Lecture 3 - Health planning Flashcards
Why do we need health planning systems?
There are limitations to market-based systems in healthcare. Planning systems can be used in place of markets.
What are some limitations of a market-based system in healthcare?
- Market failures like information asymmetry and externalities (e.g. pandemics)
- Market-based systems assume consumers can make good choices, but the healthcare environment is so complex this may not be possible
- Healthcare does not follow a supply and demand curve. Demand = need and need is so difficult to estimate. Market systems rely on this relationship.
What are the 3 planning theories?
- Rationalism
- Incrementalism
- Mixed scanning
What are the features of rationalism planning?
The aim is a comprehensive analysis that considers all possible data and solutions.
A very structured approach with a series of logical steps to achieve a clearly defined goal.
What are some tradeoffs of a rationalist approach to planning? (5)
- Time consuming
- Gathering all the data may be impractical
- Reaching a consensus on a specific goal may be challenging
- Specialist intensive
- May not have the capacity to undertake such a large endeavour
What is a real-world example of the rationalist approach to health planning?
PAHO CENDES
A joint venture by the WHO and the Central University of Venezuela to create a national health planning approach for Latin America.
Programs were created at local health centres. These programs were then grouped together to create regional programs. Finally, the regional programs were grouped together to create the national health program.
In theory, planning at the local, regional and national level would allow for a comprehensive approach.
It is a very logically structured approach where one step cannot be started until the proceeding step is completed.
What are the weaknesses of the PAHO CENDES approach to health planning?
Highly intensive
Requires data collection, even at the local level which may not be properly equipped to handle admin
Time-consuming
Does not consider political factors in the planning process
Neglects parts of the health system where formal structures do not exist
What are the features of incrementalist health planning?
Make smaller, achievable goals based on existing policies and procedures. It prioritises practicality and building on existing success
What are the limitations of incrementalist health planning?
Can lead to a lack of innovation
Exacerbate pre-existing issues
Might not be bold enough to tackle complex problems
There is a risk of planning becoming an institutionalised bargaining system where there is a focus on short-term wins of powerful stakeholders instead of a focus on long-term goals
What is a real-world example of the incrementalist approach to health planning?
UK Government’s goal is to become “smoke-free” by 2030. Want to make the adult smoking population 5% or less.
Establish multiple smaller interventions to get to their goal.
1. Provide free vapes to adult smokers in “Swap to Stop” packs issued by local authorities
2. Change the TRPR and CAP regulations so that vaping can be promoted as a safer alternative to smoking through the use of government-approved messaging inserts in cigarette packages
3. Use public health campaigns to promote vaping as a safe alternative to smoking
Build on previous successes:
- Making sexual health testing free to prevent the spread of STDs
- Change4Life public health campaign in the UK worked to reduce childhood obesity
What are the features of a mixed scanning approach to planning?
Aims to strike a balance between the rationalist and incrementalist planning models.
Priority setting is a key concept.
2 levels of analysis: wide angle and close up.
1. Wide angle: look at the big picture to identify areas which require additional consideration. Makes it more likely that all major trouble areas will be considered.
2. Close up: in-depth consideration of areas identified by wide-angle view
The end goal is “satisficing” - aims for an adequate result instead of an optimal one.
What are the limitations of a mixed scanning approach?
Solution is likely not optimal due to “satisficing”
May not uncover issues that would be identified with a more in-depth look at more areas
What is an example of a mixed scanning approach? Hint: not real world
Could be used to target antibiotic resistance. Using the “wide angle” policymakers would look at the landscape of bacterial infections to identify the bacteria which are most commonly resistant. They can then investigate these bacteria in more detail to understand the mechanisms which underlie their resistance, prescription practices, evaluate alternative treatment options and explore new innovative treatments.
This approach would not solve every instance of antibiotic resistance, but would help to mitigate the priority bacterias.
What are the 2 types of group consensus techniques
- Nominal group technique
- Delphi technique
Explain the nominal group consensus technique is
Steps: silent generation of ideas, display ideas for everyone, clarify ambiguities or misunderstandings, consolidate similar ideas, and individuals rank the ideas. Typically the idea with the highest total ranking is chosen.
