Accountability for NGOs
INTERNATIONAL HEALTH SYSTEMS
HEALTH SYSTEMS FEATURES
Personal and public health service provision
Healthcare workforce
Access to essential medications and technologies
Health information system
Health financing system
Oversight
Adapted from
Birn A-E, Pillay Y, Holtz TH. Textbook
of International Health. New Yo
k: Oxford University Press; 2009.
CATEGORIZATION OF APPROACHES TO SELECTED HEALTH SYSTEM
National Health Insurance National Health Service Pluralistic
Health as a Right Fundamental Fundamental Health as a personal good
Ownership of facilities Vast majority public and private, not-for-profit Overwhelmingly public Public, Private, for-profit and private, not-for-profit
Employment of Providers Largely private The health service and private Largely private
Form of Insurance Largely government single payers and firms working with governmental schemes Overwhelmingly public insurance linked to the health service Public insurance and private, for-profit and private, not- for-profit with substantial numbers lacking insurance
Financing of Insurance Some based on individual premiums, others based on employee and employer payroll taxes, some are tax based Overwhelmingly tax- based Taxes, employer and employee insurance contributions, individual purchase out of insurance and out-of-pocket
Country Examples France, Canada, Japan, Germany United Kingdom India, Nigeria, Philippines, USA
Challenge of health policy making in the 21st century
Healthcare is one part of the society that is always under some degree of scrutiny and regulations – thereby affecting health policy directly or indirectly.
Medicine within social organizations
Policy-making challenges
Analysis of micro and macro models
4
MICRO AND MACRO MODELS
The political process
In the most fundamental way, health policy making is a political process.
Most policy making usually involves governmental and NGOs and individuals.
Micro and macro frameworks
Analogous to economics
Health policy making can be usefully described using both micro and macro framework, just like in economics.
5
MICRO POLICY MAKING
Characteristics of the policy marketplace model
⚫
Assumption
Marketplace assumes that individuals and groups are constantly interacting to satisfy their needs
Policy actors
All policy actors are both suppliers and demanders because they must exchange some commodity in the marketplace to purchase the other goods that they want.
Disparities in powe
Just like in economics, individuals and groups that can supply more can demand more in exchange.
Cu
ency used
The cu
ency used in exchanges can be money, but it can include superior leadership, more effective organization, access to and greater articulation through communications media and greater group member willingness to exert great efforts in order to advance the interests of the group.
Impact of governmental regulation
To gain control over their relevant areas of the marketplace, NGOs will attempt to forge enduring alliances with governmental agencies.
6
Macro Policy Making
- The policy systems model
Complexity
Inte
elatedness
Cyclical processes
7
MACRO POLICY MAKING
– THE POLICY SYSTEMS MODEL
Longest’s model of health policy development
Recognition of inputs
Policy formation
Policy outputs
Implementation
Outcomes
Feedback & subsequent modifications
8
CONVERGENCE OF PROBLEMS AND RESPONSES
9
Cost containment
Access to care
Disadvantaged subpopulations
Informal payments (
ibes; co
uption)
Political instability
Impact of new technologies
Cost and complexity
Balance between old and new
Economic and ethical conflict
CONVERGENCE OF PROBLEMS AND RESPONSES
Quality of care considerations
Technologic complexity
Enable the aggregation of data
New information technology
Measuring health outcomes
Potential benefit of health IT
Consensus about existing problems
US system expensive, wasteful, unsustainable
10
CONVERGENCE OF PROBLEMS AND RESPONSES
Sustainability
Growing financial stress on public and private sectors
Achieving sustainability
Quest for common ground
Digital backbone
Incentive realignment
Quality and safety standardization
Resource deployment
Innovation
Adaptability
11
NATURE OF TRADEOFFS, IDEOLOGY, AND ETHICS
Tradeoffs
Source
Importance
Economic efficiency and political equity
Prioritizing efficiency and equity
12
NATURE OF TRADEOFFS, IDEOLOGY, AND ETHICS
Tradeoffs
Political obstacles
Expectations of the populace
Ethical and ideological disagreements
Social experimentation without public consultation
Undeveloped “rule of law”
13
NATURE OF TRADEOFFS, IDEOLOGY, AND ETHICS
14
Tradeoffs
Components of justice
Justice has both individual and social component. Ethical health policy making implies an acceptance of
individual autonomy
In health policy making, the social component is reflected primarily in the debate over distributive justice or the fairness in the distribution of health benefits and burden in society. Egalitarian view of justice where equal access to health services for all citizens, regardless of income or class is of central importance.
Libertarian perspective
There is also a libertarian perspective of fairness that would argue against Egalitarianism.
POLICY-MAKING AROUND THE WORLD
Assessment of ability address challenges
Assessment of sustainability of US system
No reform will lead to de facto rationing
Reform faces significant political problems
Something major will occur in the next one or two decades
15
POLICY-MAKING AROUND THE WORLD
Equating national health service with rationing
Situation in developing countries
Political instability
Social inequality
Immature economies
16
OVERALL HEALTH SYSTEM PERFORMANCE RANKING, SELECTED COUNTRIES
Data from WHO. The World Health Report 2000, Annex Table 1. Geneva. 2000.
