Health Flashcards
(14 cards)
How is Health Care Provided?
Health care publicly provided on a universal basis and funded through general taxation.
What are National Health Systems?
- All citizens therefore entitled to basic health care, including hospital and GP services and medicines not paid for at the point of use.
- Health care infrastructure such as hospitals and primary care services are either publicly owned and/or controlled.
- Access to services (GPs, hospitals, specialists) strongly regulated by the state.
- e.g. UK, NZ, Scandanavia, Southern Europe….
What is a Social insurance based systems?
Germany- first country to develop this type of health system in the 1880s under Bismarck – now common across continental Europe.
- Health care is usually paid for by compulsory/social health insurance based on employer and employee contributions + some taxation.
- Insurance fund(s) are usually non-profit based, but not necessarily. Where more than one fund exists assumption is that competition keeps costs down (but questionable).
- Funds usually contract services from public, private hospitals and independent doctors.
- Greater degree of patient choice in accessing services than NHS type systems
What are Private health insurance systems?
- Private health insurance companies enter the health insurance market in order to make a profit and operate predominantly in countries with weak public health care provision.
- Private insurance is voluntary and the cost is usually risk–related (individual health status and behaviour, e.g. smoking).
- Does not have the solidaristic quality of social insurance systems
- This makes (subsidized) private insurance compulsory and somewhat socializes the system
Why is Expenditure on Health Care Growing?
- Costly advances in health treatments and technologies
- Advances allow people with chronic conditions to live longer
- Ageing populations
- Rise in health care consumerism
How are countries trying to contain expenditure?:
- Rationing/waiting lists
- Co-payments
- User charges
- Removing certain services/drugs from public service
- Managerial reforms – making public health systems more like private markets
Problems with containing expenditure
- Shifts costs from the public system to the individual
- Those who cannot afford lose out (health inequity – moves away from equal treatment for equal need to treatment dependent on ability to pay)
- Potentially increases health inequalities
- Cost effectiveness of managerial reforms are questionable.
Where does the Irish health care system fit?
- Ireland is a mixed System, mix of national health and private health systems.
- ‘Ireland’s health policy ideals at present are aimed towards the principles of individualism, self-help, and the supremacy
of the private market’ (Malone and Millar, 2019:2)
-Basic hospital care available to everyone, funded trough taxes.
GP care only available free to 48% of pop
Problems with Irish health system
- Approx. 48% of the population paying for private health care insurance
- Most of private care delivered through public system
- Up to 40% of care in public hospitals is private (Burke and Considine, 2013).
- We have entangled two different systems
Two Tier System Access Issues?
-Private patients skip waiting times in same hospital
- Private patients benefit from consultant servant, paid fee per patient rather than salary for public.
- Wren and Connolly (2019) argue that Irish health policy has long been guided by the ‘perception of healthcare as a marketable commodity rather than a right’.
- Private system
Consequences of the two tier health system
- It exacerbates health inequalities and the social gradient of health (see part one).
- It is reflected in disparities in unmet health needs.
- Ireland is above the EU average for unmet health needs (2.6% vs. 2.2%)
Historical Period efforts to change Health System
Changes have been attempted, but blocked by actors e.g. political parties, catholic church, private firms and doctors
- 1911 – rejection of health insurance (entitlement to free GP services and medicines)
- 1940/50s – rejection of universal mother and child scheme, proposed by minister for health Dr Noel Browne
- 1980s – severe public health cut-backs
- 1990s-2000s growing privatization including National Purchase Treatment Fund and private hospital
What is SláinteCare?
It recommends the phasing in of a single tier universal health system (a national health type system) and the phasing out of private care in public hospitals. Much greater emphasis is also placed on primary and community care.
- Everyone would access services with a health care Cárta Sláinte
- Proposed 2,590 new public beds, 48% increase in primary care workforce, 3,000 increase in residential care beds, 20% increase in homecare.
Current Progress on SláinteCare
- To date there have been some changes – expansion of GP care, abolition of hospital charges, growing expenditure on primary care facilities and diagnostics and increasing bed capacity…
- But still heavy reliance on private sector delivery, long waiting lists, private care in public hospitals etc etc.
- There are also objections raised by Irish Medical Organisation about removing private care from public hospitals…
- Whilst GPs also raising concerns about contractual changes required
