BIOE 301Lecture FiveReview of Lecture Four Developing World1. Cardiovascular diseases, 2. Cancer (malignant neoplasms), 3. Unintentional injuries, and4. HIV/AIDS Developed World 1. Cardiovascular diseases, 2. Cancer (malignant neoplasms),3. Unintentional injuries, and 4. Digestive Diseases1. Heart Disease What is one of the most common first signs that a patient has ischemic heart disease? What are four treatments of ischemic heart disease? Drug eluting stents have been in the news lately. Why?2. Increase Your Lifespan Name four things you can do to increase your life expectancy by >14 years.3. Cancer Name three common cancer screening tests. Why don’t we screen everyone with these tests?Unit TwoEvery nation, whether it has many healthcare resources or only a few, must make decisions about how to use those resources to best serve its population.Goal of health system:Improve health of population in a fair and responsive mannerRoles of health system:1) Generate human resources, infrastructure and knowledge to provide health care2) Provide health care services3) Raise and pool economic resources to pay for healthcare 4) Provide stewardship for healthcare systemWhat is a health system?Human resources, physical infrastructure, healthcare technologies, and economic resources devoted to improving the health of the population.Types of health system:1) Entreprenuerial: United States, Bangladesh2) Welfare-Oriented: Canada, India3) Comprehensive: United Kingdom, Sri Lanka4) Socialist: Cuba, VietnamAssessment of health system:Measures of healthMeasures of fairnessDecreasing market interventionWho Pays to Solve Problems in Healthcare?Overview of Lecture 5 Health Systems What is a health system? Goals of a health system Functions of a health system Types of health systems Performance of Health Systems Examples of health systems Entrepreneurial Welfare-Oriented Comprehensive SocialistHow Many $ to Gain a Year of Life? Need a way to quantify health benefits How much bang do you get for your buck? Ratio Numerator = Cost Denominator = Health Benefit Several examples $$/year of life gained $$/quality adjusted year of life gained (QALY) $$/disability free year of life gained (DALY) Can we use this to make decisions about what we pay for?League TableTherapy Cost per QALYMotorcycle helmets, Seat belts, Immunizations Cost-savingAnti-depressants for people with major depression $1,000Hypertension treatment in older men and women $1,000-$3,000Pap smear screening every 4 years (vs none) $16,000Driver’s side air bag (vs none) $27,000Chemo in 75 yo women with breast CA (vs none) $58,000Dialysis in seriously ill patients hospitalized with renal failure (vs none)$140,000Screening and treatment for HIV in low risk populations$1,500,000What Happens When You Don’t Have Health Insurance? United States If you meet certain income guidelines, you are eligible for Medicaid Texas: TANF (welfare) recipients, SSI recipients Eligibility rules and coverage vary by state State pays a portion of the costs, federal govt. matches the resthttp://www.coaccess.com/images/mcdCard.gifWhat Happens When Medicaid Doesn’t Cover a Service? Oregon – July, 1987 Oregon state constitution required a balanced state budget, surplus returned to taxpayers Voted to end Medicaid coverage of transplants Typically 10 transplants performed per year $100,000-$200,000 per transplant $1.1 M cost to state (federal govt. pays the rest) Voted to fund Medicaid coverage of prenatal care Would save 25 infants who die from poor prenatal careA Tale of Two Children Oregon – August, 1987 Coby Howard 7 year old boy Developed leukemia Required a bone marrow transplant Was denied coverage Mom appealed to legislature, denied coverage Mom began media campaign to raise $$ Raised $70k ($30k short of goal) Coby died in December, 1987 Coby was “forced to spend the last days of his life acting cute” before the cameras Ira Zarov, attorney for patient in similar circumstancesA Tale of Two Children Oregon, 1987 David Holliday 2 year old boy Developed leukemia Moved to Washington state, lived in car Washington state Medicaid covered transplants No minimum residency requirementHealth Systems Face Difficult Choices Primary goal of a health system: Provide and manage resources to improve the health of the population Secondary goal of a health system: Ensure that good health is achieved in a fair manner Protect citizens against unpredictable and high financial costs of illness In many of the world’s poorest countries, people pay for care out of their own pockets, often when they can least afford it Illness is frequently a causeof poverty Prepayment, through health insurance, leads to greater fairnessHealth Systems Reflects historical trends in: Economic development Political ideology Provide four important functions: 1. Generate human resources, physical infrastructure & knowledge base to provide health care2. Provide health care services Primary clinics, hospitals, and tertiary care centers Operated by combination of government agencies and private providers 3. Raise & pool economic resources to pay for healthcare Sources include: taxes, mandatory social insurance, voluntary private insurance, charity, personal household income and foreign aid4. Provide stewardship for the healthcare system, setting and enforcing rules which patients, providers and payers must follow Ultimate responsibility for stewardship lies with the governmentActivityCreate Your Own Health SystemTypes of Health Systems Economic Classification Political Classification: Entrepreneurial Strongly influenced by market forces, some government intervention Welfare-oriented Government mandates health insurance for all workers, often through intermediary private insurance agencies Comprehensive Provide complete coverage to 100% of population almost completely through tax revenues Socialist Health services are operated by the government, and theoretically, are free to everyoneTypes of Health SystemsEntrepreneurial Welfare OrientedComprehensive SocialistHigh Income DevelopedUnited States Canada GermanyJapanAustraliaUnited KingdomSpainGreeceSoviet UnionMiddle Income DevelopingPhilippinesThailandSouth AfricaPeruBrazilEgyptMalaysiaCosta
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