Health Service delivery Modeling by Dr Sujuudpptx

Health Service delivery models by dr Sujuud

1. Health service delivery Models Dr Salad Abdi Farah “Dr Sujuud ” MBChB, BPH, MHSM, MIM 1

2. Health Models And Health service delivery Models 2

3. Learning Objectives By end of the lecture you will be able to: Know about universal healthcare & its various models Understand Beveridge Model Understand Bismarck Model National Health Insurance Model Out of pocket systems tiered system diffuse system. Compare & Evaluate various healthcare models 3

4. Health system A good health system delivers quality services to all people, when and where they need them The exact configuration of services varies from country to country, but in all cases requires; robust financing mechanism ; well-trained and adequately paid workforce ; reliable information on which to base decisions and policies; well maintained facilities, logistics to deliver quality medicines and technologies’ providing equitable access to people- centred care an efficient governance mechanism. 4

5. The conceptual models of Health Conceptually health can be delivered by modifying or removing what causes ill health Social Model of Health ; The social model of health examines all the factors which contribute to health such as social, cultural, political and the environmental. Medical Model : also termed Bio Medical Model. It focuses on physical or biological aspects of disease and illness. It is a model of care being practiced by doctors and other healthcare professionals 5

6. Universal Health Coverage   Universal health coverage (UHC) means that all people have access to the health services they need, when and where they need them, without financial hardship It is organized around providing a specified package of benefits to all members of a society with the end goal of providing; improved access to health services (responsiveness) and improved health outcomes 6

7. ..Universal healthcare Universal health coverage is the single most powerful concept that public health has to offer. (Margret Chan Former DG WHO) Most countries implement universal health care through legislation, regulation, and taxation The bulk of costs come from a combination of compulsory insurance and tax revenues 7

8. Health Insurance “Coverage that provides for the payments of benefits as a result of sickness or injury” Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses Health Insurance can be Compulsory or Voluntary 8

9. Models of Health Care System 9

10. Health System According to Funding Types All healthcare systems occupy a distinct place on the “public versus private” continuum in terms of the financing and delivery of healthcare . (a) national health service model (b) entrepreneurial model or (c) mandated insurance model.” 10

11. A• Under a national health service (e.g. the United Kingdom and Spain), universal coverage is publicly financed through taxation. Healthcare delivery occurs via mostly public mechanisms; hospitals are publicly owned medical services are primarily delivered by government-salaried physicians . 11

12. B• In an entrepreneurial model of healthcare (e.g. the United States), people voluntarily purchase employment-based or individual insurance the healthcare delivery mechanisms (providers and healthcare facilities) exist largely in the private sector. Financing can come from both private and public sources . Consumeristcommercial -capitalist 12

13. mandated insurance model C• compulsory universal coverage is publicly financed and health care is delivered by both public and private entities . Within this category, systems can be further classified as following a national health insurance/single-payer model (e.g. Sweden) or a multi-payer health insurance model that relies on sickness funds to provide universal health coverage (e.g. Germany and France) 13

14. Another Classification Health Systems Based on the Sources of Funding 14

15. Four Basic models These systems tend to follow general patterns however researchers identify Four basic Health Care Models:- The Beveridge Model The Bismarck Model The National Health Insurance Model The Out-of-Pocket Model 15

16. William Beveridge Born in Rangpur , BD Director London School of Economics A social reformer Chairman of the committee which presented report to the Parliament on Social Insurance and Allied Services in 1942, paving way for NHS 16

17. The Beveridge Model "Public Model" - “Socialized Medicine Model” National Health Service (NHS) was, among the world’s first tax-funded healthcare systems to be completely free at the point of use 17

18. Characteristics In this system, health care is provided and financed by the government through tax payments , just like the police force or the public library; healthcare being a public service Single payer system – Government being the single payer, removes all the competition in the market to minimize expenses and standardize benefits Majority hospitals are owned by the government; while most of the GPs are not public employees but rather independent contractors to the NHS, Nearly half (47%) of the NHS budget is spent on acute and emergency care 18

