Module 5 Flashcards
(30 cards)
What is the WHO formula for measuring the performance of a health system?
Good health of the population 50%
Responsiveness to people’s expectations 25%
Fair financial contribution 25%
What are the problems with measuring a health system’s performance?
Disagreement of objectives Narrow definition of health system Health system only one minor determinant of health How to measure potential performance? Lack of accurate data
What are the five Gauld et al criteria for analysing a health system?
Health outcomes Quality Access Efficiency Equity
Which aspects of health outcomes are used as indicators in the Commonwealth fund?
Mortality amenable to health care
In hospital mortality for acute myocardial infractions
Which aspects of access and equity are used as indicators in the Commonwealth fund?
Cost-related access problems in the past year
Problems paying medical bills in the past year
Access to a doctor or nurse when sick or needing care
Difficulty getting after hours care without going to an ED
Waited less than a month to see a specialist
Which aspects of quality/access are used as indicators in the Commonwealth fund?
Rated quality of care in the past year as good or excellent
Medical errors in the past two years
After discharge, primary care doctor receives information to manage patient within 48 hours
Experienced co-ordination gaps in the past two years
Doctor patient communication and communication
Which aspects of efficiency are used as indicators in the Commonwealth fund?
Average health care spending per capita
Health care spending as a percentage of GDP
What are the five potential ways that healthcare can be funded?
Voluntary contribution Direct payment Private insurance Social insurance Taxation
What are the key components of direct payment?
Consumers cover all or part of the cost
In NZ this is most common in general practice
No moral hazard
Can increase social inequality
What are the key components of taxation?
Revenue for health services is collected from taxes on income and goods+services
Progressive so those on lower incomes pay less tax
No link between how much an individual contributes and the quality of health care received so reduces inequalities
Taxes are never spent only on health so the percentage actually spent on health depends on the budget
What are the key components of private insurance?
For profit insurance companies cover the cost of health care
Health is an individual rather than social responsibility
Lower risk individuals do not cover the cost of higher risk individuals
Insurance companies must make a profit and so are subject to market variability
Increases inequalities as there is a direct link between how much an individual contributes and the quality of care received
What are the key components of social insurance?
Health costs covered by sickness funds which are non-profit non government organisations
Employees pay a fixed % of their salary into a sickness fund
Employers often supplement this contribution
Quality of care is not determined by how much an individual contributes
Additional insurance can be set up for high risk or low income groups
Regulated by the government but not run by it
What are the advantages of funding health care through tax?
Better at facilitating access and equity
Better at some aspects of quality-coordination
Better at efficiency and controlling costs
What are the disadvantages of funding health care through tax?
Can create some access problems-wait times
Worse at some aspects of quality-less patient choice+lower pay for health professionals
Moral hazard
What are the advantages of funding health care through private insurance?
Markets can stimulate quality improvement
Higher degree of patient choicee
What are the disadvantages of funding health care through private insurance?
Restricts health access Works against equity More difficult to control costs Quality a problem in some areas-patient safety Moral hazard
What are the advantages of funding health care through social insurance?
Universal coverage increases equity and access
More clinicians per capita
What are the disadvantages of funding health care through social insurance?
Expensive and complex to administer
Relatively expensive for employees and employers
Some difficulty controlling costs
Quality difficult in some areas-integration and continuity
Moral hazard
How can increased access actually negatively impact on equity?
Those who are healthier or have higher incomes may have greater access
Which two methods of funding health care make a health system highly accessible if they compose more than 80% of the system?
Taxation
Social insurance
Which two methods of funding health care decrease access if they make up more than 35% of a health system?
Direct payment
Private insurance
What is the relationship between the source of health care funding and quality indicators?
There is no relationship
Which methods of funding health care result in a higher proportion of spending on health care?
Direct payment
Private insurance
What does charging copayments negatively affect?
Access and equity
