Political Factors:

In many countries, due to political reasons, the whole health care department's personal changes. In general, the "new" people that come in, are giving the position because of their political support and not because of any skills that they may have. There are no professionally trained Health Care Managers (has been until very recently a problem with the administration of health care systems in the US)

In many cases, these people do not even know how a public health care system is suppose to function.

Decentralization

Decentralization is probably the worst thing that has happened to healthcare. When the need has been clearly shown that systems should be intergraded, it seems that some policy organizations are pushing for the Decentralization of systems.

In Decentralization it is impossible to collect the information needed to form informed decisions that efficiently allocated resources.

The recent trend in decentralization has put a great burden on Health Care Systems. While the decentralization process has taken place (to some extend), the training of managers has not taken place. At least, before decentralization, there were people trained to "do things"...today, with each change of administration a new group of new individuals come into the system with no professional knowledge.

The “reality of it all” is that desire for local units to increase their degree of control over the day to day operations may not be possible when the local units have “real problems” with no one having the skills to solve these problems.

While per capita payment by the Federal Government to the states is “ok”…what it may be lacking is the “volume” efficiency in lower pop areas – there may not be sufficient money to pay for the overhead.

Fiscal Realities

Fiscal realities have a profound influence on the kinds of health care services that a country can deliver. But politics and culture have at least as much impact. These interacting components produce the structure and operating form of the health care delivery system.

The individuals overall health status is influenced by a combination of all of these components acting together. There include, at least, a combination of the following:

• Individual Factors such as genetic makeup and personality characteristics
• Individual Life Style such as diet, tobacco, alcohol, or drug use, and exercise.
• Physical Environment including quality of housing
• Political Influences
• Demographic Influence
• Cultural Influences
• Social
• Economic
• History
• Interrelationships Among these Components

Completion is all about Better healthcare for the population

While competition may produce the best hospitals…it does not promulgate those best practices to others. The assumption is that everyone will compete in producing the “best solutions”…creates the environment where no one wants to share information…and what may happen, is that one organization produces the “best practices” and runs all others out of business…thus creating a monopoly.

Also a "Profit" based system is all about making money! A business does not have to be the "best" in order to make money. Many business finds niches for themselves that is far from producing the best care and still make money.

Payment for Quality

Incentives work well when things are going up but work negatively when things are going down.

• The winners do well, the losers do worse (and there are more losers than winners!)
• Therefore….losers should receive “education” and have ways to improve and to keep the “moral problems from bringing the losers down even more
• Incentives may drive costs up -> only work when you keep increasing them...look at the healthcare workers demanding that they should be paid for good service!...[I am not going to say what I think about this]

Today’s evaluation of  “money for quality money” is dependent on a list of "indicators". First, a list is bad because the employee concentrate on this only. Why should he do otherwise? Lists may include (1) patient survey (2) employee survey, (3) etc...any and every one of these surveys can be manipulated.

Data Sharing

Now just why would a private organization want to share their customer list with anyone else?

Federal Transfer Payments

Federal Governments transfer payments to the states based on per capita does not consider the needs of the population of that state. It seems that the "rich" are getting richer and the "poor" are getting poorer! Volume can products efficiency in healthcare delivery (if efficient management takes place) and thus costs for delivery may be lower.