19. characteristics The 3 founding principles of this system are: Meeting the needs of everyone Free at the point of delivery of care (now co pay for prescriptions, dentures & dentistry) Based on urgency of care and not on the patient’s ability to pay 19

20. The countries using this model, beside United Kingdom, are Ireland Sweden Norway Finland Denmark Spain Portugal Italy Greece Canada Australia 20

21. Bismarck Model Named after the German statesman who dominated European affairs from the 1860s to his dismissal in 1890 He unified numerous German states into a powerful German Empire under Prussian leadership, then created a "balance of power" that preserved peace in Europe from 1871 until 1914 21

22. Bismarck Model “Mixed Model" - “Sickness Funds” Within the Bismarck model, employers and employees are responsible for funding their health insurance system through "sickness funds" created by payroll deductions. Providers and hospitals are generally private, though insurers are public. In some instances, there is a single insurer (France, Korea) while multiple competing insurers in other countries, like Germany and the Czech Republic. 22

23. Characteristics Unlike the Beveridge model, the Bismarck model doesn't provide universal health coverage. It requires employment for health insurance, so it allocates its resources to those who contribute financially. The primary criticism of the Bismarck model is how to provide care for those who are unable to work or can't afford contributions, including aging populations and the imbalance between retirees and employees. 23

24. Germany, is found in countries such as France Switzerland Japan Central South East European (CSEE) and some employer-based healthcare plans in the U.S 24

25. The National Health Insurance Model The national health insurance model blends different aspects of both the Beveridge model and the Bismarck model. First, like the Beveridge model, the government acts as the single-payer for medical procedures. However, like the Bismarck model, providers are private. The national health insurance model is driven by private providers, but the payments come from a government-run insurance program that every citizen pays into. Essentially, the national health insurance model is universal insurance that doesn't make a profit 25

26. ….characteristics Essentially, the national health insurance model is universal insurance that doesn't make a profit or deny claims. The primary criticism of the national health insurance model is the potential for long waiting lists and delays in treatment, which are considered a serious health policy issue. Used by Canada, Taiwan, and South Korea, and similar to Medicare in the U.S. 26

27. Out of Pocket Model The out-of-pocket model is the most common model in less-developed areas and countries where there aren’t enough financial resources to create a medical system like the three models In this model, patients must pay for their procedures out of pocket.  It is a market driven healthcare, put simply, anybody requiring medical treatment must pay for it on the spot There is no universal insurance system and income taxes are not raised to provide access to healthcare for all citizens This method is most common in developing countries – WHO & World bank report 2017 27

28. No system for poor? Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease If they have nothing, they don't get medical care 28

29. Which system? No system of health care is perfect There will always be a trade offs Longer waits Higher taxes or compulsory insurance Providers – private vs public Rich can always purchase the treatment of their choice Poor have to rely on social net works or only seek medical care when they can come up with enough money to pay for Many countries have a mixture of these basic models 29

30. Introduction: Complexity of Health System in USA Relies on a combination of governmental action, market forces, and voluntary charitable initiatives to deliver health services. The health care delivery system in USA is in piecemeal. Health System in USA

31. Health-Care Purchasers:

32. Models of Health Care System 32

33. Health Care Delivery System There is no perfect healthcare delivery system for a country. Some models seem to work better than others but each has its own advantages and drawbacks. Broadly, healthcare delivery models could be classified under tiered system diffuse system. 33

34. 1- The Tiered System The tiered system is made up of regionalized systems of healthcare delivery divided into Primary care Secondary care Tertiary care. Such a pyramidal system is more common in UK and in HMOs (Health Maintenance Organizations) in US. 34

35. Levels of care:

36. 2- Diffuse System In the diffuse system there is no such division. In this system patients can directly approach specialists without consulting GPs or PCPs first. The boundaries between GPs, internists, family practitioners and pediatricians are blurred. Many internal medicine specialists provide primary care, many family practitioners provide secondary care. 36

37. The diffuse system is the relatively more common in United States. It is a diamond type of system with most hospitals providing a mix of multi-specialty secondary and tertiary services. The stress is on getting the latest technology and advanced clinical care closer to home. 37

38. Levels of illness prevention:

39. Thank You Questions & Comments 39