❤️‍🩹Intro to Public Health Unit 12 – Healthcare Systems & Policy in Public Health

Key Concepts & Definitions

• Healthcare systems encompass the organization, financing, and delivery of health services to meet the health needs of a population
• Public health focuses on promoting and protecting the health of communities through education, policy making, and research
• Health policy refers to decisions, plans, and actions undertaken to achieve specific healthcare goals within a society
• Universal health coverage ensures that all people have access to needed health services without suffering financial hardship
• Social determinants of health are the conditions in which people are born, grow, live, work, and age that shape health outcomes
  • Includes factors such as income, education, housing, and access to healthcare
• Health equity is the absence of unfair and avoidable differences in health status across population groups
• Primary care serves as the first point of contact for patients and provides comprehensive, coordinated, and continuous care
• Specialty care focuses on specific areas of medicine (cardiology, oncology) and typically requires referral from primary care

Historical Context of Healthcare Systems

• Early healthcare systems emerged in ancient civilizations (Egypt, Greece, Rome) with a focus on religious and spiritual healing
• The Middle Ages saw the rise of hospitals run by religious orders to care for the sick and poor
• The Renaissance period brought advances in medical knowledge and the professionalization of medicine
• The Industrial Revolution led to the development of public health measures to address poor living conditions and the spread of infectious diseases
• The 20th century saw the expansion of healthcare systems and the introduction of national health insurance programs
  • The United Kingdom established the National Health Service in 1948, providing universal healthcare funded through taxation
  • The United States introduced Medicare and Medicaid in 1965 to provide health coverage for the elderly and low-income populations
• The Alma-Ata Declaration of 1978 emphasized the importance of primary healthcare and health as a fundamental human right
• Healthcare reforms in the 21st century have focused on expanding access, improving quality, and controlling costs

Types of Healthcare Systems

• Beveridge Model: Healthcare is provided and financed by the government through tax payments (United Kingdom, Spain, New Zealand)
  • Characteristics include universal coverage, government ownership of healthcare facilities, and employed healthcare providers
• Bismarck Model: Healthcare is financed by mandatory health insurance funds, typically through employer and employee contributions (Germany, France, Japan)
  • Insurers are non-profit and tightly regulated, and healthcare providers are mostly private
• National Health Insurance Model: Healthcare is financed through government-run insurance, but healthcare delivery remains largely in private hands (Canada, South Korea, Taiwan)
  • All citizens pay into the insurance program, which covers a defined set of services
• Out-of-Pocket Model: Healthcare is paid for by individuals without significant government or insurance involvement (many low-income countries)
  • Results in limited access to healthcare and high financial burdens for those who need care
• Mixed Models: Many countries have healthcare systems that combine elements of different models (United States, Australia, Singapore)
  • The United States has a mix of private insurance, government programs (Medicare, Medicaid), and out-of-pocket payments

Healthcare Policy Fundamentals

• Health policy aims to improve population health, ensure access to quality care, and control healthcare costs
• Policy levers include legislation, regulation, financing, and service delivery
• Evidence-based policymaking relies on research and data to inform decision-making
• Health technology assessment evaluates the clinical and cost-effectiveness of new technologies and interventions
• Health in all policies recognizes the impact of non-health sectors (education, housing, transportation) on health outcomes
  • Encourages collaboration across sectors to promote health and health equity
• Global health policy addresses transnational health issues and promotes international cooperation
• Health policy is shaped by political, economic, and social factors, as well as the influence of various stakeholders
• Policy implementation and evaluation are critical to assessing the effectiveness and impact of health policies

Stakeholders in Healthcare

• Patients and the public are the primary beneficiaries of healthcare and have a stake in access, quality, and affordability
• Healthcare providers (physicians, nurses, allied health professionals) deliver care and advocate for patient needs
• Hospitals and healthcare organizations are major providers of care and have financial and operational interests
• Insurance companies and payers (government, employers) finance healthcare and have an interest in controlling costs
• Pharmaceutical and medical device companies develop and market products and have a stake in reimbursement and regulation
• Government agencies (health ministries, regulatory bodies) oversee healthcare systems and develop and implement policies
• Professional associations and unions represent the interests of healthcare providers and influence policy
• Academic institutions and research organizations generate evidence and train healthcare professionals
• Non-governmental organizations and advocacy groups promote specific health issues and represent patient interests

Financing Healthcare

• Healthcare financing involves the mobilization, accumulation, and allocation of money to cover the costs of health services
• Sources of healthcare financing include government revenue, social health insurance, private health insurance, out-of-pocket payments, and external aid
• Government financing through taxation is a major source of funding in many countries, particularly those with universal healthcare systems
• Social health insurance involves mandatory contributions from employers and employees to fund healthcare (Germany, Japan)
• Private health insurance, often provided through employers, plays a significant role in some countries (United States)
• Out-of-pocket payments, including deductibles, copayments, and direct payments for services, can create financial barriers to access
• External aid from international organizations and donor countries supports healthcare in low- and middle-income countries
• Provider payment mechanisms (fee-for-service, capitation, diagnosis-related groups) influence healthcare delivery and costs
• Value-based healthcare aims to align payment with the quality and outcomes of care rather than the volume of services provided

Current Challenges & Debates

• Rising healthcare costs strain individuals, employers, and government budgets
  • Factors contributing to cost growth include an aging population, chronic diseases, and new technologies
• Ensuring access to healthcare, particularly for underserved and vulnerable populations
  • Barriers to access include lack of insurance coverage, geographic distance, and social determinants of health
• Addressing health disparities and promoting health equity
  • Disparities exist across racial, ethnic, socioeconomic, and geographic lines
• Balancing the need for innovation with the affordability and sustainability of healthcare systems
• Integrating mental health and substance abuse treatment into primary care and ensuring parity in coverage
• Preparing for and responding to public health emergencies (pandemics, natural disasters)
• Addressing the social determinants of health and promoting upstream interventions
• Navigating the political and ideological debates surrounding healthcare reform and the role of government

Future Trends & Innovations

• Personalized and precision medicine tailors treatment based on an individual's genetic, lifestyle, and environmental factors
• Digital health and telemedicine expand access to care and enable remote monitoring and management of chronic conditions
  • Includes mobile health apps, wearable devices, and virtual consultations
• Artificial intelligence and machine learning support clinical decision-making, drug discovery, and population health management
• Value-based care models align payment with quality and outcomes, incentivizing prevention and care coordination
• Population health management focuses on improving the health of defined populations through data analytics and targeted interventions
• Social prescribing connects patients with non-medical community resources (exercise programs, social support) to address social determinants of health
• Emphasis on patient-centered care and shared decision-making empowers patients to actively participate in their healthcare
• Global health collaboration and information sharing to address transnational health threats and promote health equity