COUNTRY Performance Ranking
Afghanistan 173
Argentina 75
Bangladesh 88
Bolivia 126
Canada 30
China 144
Costa Rica 36
Cuba 39
Denmark 34
Dominican Republic 51
Egypt 63
France 1
Germany 25
Ghana 135
COUNTRY Performance Ranking
Haiti 138
India 112
Jordan 83
Mexico 61
Morocco 29
Nepal 150
Pakistan 122
Philippines 60
South Africa 175
Sri Lanka 76
Turkey 70
United States of America 37
Vietnam 160
Zambia 182
ECONOMICS OF HEALTH SYSTEMS
Health services and payment models
Most high-income countries have a government-sponsored healthcare system
The U.S. has a (mostly) privately-sponsored healthcare system (except for Medicare, etc.)
Low-income countries have a mix of public and private providers that require out-of- pocket payment at the time of service
Public and Private approaches to healthcare funding and coverage
PERSONAL HEALTHCARE COSTS
High-income countries spend more than low-income countries on health care
Low-income countries generally require the highest financial contributions from patients (both as a % of healthcare costs and as a % of household income)
Total expenditure on health per capita in U.S. $ in 2009
Source: Kaiser Family Foundation
Health Consumption Expenditures per Capita, US Dollars, 2017
Source: Kaiser Family Foundation
Health Consumption Expenditures as Percent of GDP, XXXXXXXXXX
Expenditure on health by governmental and private sources in 2009
PAYING FOR PUBLIC HEALTH
Global public health is funded by a variety of contributors
Global health funding is about more than the global rich aiding the global poo
Global health funding aims to address shared health concerns and achieve mutual goals
GOVERNMENT FUNDS
The majority of public health initiatives around the world are funded by the governments providing those services
Sources of funding for the health system in 2010
BILATERAL AID
Bilateral aid: money given directly from one country to anothe
Major donor nations (>$10 billion each in 2010): United States, United Kingdom, France, Germany, Japan
Major donor nations as % GNI (>0.8%): Norway, Luxembourg, Sweden, Denmark, Netherlands, United States: <0.2% GNI
THE WORLD BANK & IMF
Multilateral aid: money pooled from many donors and given as loans that have to be repaid or as grants (gifts)
World Bank: makes loans to developing countries, usually for infrastructure projects
IMF (International Monetary Fund): makes loans to any country that could not otherwise pay the interest on their other loans
Heavily Indebted Poor Countries (HIPC) Initiative aims to forgive some loans
PRIVATE FOUNDATIONS
Private foundations are making an increasingly significant contribution to spending on global public health
Example: The Bill & Melinda Gates Foundation provides more than $1 billion each year to support health technologies
BUSINESSES
Pharmaceutical companies donate >$1 billion in products each yea
Other companies make in-kind and monetary donations as part of their corporate social responsibility plans
PERSONAL DONATIONS
Millions of individuals make donations each yea
Americans donated nearly $300 billion to charity in 2011
73% from individuals rather than foundations or corporations
Represents about 2% of disposable income
TOTAL HEALTH EXPENDITURE AS A % OF GDP AND PRIVATE EXPENDITURE ON HEALTH AS A % OF TOTAL EXPENDITURE OF HEALTH, SELECTED COUNTRIES, 2009
Data from WHO. Global Health Observatory. Health expenditure ratios.
COUNTRY Health care Expenditure as % of GDP Private Health Expenditure as % of Total Healthcare Expenditure COUNTRY Health care Expenditure as % of GDP Private Health Expenditure as % of Total Healthcare Expenditure
Indonesia 2.4 48.2 Haiti 6.1 77.9
Pakistan 2.6 67.2 Vietnam 7.2 61.3
Bangladesh 3.4 68.3 Sudan 7.3 72.6
Philippines 3.8 65.1 Afghanistan 7.4 78.5
Sri Lanka 4.0 54.8 Israel 7.6 41.1
India 4.2 67.2 South Africa 8.5 59.9
Thailand 4.3 24.2 Australia 8.5 32.3
Kenya 4.3 66.2 Brazil 9.0 54.3
Peru 4.6 41.4 Jordan 9.3 35.4
Egypt 5.0 58.9 Ireland 9.7 20.4
Cameroon 5.6 72.1 Costa Rica 10.5 32.6
Nepal 5.8 64.7 Denmark 11.2 13.6
Cambodia 5.8 72.7 France 11.7 20.8
Nigeria 5.8 63.7 Cuba 11.8 6.9
Dominican Republic 5.9 58.6 United States 16.2 51.4
Research Discussion Post
International Health System “Global Health”
Assignment & Instructions
Research Discussion TOPIC Question: - Discuss how health policy making is a political process?
To receive credit:
Must be 500 words of actual text
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