Management & Health Delivery Systems (MGMS-101)

Management & Health Delivery Systems

(MGMS-101)

ByDr. Hoda Zaki

Prof. Hospital AdministrationChair Department of Health Administration &Behavioral Sciences

High Institute of Public HealthUniversity of Alexandria

1Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

Course Description

• This course provides an overview of organization of institutions that provide health care , the people who provide health care as well as dimensions for evaluation of health systems include quality, efficiency , acceptability and equity.

Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration 2

Intended Learning Outcomes (ILOs)By the end of this lecture the student will be able to :

1. Define the health care systems.

2. Identify the goal of the health care systems.

3. Know the structure of health care delivery system.

4. Know the levels of health care .

5. Know the institutional providers of health care:

A. Ambulatory health services

B. Hospital

C. Public Health Services


What is Health?

Health is “state of complete physical,

mental, and social well-being, and not

merely the absence of disease and

infirmity” (World Health Organization)


Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

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What is health care & who’s involved?

Patient

Professional

Disease Self Help Self Care Management


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Moving the site of care


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Contemporary Health Care rests on a

successful partnership betweenPatients, Clinicians, and Delivery

Systems

What is a “System” ????

A network of integrated components

designed to work together coherently.

.


What is a healthcare system?

Health system

Health care system

Health care delivery system

all are synonymous


What is a healthcare system?

HEALTHCARE SYSTEM: A network of

integrated components designed to work

together coherently .


What is the Health Care Delivery System?

A mechanism for providing services that

meet the health-related needs of

individuals.


12Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

Definition of health care system

organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations.


http://en.wikipedia.org/wiki/Organization

http://en.wikipedia.org/wiki/Health_care

http://en.wikipedia.org/wiki/Health

WHO Definition of health care system

"A health system consists of all

organizations, people and actions whose

primary intent is to promote, restore or

maintain health.


Goals of health care system

According to the World Health Organization, (WHO)

The goals of healthcare system are:

1. good health of population

2. responsiveness to the expectations of the

population

3. fair financial contribution


http://en.wikipedia.org/wiki/World_Health_Organization

http://en.wikipedia.org/wiki/World_Health_Organization

Structure of Healthcare Delivery System

• Public sector - financed through a tax-based budgeting system at both national & local levels .- health care is delivered free at the point of service.

Why is it important to know the health sector as a Medical Equipment specialist?

• Private sector- profit & non-profit providers.- market-oriented, health care is paid through user fees at point of service .


Levels of Health Care and Referral System

• Three levels of Health Care:

• Primary level of Care

• Secondary level of Care

• Tertiary level of Care



• Primary level of Care: it Includes preventive measures such as immunization, health education, simple diagnostic & therapeutic procedures.

- provided by center physicians, public health nurses, rural health midwives, health workers

- first contact between the community members and health facility.

Examples: rural hospitals , health centers, family

health centers.Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital

Administration 18


• Secondary level of Care: it Includes more complex services than primary level such as minor surgeries and some simple laboratory examination.

- given by physicians with basic health training.

- either privately owned/government operated.

- it considered a referral center for the primary health

facilities.

Example: district hospitals



• Tertiary level of Care:• provides services for complicated cases & those who require

intensive care. it includes highly specialized & most complex services such as burn treatment , open heart surgery , transplantation

- rendered by specialists in health facilities including medical centers, general & specialized hospitals.

- It considered a referral center for the secondary care facilities

Examples: central hospitals , University hospitals,….



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Secondary level of Care

Primary level of Care

Tertiary level of Care

The Institutions Providing Health Care

A. Ambulatory health services

B. Hospitals

C. Public Health Services


Ambulatory Health Services

Definition : Ambulatory health services is the services provided to no-institutionalized patients ( walking patients) .Levels of ambulatory health services:

Primary levelSecondary level : such as ambulatory surgery ( due to advance in technology ex., the use of fiber optic, Endoscopies)

Settings of ambulatory health services:1. Solo practice2. Group practice3. Outpatient clinics /department (OPD)4. Ambulatory surgery centers 5. Emergency rooms (ER)


Solo Practice

Solo practice is a services provided by solo practitioners who are :1. physicians trained in general & family practice who provide

primary care .2. Specialized physicians who provide secondary care. Solo practitioner is a self employed physician, he does not

depend on organization or sharing resources or income with others.

solo practitioner usually have a strong relation with their patients.


Group Practice

Group practice is affiliation of three or more providers

usually physicians who share income, expenses,

facilities, equipment, medical records, and support

personnel in the provision of services through a formal

legal organization.

WHY GROUP PRACTICE (benefits of group practice)????


Outpatients Department (OPD)

OPD is established in order to :1. Decrease the overcrowding in hospitals.2. Decrease the cost of services: compare the cost of one day

in the hospital & cost of one visit to OPD.

