Health care system

By Dr Maria Moin
Department of Community Dentistry

By the end of lecture you should be able to
understand
 Historical and modern background of health
care system
 Factors influencing health care system
 Components of health care system
 Criteria to evaluate the quality of health
care system

Health care systems are complex
organizations that are in a constant process
of change and evolution.
The World Health Organization (2007) defines
it as:
All organizations, people and actions whose
primary intent is to promote, restore or
maintain health. This includes efforts to
influence determinants of health as well as
more direct health improving activities.

 Historically only the wealthy people were
able to access health care but gradually
system developed for wider range of groups
 Mays in 1991 has highlighted the political
importance and health care system reforms
were designed to prevent political instability
and improve the fitness of army recruits

 The nature of modern health care system
reflects the values and priorities of the
societies
 In the US largely privately funded and
organized health system operates based on
individual responsibilities
 In the China or Cuba health services are state
controlled and publicly funded

 Changing pattern of disease
 Socio demographic changes
 Public demands and expectations
 Professional development
 High technology
 International affairs- globalization
 Government health policy and reform
programmes

 In 19th century acute infectious conditions
were greatest problem
 Infectious hospitals and sanatorium being
built to care for people
 Today chronic health conditions are major
challenge
 Health services are now required to provide
long term care and support to improve their
quality of life and maintain their
independence

 Socio demographic change have occurred
which results in increasing numbers of very
old people
 Living longer and requiring support and care
 Appropriate services need to be provided for
different groups in the community

 The people are now more aware and
knowledgeable about health issues through
media
 Increasingly expect and demand services to
meet their needs
 Health service users are now more
empowered, place different demands on
provision and delivery of care to challenge
health professionals

 Historically doctors and nurses, and to lesser
extent dentist were the only professions
 Today there is a wide range of medical and
dental specialties of health professions have
developed to implicate professional training
and service delivery
 Team approach being developed in which
different professionals contribute their skills
and expertise


 Modern medicine and dentistry rely on high
technology in terms of treatments,
equipments, materials and diagnostic
procedures
 It is expensive and require technical support
and maintenance

 Pharmaceutical industry is dominated by
multinational corporations who exert power
and influence over governments and health
policy decision

 It has major influence on health care system
development and it is the effect of changing
political priorities and health policy
developments
 In last 3o years NHS has undergone series of
reviews and reform programmes driven by
political dogma and in accordance with
international consensus on health service
development

 Structure: how is the system organized?
 Functions: what does the system aim to
achieve?
 Personnel: who works in the system?
 Funding: how is the system funded?
 Reimbursement: how are the health
professionals paid?
 Target population: who does the system
provide care for?

 Most dynamic and complex
 Three basic levels of care exist
1. Primary
2. Secondary
3. Tertiary

 Provides local general and routine services
 First point of contact between public and
system
 Examples: general practioners, pharmacist,
general dental practioners
 In NHS the primary care sector act as
gatekeeper to secondary and tertiary sectors

 physicians referrals to specialists too freely, results in
decrease earning
 specialists may complain about referrals for conditions
that they think the primary care provider should have
managed alone
 Infrequent referral to specialty care, patients may believe
their physicians are denying them necessary care
ADVANTAGE:
It selects those who will enter and those who will not thus
focuses on restraining people from overusing health care

 It provides specialist services in hospital
settings
 Examples: district general hospitals

 These are the centers of clinical excellence
which are often teaching and research
institutions
 Examples: teaching hospitals

 It can be provided in different settings
although the locations of services do not
match the population health needs
 Inverse Care Law: (Tudor Hart 1971)
Health services are located in areas where
the needs are low but in the areas where
need is greatest few services are found

 Hospitals
 Health centers and clinics
 General practices
 Dental surgeries
 Direct access centers
 Mobile surgeries
 Domiciliary care
 Workplace
 Pharmacist premises

 Traditionally health services were following the
medical model aimed to cure the disease with
few cures or magic bullets and limited treatment
effectiveness
 In 1979 Mckeown demonstrated that core
function of is to provide support and care
suffering from chronic disease to improve quality
of life
 He demonstrated that decline of mortality rates
in England not only the development of
medicinal therapies but scientific understanding
of the disease process

 Preventive advice to patients
 Health promotion within the community
 Epidemiological surveying
 Population screening
 Research
 Quality assurance and review
 Training
 Personnel

 Range of different personnel are employed
within health services
 Different health professions supply clinical
care, an array of technical, administrative
and support staff provide essential services

 Friedson (1970) developed core set
1. Tasks are highly skilled and require specialized
knowledge
2. Registration provides a monopoly of their field
of work
3. Professions have enjoyed considerable
autonomy and self regulation
4. A code of ethical practice to prevent
malpractice and exploitation of the public
5. Social status and financial rewards place the
profession firmly within the middle classes

 Spending on health services has been rising
 Indeed increasing cost of funding health services becomes major
concern for government and main motivation for reforms
The main reasons for the increasing cost are
1. Health care inflation has exceed the general rate of inflation
2. Numbers of staff employed risen sharply
3. Demands have increased steadily with more people presenting
for care
4. The proportion of people over 75 years has more than doubled
in last five years

1. Taxation: general taxes or special health
tax
2. Insurance: paid by individuals or special
health tax
3. Direct payment from individuals

 Different and complex methods are utilized
Four basic systems of payment
1. Fee for item: paid fee for each item of work
2. Capitation: paid on the basis of number of
patients registered under their care
3. Salary: employers pay annual income for
services
4. Sessional arrangements: set fee agreed in
contract

 Universal and fair access for whole
population is founding principle
 In reality access and quality of services are
not equal across society
 Marginalized and disadvantaged groups face
obstacles and barriers to access
 The quality of care is often inadequate

Based on assessment of needs or characteristics
different services targeted at groups
1. Infants and nursing mothers: mother and baby
group
2. Pregnant women: antenatal groups
3. Children and adolescents: schools and colleges
4. Adults: workplace
5. Older people: day centers
6. Disabled groups: people with mental illness
7. Disadvantaged groups: homeless people

 Any assessment consider not only views of
health professions but also opinion from
stakeholders
 The views of general public, users of
services, health service managers, health
professionals and the government need to
be considered

Maxwell in 1984 developed set criteria
1. Effectiveness: treatments and care
provided produce desired outcomes and
benefits?
2. Efficiency: how well are resources used?
3. Accessibility: can individuals in need use
and benefit from system?
4. Equity: service provide a fair system for
accessing care and outcome of use are
equal across groups

 Social acceptability: service strive to
accommodate the characteristics and
expectations of social groups
 Relevance to need: good match between the
needs of the population and services

 Health care system are large and complex
organizations
 Dentistry is a small part but it is important
that dental professionals have basic
understanding of the factors influencing
service development and components

Health care system

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