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A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations
WHO has defined these goals as :– Good health– Responsiveness to the expectations of the
population– Fair financial contribution
Healthcare System - Goals
• Many countries are struggling to address increasing costs, poor or inconsistent quality and inaccessibility to timely care
• Among developed countries, healthcare expenditures are rising twice as fast as overall economic growth
• Finally, as costs and demand rise, access to care is becoming more problematic. Many healthcare systems have demand versus capacity issues that are extending wait times for services
Healthcare System – Current Scenario
These challenges are exacerbated by driving forces that are challenging the status quo– Globalization– Changing demographics and lifestyles– Diseases that are more expensive to treat (for example, rising incidence of chronic disease)
– Proliferation of medical technologies and treatments
• Greater focus on value from the entire healthcare system
• Increasing need to activate responsible citizens• New approaches to promoting health and delivering care
• Growing resource challenges
Healthcare System – Focus Areas
Within developing countries, access to basic healthcare services is seen to be extremely limited and many simply lack access to even the most basic services. The causes can be enumerated as below:
The Challenge in Emerging Economies
There are generally five primary methods of funding
health care systems:• General taxation to the state• Social health insurance• Voluntary or private health insurance• Out-of-pocket payments• Donations to charities
Most countries' systems feature a mix of all five modelsMost countries' systems feature a mix of all five models
Healthcare System - Funding
The effectiveness with which these instruments of state policy are designed and used determines the extent to which the health
system is equitable, appropriate or fair
Healthcare System - Aspects
Staying Healthy
Long Term Condns
Mental Health
Maternity & New Born
Care for Children
Acute Care
Planned Care
Monitoring /Preventing
Diagnosing Preparing/Intervening
Recovering Monitering/Managing
Franchising•PDA, Thailand•K-Met, Kenya•PSI, Various•MinuteClinic, U S•HealthStore,Kenya•GreenStar,Pakistan
Production Specialisation•Arvind Eye, India•LifeSpring, India•Narayana Hridyalaya, India
Technology Enabled Networks•Medical, Mexico•HMRI, India•NHS Helpline, U.K.•Care Mgmgt Co., U.S.•RapidSMS, Malawi•EMRI, India
Integrated Care•Valencia, Spain•Kaiser Permanente,U.S.
CATEGORIES
OF
CARE
CARE DELIVERY VALUE CHAIN
Six factors characterize these solutions, with each doing some or all of the following:
2. Get close to the patient and follow established behaviour patterns: E.g., Aravind
has engaged in out-reach strategies – taking care straight to the villages
4. Reinvent the delivery model by using proven technologies disruptively: E.g., MinuteClinic’s IT platforms under-pinning clinical procedures and decision making
6. Confront professional assumptions and right skill the workforce: E.g., The use of community health workers at HealthStores reduces expenditure
8. Standardise operating procedures wherever possible: E.g., Aravind, HealthStores, MinuteClinic and PSI have all standardised their procedures
10. Borrow someone else’s assets: E.g., HealthStores relies on already established sites to base their micro-clinics
12. Open new revenue streams across sectors: E.g., PSI has shown its possible to cross sector boundaries to create new market opportunities in franchising
Some efforts are being made by both public and private players to address these issues :
• The government’s NATIONAL RURAL HEALTH MISSION program aimed at making infrastructure and resources available and functional.
• FOCUSED EDUCATIONAL PROGRAMMES such as Bachelor of Rural Healthcare and Rural MBBS are also on the anvil
• EMERGENCY AND REFERRAL TRANSPORT INITIATIVES such as EMRI, 108 and Janani express
• STREAMLINING PROCUREMENT OF DRUGS AND CONSUMABLES to improve availability at all public healthcare facilities
• USE OF MEDICAL MOBILE UNITS, e.g., the ‘Akha Boat’ initiative in Assam that provides basic healthcare services through mobile boats to the remote riverine islands of Assam
• PUBLIC-PRIVATE PARTNERSHIPS for operating healthcare infrastructure and medical equipment
• SET UP OF TERTIARY CARE CORPORATE HOSPITALS IN TIER II AND III CITIES and use of telemedicine by private players to reach a larger section of the country
In INDIA
“In healthcare you don’t do one big thing and reduce the price but have to do 1000 small things” – Dr. Devi
Shetty Chairman, Narayana Hrudayalaya
Short Stay Surgeries take anywhere between 24 - 72 hours from admission to patient discharge and may include Day Care Surgeries in which the patient is discharged within a day
Apart from cost containment, other benefits of out patients surgery are :
• Decompression of busy hospital beds• Less nosocomial infections • Early recovery in home environment with the family. Thus, there is less disruption of personal lives• Acceptance of day care surgeries by insurance companies has resulted in a win-win situation for all
Advantages
Merrygold Health Network is an innovative Social Franchising Program in India providing essential health care services to the poorer sections in the society. The program is being implemented through a Public Private Partnership (PPP)
The Ministry of Health and Family Welfare (MOHFW), Government of India, through its National Rural Health Mission (NRHM) has introduced the rapid home pregnancy test kits (Nishchay)
THE NISHCHAY PROGRAM
is not a program for the promotion of the pregnancy test kit alone, but is an entry point to RCH and family planning services for women seeking quality and assured RCH and FP services.
Important key issues addressed by Nishchay are: Low percent of women starting ANC in first trimester due to late
detection Contraceptive Provisioning (IUD/Pill) not started after ruling out
pregnancy High unsafe abortions due to late detection of pregnancy
• Cost efficiency due to higher volume• Provide higher quality care due to
greater specialization• Easily attract human resource• Economies of scale and scope• Ease of operation• Increase consumer satisfaction• Competitive pricing and increased
choice for consumer
Examples : Medfort Hospitals, Center for Sight, Aravind Eye Care, Aster Vision, Renkare (dialysis centers)
Single Specialty Hospitals - Advantages
In medicine, end-of-life care refers to medical care not only of patients in the final hours or days of their lives, but more broadly, medical care of all those with a terminal illness or terminal condition that has become advanced, progressive and incurable.
Therefore, end of life care centres have three objectives:• To reduce the agony and burden of prolonged dying process• To develop mental peace at the time of death• To establish ethical principles supporting death in the Indian hospitals
V. END OF LIFE CARE CENTERS
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