I need the following question answered:
Question - Social and economic characteristics of the patient influence a healthcare system. How?
Accountability for NGOs INTERNATIONAL HEALTH SYSTEMS Module: 1 7 Global Health and Health Systems What is a “health system” Total of the organizations, institutions, and resources whose primary purpose is to improve health Required components of a health system Staff; Funds; Information; Supplies; Transport; Communications and overall guidance & direction. Provide services that are: responsive and financially fair, while treating people decently. 8 Concepts to be considered Health: “State of complete physical, mental, and social well being and not merely the absence of disease and infirmity” System: “Human body is a system comprising of many physiological subsystems (respiratory; circulatory; neurological; endocrine, and musculoskeletal) that are interconnected in a holistic way.” Identifying ‘inputs’: As with any system, a health system has inputs (financial, material, and human resources) Health systems arise within a social, cultural, political, and economic context with considerable diversity in size, scope, and form. 9 Select Health System Financial Input Data (in US dollars) Financial and Health Care Resources for Selected Countries. Data from Global Health Facts, and Encyclopedia Britannica Online Academic Edition, World Data, 2007. Financial and Health Care Resources for Selected Countries, continued Data from Global Health Facts (http://globalhealthfacts.org), and Encyclopedia Britannica Online Academic Edition, World Data, 2007. BUILDING BLOCKS OF HEALTH SYSTEMS Critical success factors Service delivery Health workforce Health information Medical technology Health financing Leadership and governance 13 Health Systems Building Blocks (Critical Success Factors) BUILDING BLOCKS OF HEALTH SYSTEMS One widely accepted way of measuring the building blocks or the overall functioning of a health system is through the lens of: Cost Quality Access 15 The cost, quality, access triangle BUILDING BLOCKS OF HEALTH SYSTEMS Measurement of functioning of health system Cost Quality Access Innovation* * In the era of rapid globalization, it is increasingly prudent to add a fourth dimension, innovation. 17 The cost, quality, access, innovation diamond HEALTH SYSTEMS WITHIN LARGER SOCIAL SYSTEMS Anderson model Predisposing factors Family characteristics, social structure, and health beliefs Enabling factors Family & Community Resources Need factors Illness & Response to Illness Behavioral Model for Vulnerable Populations’ 19 The Behavioral Model for Vulnerable Populations. Gelberg L, Andersen RM, Leake BD. Health Services Research, 2000; 34(6):1273-1302. Page 1278. HEALTH SYSTEMS WITHIN LARGER SOCIAL SYSTEMS Impact of social circumstances Behavioral Socioeconomic status influences behaviors Material Lack of food, shelter, and safety can lower health status. Psychosocial Complex pathway requiring connection between social structure and health. 21 Summary of some of the social determinants of health status. Summary of some of the social determinants of health status. Summary of some of the social determinants of health status. Summary of some of the social determinants of health status. CONCLUSION Health systems evolve Challenges to health systems Determinants Impact of globalization Need for sustainability 26 Introduction to Health Systems James A. Johnson and Carleen H. Stoskopf ▸ Introduction A health system as described by the World Health Organization (WHO) is the sum total of all the organizations, institutions, and resources whose primary purpose is to improve health. A health system needs staff, funds, information, supplies, transport, com- munications, and overall guidance and direction. Fur- thermore, it needs to provide services that are responsive and financially fair, while treating people decently.1 Within this definition, there are several concepts that need to be understood before one embarks on the task of studying health systems. First and foremost, an agreed-on definition of health is paramount. Health is too often seen as a concept that applies only to physi- cal well-being or the absence of disease; however, the most widely accepted definition of health is the one first published by the WHO in 1948. Health is a state of complete physical, men- tal, and social well-being and not merely the absence of disease or infirmity2 This comprehensive concept of health is the one used in this book and serves to inform discussions on health systems. The other key word that needs to be explored here is the word “system.” The human body is a system com- posed of many physiological subsystems that are inter- connected in a holistic way. The subsystems, including respiratory, circulatory, neurological, endocrine, and musculoskeletal systems, communicate and are inter- dependent. They work together for the purposes of survival, adaptation, growth, and development. They also interact with the environment and respond to feedback from within and outside the system. In many ways, the interconnectivity of the various subsystems and its extension as a whole into the environment form the building blocks of larger systems, such as family, community, and nation. Thus a natural (biological) system, such as a human being, is also a participant in and a creator of larger social systems. The human- created systems have many of the same attributes of biological systems. Additionally, it can be said that these larger systems are characterized by ■ A structure that is defined by its parts and processes. ■ Generalizations of reality. ■ A tendency to function in the same way, involving the inputs (material, human resources, finances, etc.) and outputs (products and services) that are then processed, causing them to change in some way. ■ A system’s various parts, which have functional as well as