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International Health Leadership Program Policy Context for Reform Pam Garside University of Cambridge.

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Presentation on theme: "International Health Leadership Program Policy Context for Reform Pam Garside University of Cambridge."— Presentation transcript:

1 International Health Leadership Program Policy Context for Reform Pam Garside University of Cambridge

2 Values Evidence Based Medicine/Policy Accountability

3 International Health Leadership Program u VALUES AND ACCOUNTABILTY n What are the values to guide design and implementation of the health care system? n What is the model of accountability for performance?

4 Policy Challenges and Core Competencies Needed u Making explicit the basic values u Management n Evidence-based medicine - reasonable? u Accountability

5 Need for Reform of Health Systems u Arguments n Humanitarian argument - health care is public good n Economic advantage/vitality u Issues n Resource constraints n Inequity of access n Mal-distribution of resources n Uneven quality of care n Political problem

6 Unstable Health Care Systems Increasing Complexity Inadequate capacity to plan and manage Weakened resource base (financial and human capital) Declining System Performance Health worker stress Gaps between science and practice Disparities/ Inequities Reduced public confidence Dramatic shifts in organization and financing

7 Core Competencies of Sustainable Health Care Systems u Policy/Planning n Making explicit the basic value framework n Environment assessment/strategic planning/forecasting n Legislative and regulatory n Developing essential infrastructure; workforce, IT, etc. u Management n Resource allocation and management n Integrate l Intersectoral l Public and private n Prudent use of technologies n Develop/organize human resources n Generate public good will u Evaluation n Monitor performance n Foster accountability n Implement change

8 WHO Health-For-All in the 21st Century (HFA) Policy “Value Positions” u Health is a prerequisite for human development u A notion of equity or fairness should be at the core of all health system development u Health systems need to adapt and respect the local context and respond to the needs of the population u New mechanisms for transparent policy dialogue priority setting accountability need to be established u Aggregate population based need better expresses societies priorities in health than patient based demand u Health systems must be conceived as an operationally linked to other elements of a countries social and economic development u Health interventions should have a strong evidence base u Case for the individual must be integrated within public health functions that address population needs

9 Values uSolidarity uEquity uFairness uAutonomy (Personal) uAutonomy (Professional) uEfficiency uEffectiveness u Choice (Individual)

10 Values: Discussion u What if any values are missing? u What are three most important for design and management of health care systems? u What values are inherently inconsistent or trade-offs?

11 Evidence-Based Medicine (and Policy?...)

12 The application of science and related knowledge to: u Medical decision making at the individual level u Organization of/and delivery of health care at the population level

13 Evidence-Based Medicine: Limitations/Risks u Financial/affordability u Knowledge gap u Cultural insensitivity u Equity/fairness

14 Evidence-Based Medicine: Merits u Science-based/logical u Effective: achieves desired outcomes u Rational: for distribution/ management of resources u Inclusive/transparent

15 Evidence-Based Medicine What is reasonable?

16 Accountability The obligation to provide a justification and to be held responsible for its actions by another interested party.

17 Accountability - For What? u Medical decision-making u Financial u Individual respect n Patient vulnerability n Confidentiality n Cultural uniqueness u Practitioner/Institutional behavior u Equity/fairness u Procedure for resolving dilemmas

18 Regulation and Accountability: Methods u Professionalism u Market competition/choice u Disclosure u Accreditation/Licensure u Legal (individual and institutional litigation) u Legislation/regulation

19 Accountability: Models ConceptionDomain Methods of patientsof accountability ProfessionalRecipient ofPatient, physicianLicensure, Certification prof. servicesProf. AssociationMalpractice suit EconomicConsumer ofMarketplace andChoice and “exit” health care regulation commodity PoliticalCitizen Government “Voice” and receivingreforms andgovernment pressure public goodactions Adapted from Emanuel and Emanuel Annals of Internal Medicine, Jan 15, 1996

20 Accountability u What are pros and cons of 3 models? u Which model is most predictable to serve public interest? u What are implementation issues?

21 Characteristics of Optimal Health Care Systems u Sustainable financing u Prudent resource management u Attention to quality of care u Respect for individual needs/choices u Accountability


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