Week 1, Comparative Health Care Systems
Week 1, Comparative Health Care Systems PHP 1100
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This 3 page Class Notes was uploaded by Isabel Blalock on Thursday February 4, 2016. The Class Notes belongs to PHP 1100 at Brown University taught by Dr. Omar Galarraga in Winter 2016. Since its upload, it has received 35 views. For similar materials see Comparative Healthcare Systems in Public Health at Brown University.
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Date Created: 02/04/16
Comparative Health Care Systems 02/02/2016 ▯ ▯ Lecture 2 ▯ Low and middle income countries 18% of income 11% of global spending 93% of disease ▯ ▯ 3 dimensions to consider when moving towards universal coverage ▯ ▯ Micro vs. macro levels Micro: individual agents Consumers, producers Macro: aggregation at district, sub-national, national and regional levels How do you aggregate? “digital backbone” o Without “digital backbone”, very difficult to collect data and information ▯ ▯ Higher GDP per capita Increased labor productivity o Increased school attendance Increased child health and nutrition Improved adult health and nutrition Increased access to natural resources and global economy Interactions How do agents interact? o Market system vs. other types of exchange What is the currency? o Money, intensity of lobbying, effective organization Disenfranchised groups lack all types of currency ▯ ▯ Macro systems Complexity Interrelatedness Cyclical process ▯ ▯ Health system are: self organizing, constantly changing, tightly linked, governed by feedback, non-linear, history dependent, counter-intuitive, resistant to change ▯ Health as a “social good”, not just individual or “economic good” government intervention Societal income matters, but institutions matter even more.. Ex: famine—problem is not lack of food, but lack of infrastructure, political will, democratic institutions ▯ ▯ Who has political power? Who gets what, when and how Who takes care for the “little guy”? ▯ ▯ Alignment of incentives Political and economic process can benefit all populations if there are common interests and aligned incentives o Medicare Part D—pharmacy benefits o PEPFAR coverage President’s emergency plan for AIDS relief 15 billion invested in HIV prevention and treatment subsidy to pharmaceutical companies For healthcare reform, system’s incentives must be aligned ▯ ▯ Choosing most cost-effective question How? Quest for common ground “basic health benefits within the context of social priorities” ▯ ▯ 1) Aligning policies, priorities and perspectives among donors and national policy-makers ▯ 2) Managing and coordinating partnerships and expectations among system stakeholders ▯ 3) Implementing and fostering ownership of interventions at the national and sub-national level ▯ 4) Building capacity at the country level to apply a stems analytic perspective ▯ ▯ I. Intervention Design ▯ 1) Convene stakeholders ▯ 2) Collectively brainstorm ▯ 3) Conceptualize effects ▯ 4) Adapt and redesign ▯ ▯ II. Evaluation Design ▯ 5) Determine indicators process indicators—are more people coming to clinic, are more people being hired, are more people taking necessary drugs ▯ 6) Choose methods ▯ 7) Select design ▯ 8) Develop plan and timeline ▯ 9) Set a budget ▯ 10) Source funding ▯ ▯ Key issues Financial incentives User fees and alternative health financing strategies Task shifting Vertical programs vs integrated primary health-care Quality improvement strategies ▯ ▯
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