structural relationships. Human-created systems can be small, as in the three-person family, or quite large, as in a nation- state such as India with a billion people. The most widely dispersed human-created systems are orga- nizations. As with the other examples described previously, organizations share the same attributes 3 CHAPTER 1 C o p y r i g h t 2 0 1 8 . J o n e s & B a r t l e t t L e a r n i n g . A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w . EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 1/21/2023 10:11 AM via WAKE FOREST UNIVERSITY AN: 1229396 ; James A. Johnson, Carleen Stoskopf, Leiyu Shi.; Comparative Health Systems Account: s8853755.main.ehost One of the major “inputs” into any healthcare system is patients. Patients present with a variety of symptoms/diseases/injuries; however, they also come with a myriad of characteristics, such as personal- ity, life experiences, knowledge, attitudes, cultural norms, education level, income level, intellect, preju- dice, religious and other belief systems, emotions, bio- logical strengths and weaknesses, and genetic makeup. In addition, patients may or may not be plugged into society’s infrastructure, such as having access to trans- portation, childcare, or health insurance. The com- plexity these many factors create cannot be overlooked by healthcare systems nor should they be overlooked by health policymakers. It has been well established that income is perhaps one of the best predictors of health. The income gradient within a population is highly associated with health status of individuals or groups in that population, and the per capita incomes and the GDP of nations are also highly correlated with the health status of that country’s population. Taken from this perspective, health policy makes us also be and adapt accordingly to their environments. In fact, organizations are complex human systems that have evolved over time and continue to do so.3 The natural emergence of human-created systems, such as organizations and communities, proba- bly grew out of instinct for survival. In the hostile world of early humankind, food, shelter, and safety needs usually required cooperative efforts. In turn, cooperative efforts typically require some form of organization.4 This is no less true in the case of pro- viding health. In order to meet the criteria of health as a state of complete physical, mental, and social well-being, individuals, communities, organiza- tions, and nation-states have worked together to form elaborate and diverse health systems through- out the world. As with any system, a health system has inputs. These include financial, material, and human resources that differentiate one health system from another. The data in TABLE 1-1 clearly demonstrate some of these differences. TABLE 1-1 Select Health System Financial Input Data, 2015 (in U.S. dollars) Data from World Health Organization. (2014). Total global expenditure for health $6 .5 trillion plus Total global expenditure for health per person per year $948 Country with highest total spending per person per year on health United States ($8,362) Country with lowest total spending per person per year on health Eritrea ($12) Country with highest government spending per person per year on health Luxembourg ($6,906) Country with lowest government spending per person per year on health Myanmar ($2) Country with highest annual out-of-pocket household spending on health Switzerland ($2,412) Country with lowest annual out-of-pocket household spending on health Kiribati ($0 .02) Average amount spent per person per year on health in countries belonging to the Organisation for Economic Co-operation and Development (OECD) $4,380 Percentage of the world’s population living in OECD countries 18% WHO estimate of minimum spending per person per year needed to provide basic, life-saving services $44 Countries where total health spending was lower than $50 per person per year 34 Countries where health spending was lower than $20 per person per year 7 4 Chapter 1 Introduction to Health Systems EBSCOhost - printed on 1/21/2023 10:11 AM via WAKE FOREST UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use size, scope, and form. As a result, health systems have structure, processes, and outcomes that vary consider- ably. TABLE 1-2 shows some of the variation along these three dimensions for the countries selected for this book. As you will see here and in subsequent chapters, financial and human resource inputs do interrelate with health outcomes. concerned with poverty and lifting populations out of poverty through social policies designed to improve education, housing, infrastructure, job creation, and the environment. Health systems arise within a social, cultural, political, and economic context. As with all human constructed systems, there is considerable diversity in TABLE 1-2 Healthcare Resources for Selected Countries Spent per capita on health % of total health expenditure Percent of GDP US $ PPP $ Government Private Out-of-pocket % of total government expenditures spent on health Australia 9 .4 6,110 4,991 66 .6 33 .4 57 .1 18 .7 Bangladesh 3 .7 32 95 35 .3 64 .7 93 .0 7 .8 Botswana 5 .4 397 851 57 .1 42 .9 12 .7 8 .8 Brazil 9 .7 1,085 1,454 48 .2 51 .8 57 .8 6 .9 Canada 10 .9 5,718 4,759 69 .8 30 .2 50 .1 18 .5 China 5 .6 367 646 55 .8 44 .2 60 .3 12 .6 DR Congo 3 .5 16 26 53 .1 46 .9 69 .8 12 .9 France 11 .7 4,864 4,334 77 .5 22 .5 32 .9 15 .8 Germany 11 .3 5,006 4,812 76 .8 23 .2 55 .6 19 .4 Ghana 5 .4 100 214 60 .6 39 .4 91 .9 10 .6 India 4 .0 61 215 32 .2 67 .8 85 .9 4 .5 Ireland 8 .9 4,233 3,867 67 .7 32 .3 52 .1 14 .1 Israel 7 .2 2,599 2,355 59 .1 40 .9 64 .5 10 .5 Japan 10 .3 3,966 3,741 82 .1 17 .9 80 .2 20 .0 Jordan 7 .2 336 761 66 .0 34 .0 69 .1 13 .5 Korea 7 .2 1,880 2,398 53 .4 46 .6 78 .6 11 .5 Mexico 6 .2 664 1,061 51 .7 48 .3 91 .5 15 .4 Nigeria 3 .7 109 206 23 .9 76