Function of OPD:3. Provide primary care & specialized services.4. Follow up of patient after hospitalization.5. Training for medical students & house officers .


Ambulatory Surgery Centers

It is one-day surgical care , the patient is discharged 1 to 3 hours after surgery when recovery from anesthesia is sufficiently complete.

Settings of ambulatory surgery:1. Freestanding ambulatory surgery centers: they are independent

of hospital.2. Hospital- based ambulatory surgery centers they are affiliated to

hospital.3. Office- based ambulatory surgery centers where physicians

perform surgery in their offices.What are the disadvantages of office-based ambulatory surgery ???


Emergency Rooms (ER)

ER provides services for urgent cases.

ER require sophisticated facilities & highly trained personnel.

ER must accessible 24 hours a day.

People needing emergency care either transport themselves

or call an emergency number for ambulance .

Specialized ambulance services including mobile coronary

care units & shock –trauma vans .


Hospitals Definition of Hospital (AHA,1967): Any institution which has at least

six beds ready for use beyond 24 hours by patients requiring diagnosis, treatment or care of illness, injury or pregnancy and satisfying the following minimum requirements:

1. Nursing service around the clock.2. Organized medical staff governed and approved by the

administration bylaws, rules and regulations.3. Well designed physical plant that insures the safety and welfare

of the patients.4. Records of clinical work on all patients accepted for care.5. Clinical laboratory services.6. Diagnostic X-ray services.7. Treatment facilities for surgery and obstetrics.


Classification of Hospitals

Hospitals are classified according to:

1. The type of services provided (general or special hospitals).

2. Administrative ownership (governmental and non-

governmental hospitals).

3. Length of stay (short term – long term hospitals).

4. Bed capacity /number of beds: small & large hospital .

5. State of accreditation (accredited hospitals, non-accredited

hospitals)



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Classification of hospitals according to type of services provided

General hospitals Hospitals that are organized, equipped and

staffed to cover a wide range of medical specialties for both sexes and all age group.


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Classification of hospitals according to type of services provided (Cont.)

Specialized hospitalsHospitals that are organized, equipped and staffed to

cover the health care needed for: A special disease e.g. T.B., leprosy, or cancer

hospitals. A special disease category e.g. cardiology, fever,

orthopedic, and ophthalmic hospital. A special group of population e.g. children, geriatric,

or women hospital


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Classification of hospitals according to administrative ownership

Governmental /Federal Hospitals

Non-Governmental Hospital: A. Voluntary non-profit hospitalsB. Private profit hospitals


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Characteristic of Governmental/Federal Hospital

1. These hospitals are people’ hospitals.

2. They are not run for profit.

3. They mainly admit free patient, may admit part-payers. The payment is for better accommodation but not better medical care.

4. The administrator and other employees of the hospital are civil employees.


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Characteristic of Governmental/Federal Hospital (Cont.)

5. These hospitals usually provide free programs for outpatients and emergency care.

6. Most governmental hospitals are involved in education, research and training of health personnel.


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Voluntary non-profit hospitals

These are owned and operated by community bodies interested in the health and welfare of the people e.g. ,organized community bodies , religions bodies, and private corporation organized not for profit .


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Characteristic of Voluntary non-profit hospitals

1. They are administrated and controlled by administrative board

2. They are socially oriented.

3. They are usually admit full payers, part-payers and also free patients.

4. They are financed from the fee collected from patients, gifts and donation and governments subsidies which are usually provided to keep the fees down and to support free cases.

5. They usually operate outpatient and emergency care (free, part-payers and full payers programs).


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Private-profit hospitals

• These hospitals are owned and operated by private persons (doctors or lay people).


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Characteristic of private hospital1. They are business institutions operated primarily for profit

making, so they pay taxes.

2. They only admit pay-patients, whether the cost of care is paid directly from patients’ pocket or through a third party ( e.g. a health insurance organization).

3. In most cases, these hospitals don’t have organized programs for emergency care and perhaps for outpatient care.

4. They are not involved in teaching research or training of professionals.


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Classification of hospitals according to length of stay

Short stay hospitals: 90 % of all admitted patients stay less than 30 days.

Long stay hospitals: 90% of all admitted patients stay 30 days or more.


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Classification of hospitals according to bed capacity

The size of the hospital is usually expressed in terms

of its bed capacity, which is “the number of beds normally set up, equipped and staffed for use by in-patients beyond 24 hours except newborn bassinets”.

Small hospital has 50-100 beds.

Large hospital has more than 100 beds.


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Classification according to state of accreditation

Accredited hospitals: these are hospitals which meet or exceed thestandards set by the JointCommission on Accreditation of HealthcareOrganization (JCAHO).

Non-accredited hospitals: these are hospitals which do not meet thestandards set by (JCAHO).


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Thank you

Documents

Management & Health Delivery Systems (MGMS-101)