A good system is one that organized in a way to ensure timely access to the highest attainable standard of care to all its citizens; one that has the right programs managed by competent professionals; one in which clinics provide preventive and curative care for the most common conditions, i. All this is done in accordance with the respective program norms and standards. It is simple, but difficult because most countries lack well designed programs or the management capacity to implement them making the best of all the resources they have and they do not have a plan to get there.
That is what I was talking about this week in Johannesburg to a group of international development colleagues. I will share their response next week. What do you think a good health system is? E-mail [email protected]. Global Development Small Business Consortium. We could do better with different policy choices. On the issue of universal coverage, things are a bit more complicated. While its narrowly true that the U. Some countries have universal coverage for their citizens but not necessarily for immigrants or other groups.
Second, it is important to consider what is actually covered. While most Americans can get access to the latest treatments, in many countries, access to the most expensive therapies can be difficult or non-existent. And that would be good. They tend to be among the leaders in acute care quality, when healthcare means the difference between life and death, although the quality of primary care could surely be better. And America is the innovation engine of the world, pumping out new drugs and treatments that benefit the whole world.
All of that earns America a high rank in my book — behind Switzerland and Germany but ahead of others. You can disagree but overall, while the U. Health System Organization So what is the ideal way to organize a healthcare system to accomplish these goals? Evaluating Health Systems That leads us to the next question: what metrics should we use?
My Rankings Based on these measures for country data, see Table 2 , my ranking of the selected health systems is as follows: Switzerland Germany U. Health and social care are inseparable, yet few countries give the latter the attention it deserves. Aged care in particular is often the weak link in health systems. One country that has grasped the importance of aged care is Japan, which in saw the threat that elderly needs posed to its health system and took action.
The tax paid for a national aged care service that funds home, community and residential care for all citizens on a means-tested basis. This model puts a vital brake on costs that explains much of the slower rates of spending growth in these countries compared with those with disparate payers such as the US, Germany or the Netherlands.
The Guardian Healthcare Professionals Network is media partner for the summit. Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter GdnHealthcare to keep up with the latest healthcare news and views. Which drug should the government purchase? According to efficiency criteria, the government should spend its budget to purchase drug B, whose benefits -- the number of lives saved -- are higher.
Although in this example we are comparing costs in dollars and benefits in numbers of human lives, benefits are often quantified in monetary terms. Assessing efficiency is not limited to clear-cut benefits, however; in fact, we must take marginal benefits into consideration. In the opinion of experts, 40 lives could be saved if this entire budget were spent on drug A, but 80 lives could be saved if it were spent on drug B.
Here again, the government should give priority to drug B. Obviously not. Overall, then, it would be more efficient to allocate the budget equally between drug A and drug B.
Assessing efficiency helps us when choices must be made from various medical practices and treatments. Marginal benefits must always be taken into consideration. Is the marginal efficiency of treatment A greater or less than that of treatment B? Or must a choice be made between the present and the future?
For example, is it better to allocate more money to treatment of an illness or to research to find a complete cure for it? Assessing efficiency is an effort to compare the costs and benefits for society as a whole and to highlight the economic effects of public expenditure options so that governments can ascertain which additional investments maximize net benefits.
We must also accept the fact that efficient allocation of resources grows out of a choice that will always have moral and societal dimensions. Should money be invested in equipment to treat rare cases, or in preventive programs that benefit thousands of people?
What priority should be given to services that do nothing to alter the course of an illness but improve the quality of life? Should priority be given to services for children, or services for senior citizens; to physical, or mental problems? Why are some individuals rather than others selected to receive a particular treatment?
Answering these questions will always be difficult. Along with clinical and economic concerns, ethical considerations should be part of the budget decision-making process. Efficiency could also be assessed from a macroeconomic perspective in an effort to determine the proportion of resources to be allocated to health care. In this case, however, it is obviously easier to define a theoretical criterion of macroeconomic efficiency in health care than to demonstrate what is or is not, in current practice, optimum allocation of health care resources at a cost considered acceptable for society.
No one has yet determined the optimum proportion of resources or the ideal percentage of the Gross Domestic Product GDP that governments should allocate to health care expenditures. There seems to be no standard, as is shown by the variation in proportions of GDP allocated to health care, and the importance of the public health care sector, in various countries.
Which country has the ideal system? There is no real answer to this question. According to Evans, "There is It is anticipated that Canada, like several other countries, will pay more attention in future to effectiveness and efficiency in order to streamline its health care system.
We are entering an age, therefore, where questioning will be axiomatic in health care provision. New techniques will no longer be universally implemented without evaluating value versus costs.
Even common procedures will come under more intense scrutiny as the need for justification increases. This trend toward more systematic assessment of effectiveness and efficiency is justified from four points of view. First, greater effectiveness and efficiency alleviate some funding problems of public health insurance systems; second, more effective delivery of services directly improves their quality; third, more effective health care directly contributes to improvements in health; fourth, effectively delivered health care makes the system more efficient.
However, there are some barriers to systematic assessment of the effectiveness and efficiency of health care. Although economic theory offers some useful tools, Canada does not always have enough information to carry out such assessments. The scarcity of indicators for measuring improvements in health and the shortage of information on the effects of medical treatments make it difficult at present to assess the effectiveness of care and the overall performance of the health care system.
First, there are few ways to measure improvement in health following medical treatment, so the effects of the health care system are still often unknown. One reason is that it is not always easy to dissociate the effect of the treatment itself from the effects of other influences. Indeed, health depends on a great many interrelated factors, and we are not able to ascertain unequivocally the specific influence of health care on health. For example, it is often impossible to assess the effectiveness of hospital care because there is no follow-up after the patient leaves the hospital.
Some writers even suggest that is impossible to measure the cost-effectiveness of hospital care:. It is pointless to produce effectively something useless or something that could be produced under different conditions.
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