 of total contributions) and employees (2/3 of total contributions). Contributions go to insurance companies (non-profit funds). These organizations make contracts with hospitals, associations, dentists and pharmacists. Doctors are paid based on contracts with insurance carriers. The state has a key role (buildings, equipment) and public control. Germany, Holland, France, Austria, Belgium, Ireland, Slovenia, Serbia, Bosnia and Herzegovina Disadvantages: lack of funds, dominant role of the state in decision-making and financing, patients do not choose where and how to be treated.

14. Beveridge model Budget health insurance William Beveridge, 1942 first application in Great Britain It is financed from the tax-budget, all residents are included, free access to services. All residents of the state, not only employees, have access to health services under equal conditions. It provides equality and equality in the use of health services to all citizens according to needs, not according to the ability to pay. The state is the owner of the equipment and institutions, and of the leadership. Disadvantages: doctors are civil servants, long waiting lists for interventions that are not urgent. The doctor is paid according to the number of patients and services. Great Britain, Canada, Denmark, Norway, Finland, Sweden, Spain, Italy, Greece.

15. Semashko's model The state is responsible for the health care of the entire citizenry. Former USSR. Similar to the Beveridge model. Private healthcare is prohibited by law, as is private insurance. High coverage of the population with health services. The disadvantages were: lack of adaptation to the needs of patients, insufficient scope of health services, large number of doctors per population, use of old equipment.

16. Market entrepreneurial model Large companies pay their employees basic health insurance. But not everyone, more and more citizens cover their health costs. 20% of Americans are without any insurance. The market (entrepreneurial) model means that health insurance is organized and implemented by private organizations (insurance companies and agencies) on a for-profit basis. It is financed from the insured's private funds, usually insurance premiums (contracts). The amount of the premium depends on the risk assessment of the disease (age, previous health condition, poverty, family). The insured himself chooses the insurance model. Lack of mandatory health insurance, excessive costs of health services. USA spends the most per capita about $5300 per year, Switzerland $3500, Japan $2000, Turkey $446. Reason: medical services, material, technology, medicines are more expensive. More expensive equipment more expensive treatment. Doctors pay insurance to protect themselves from possible penalties for wrongful treatment. USA, Switzerland, Turkey.

17. Current State of Health Financing in India The main methods of financing for health care include the national health insurance system, general revenue, private insurance, community-based insurance and out-of-pocket payments . The public sector is responsible for providing healthcare services to the majority of the population, particularly those who are unable to afford private healthcare. The private sector, on the other hand, caters to those who can afford to pay for healthcare services . Despite the government's efforts to increase funding for healthcare, India's public health expenditure remains low compared to other countries with similar levels of economic development. A country of 1.3 billion people but India spends barely 1.5% of its GDP on healthcare, which is amongst the lowest in the world.

18. Current State of Health Financing in Italy The National Health Service was founded in 1978. At the head of the Italian health system is the National Health Service ( Servizio Sanitario Nazionale ), which provides universal health insurance coverage to users, which is largely free. The system is organized in three levels: national, regional and local. At the national level, the Ministry of Health (along with several specialized agencies) sets the basic principles and goals of the health system, determines the basic package of health services guaranteed throughout the country, and allocates national financial resources. The national level has exclusive powers in determining the basic package of health insurance, which must be guaranteed throughout the country and must be in most cases free of charge or with partial cost sharing, and financed from the budget collected through general taxation.

19. The method of collecting funds for the financing of the health care system TAXES CONTRIBUTIONS PREMIUMS PAYMENT OF THE FULL PRICE OF THE SERVICE PARTICIPATION DONATIONS AND GIFTS

20. The method of collecting funds for the financing of the health care system Taxes Taxes - general and specific, represent a type of public revenue, the amount of which is determined by the state, and there is no connection between the amount of tax and the benefit that the taxpayer has from the tax, nor can it influence the distribution of funds. 2 . Contributions Individual and employer contributions, as well as premiums for voluntary insurance. And contributions are forced contributions, but intended for a specific purpose and there is a correlation between the amount of contributions and the character and value of the service.

21. The method of collecting funds for the financing of the health care system 3. Premiums With private insurance, there are premiums instead of contributions. The amount of the premium is determined by the contract between the insured and the insurance, and is defined by the probability of the occurrence of the risk - it is defined by various characteristics of the contracting party - the patient. 4. Participation Participation - as the insured's personal participation in the costs of using health services, and is determined by a percentage of the price of the service and serves as an additional source of financing and moderator of the use of services, especially in systems with full coverage and a large scope of health insurance rights.

22. The method of collecting funds for the financing of the health care system 5 . Payment of full price The least popular method of paying for services in healthcare, when the user pays for the service, and the system may or may not reimburse him for the service.