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What is Healthcare Reform?
Health Sector Reform has been defined in a variety of ways, however in general, the goals of Health Sector Reform should not be unlike the goals of any other organization… to provide the best of service, manage the organization in an efficient and effective manner, predict trends, minimize risks, and maximize the returns of invested resources. The Core Goals and Priorities for Healthcare System are defined as:
The USA Institute of Medicine lists the following as Quality of care:
I would assume that if you are effective and efficient you are safe and providing care in a timely manner. I also would assume that if you are caring for the individual you are providing patient-centered care. Equitable? I am not sure that the healthcare in the USA is remotely equitable (maybe if you pay the same amount of money you receive the same amount of care is what this means!). There is absolutely nothing sustainable about the USA system of care and everyone definitely doesn't have access.! Efficiencies in the market, including that of health care (assuming that you believe that healthcare operates in a market like other services) , depend on the interaction of the internal market forces such as the number of buyers and the number of sellers and the price each is willing to spend, the external market forces such as political processes that may distort the pure market functioning, and the availability of information that each group has to make their decisions. By this definition, health care is an extremely inefficient market. Information is not available, governments supply what services they can afford or supply services based on political decisions. Donor organizations have their own agenda, and the buyers (individuals) receive only what is offered to them by health care professionals they do not understand. Prices are certainly not determined by the buyer and are generally not prices that the buyer can afford. Baum & Senski (1989) reported that 60% of Thai farmers who sold land were forced to do so because of the costs of ill-health. It is InHCc’s belief that the greatest cause of the failure of health care systems is the lack of information.
This lack of information prohibits any real progress in changing health care processes. Lack of information limits cost-benefit analysis that could improve the methods used. One director of a Health Economics Unit in a developing country stated to InHCc that the actual money spent for services were three times that calculated in their cost-benefit analysis. Why? He did not know!
Health System Reform ChallengesManagement
Access Access to care may be decreasing. The Cost of Care is increasing to the point that governments are having to make cuts in their support. There have been sharp increases in the "Out of Pocket" expenditures in healthcare either because of increases in fees by the government health care facilities or a decrease in the Quality of Services Received. Quotas are now being placed on physicians to the point that individuals are not receiving the care that they should.
Healthcare Costs Health care is not an efficient market in the rich world because—be it in Europe, where the state typically pays the bills, or in America, where private insurance companies do—the customer does not have to shop around. Patients neither know nor care how much anything costs, so they demand the best of everything, which is wonderful for the makers of hugely expensive equipment. A second factor—which applies more in America than in Europe—is red tape. America’s Food and Drug Administration (FDA) is excessively risk-averse: it often takes twice as long to approve a new medical technology as European regulators do. America’s confusing approvals process deters upstart medical-technology firms, since they typically lack the deep pockets and army of experts required to navigate it. And for a device to succeed in America it must be blessed not just by the FDA but also by the bureaucrats who oversee Medicare and Medicaid, the two huge government health-care schemes. Obtaining that blessing can take years. (Reprinted in part from The Economics)
Equity It seems that the gaps in the coverage of basic services and programs is getting larger. Governments are hard pressed to keep up with the demand for services and costs are outpacing the resources available,
Effectiveness Relatively little progress has been attained in improving "real" effectiveness of the system. "Bells and Whistles" are getting more expensive...and a lot of moving around of food on the plate...but nothing is really being done to benefit the individual and their household. While "Quality of Care" is being "sold" to the population, Quality often means more expensive services that provides very little additional benefits.
Quality Quality of care may be oversold. The population is being sold on "Quality" but we have no definition of what is "enough." In many cases the increase in Quality is not justify by the increase in the cost for that quality.
Efficiency The health System still suffers from lack of professional management. The "Health Industry" is still 20 years behind "Businesses" in efficient management practices.
Sustainability The Driving motivation of reform have been centered on economic factors. There is no way to keep up with demand and it appears that the system is not spending any money to education the population/or of the population's willingness to practice "Preventive" medicine. It seems that the whole program adapted for sustainability is to "improve the medium of resource generation" and very little is done to increase the efficiency of care.
Innovation and Improvement Innovation and Improvement is being made in health care but are they the type of improvement that translate into better care. Is the "Cost-Benefit" worth it or are we merely increasing the "Quality" of care to the point that we cannot afford it?
While challenges are very different between developed and emerging nations they all share many of the same problems. The Major Health Challenges Issues are:RequirementsA Healthcare System is complex and in order for it to function properly it must contain the same management processes as any other business. These are: (Commonwealth Fund, 2006)
The first stated requirement is to establish the mission and strategy for obtaining directing this mission. While the mission may be the same for all health care systems...to provide good health...there may be many different opinions as to what is health and how much the system must provide. The second stated requirement that health care should emphasize coordination and integration, yet, at the same time many says that the only way to deliver good health is through "competition" and "decentralization." The third requirement of establishing and tracking metrics for health outcomes, quality of care, etc., is also difficult. Which metrics indicator good "Health Outcomes" and what is "Quality of care"? As you can see, while the requirements may be the same for all management processes, health care is more complex then selling widgets where the mission may be very clear...make more money. This web site will attempt to discuss these issues or give links where possible. Healthcare Reform
Agreements on decisions, the overcoming of bureaucratic constraints and the decentralization of control cannot come about without “informed” decisions. While in general, Health Policy reform has had their “efforts focus on a number of key institutions including the Ministry of Health (MOH), the Social Security Institute, and the Legislative Assembly,” very little has been directed to the level that counts…to the individual.
Although others have defined Health Sector Reform in a variety of ways, in general, the management of Health Care should not be unlike the management of any other organization; to make decisions, information is needed to predict trends, minimize risks, and maximize the investment. Agreements on decisions, the overcoming of bureaucratic constraints and the decentralization of control cannot come about without “informed” decisions. In the past it was simple to implement health care reforms. It was easy to promote immunization programs or to advocate the use of antibiotics. However now with most countries the epidemiologic transitions, it becomes more difficult in setting priorities. With decreasing mortality, the demand for medical care does not decline, but increases. As the population in many developing countries continue to increase, as the population ages and as the populations demand more from their governments, governments need to operation more effectively and more efficiently. The only way that this can happen is not only by gathering information but using information. Collections of data serve very little good if the data collected cannot be used by management to make changes.
Healthcare Demand for InformationProviding information and collaboration are core values in Health Care Services. National and local agencies need the means to manage their resources and put the right information in the hands of the right government officials at the right time so that they can make informed decisions quickly and act promptly. Health Care Policy Reform demands information on a routine basis to provide:
There are a number of challenges to achieving this end:
Value of Data ComparisonsThe process of health care development benefits enormously from comparing information across health care units including national boundaries. Features of each system can be examined and evaluated against the results obtained. Careful examination can determine which processes that seem to work well and can be duplicated across systems. Systems that fail to produce good results can be more adequately evaluated if they are compared with processes that do work well. Links
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