1. Comparing health systems Week 19 Comparative Sociology

2. Outline Macro factors in healthcare systems Health systems Ideal Types Pressures on health systems

3. Health care systems Health care systems deliver services to individuals They are also a major part of the economy They are subject to political battles –Between political parties –Between individuals and service providers/political parties

4. Shaping Health Care Systems  Political factors include:  Extent of State Involvement  Local/national divides  How decisions over structure/entitlement are made?  Values underpinning decisions  Form of organisations  Power of professional groups

5. Shaping Health Care Systems  Social and Economic factors include  Historical Background  Social structures  Social divisions, Employment patterns etc  Strength of national economy  Budgets may go up or down  Impact of the global economy

6. Shaping Health Care Systems Cultural factors –How much a society values its health care system. –Different nations value Different levels of provision Different types of provision May respond differently to the same issues

7. Shaping Health Care Systems Demand for health care influenced by factors such as –Population size –Geographical distribution –Age and Gender –Normative expectations (eg number of children in a family)

8. Shaping Health Care Systems Epidemiological trends –In Developed Countries Reduction of rates of infectious disease Growing levels of chronic illness Emphasis (or not) on preventive services.

9. Discuss with the people sitting next to you the factors you think might be most important.

10. Ideal Types of health care systems Considers the degree of government involvement Free market system vs. government monopoly But most countries have a mixture so models only used for macro comparisons

11. Models based on State Funding Three main types of health care systems emerge along this continuum 1. Private insurance (US) 2. Social insurance(Germany) 3. National Health Service.(New Zealand)

12. Private insurance Minimum state involvement in direct provision or funding –May have safety net provisions for vulnerable groups Individuals/Employers purchase insurance Health care providers are privately owned Health Care best provided by free market Outcome: –Extreme inequality and high cost (people and money)

13. Social insurance Compulsory health insurance (non-profit) Funded by State, employer and individual contributions Service provision often private with some public ownership Outcome: Unequal financial burdens

14. National Health Service Universal coverage funded out of general taxation Equitable system assumptions of collective responsibility for health care Services owned or controlled by the State Outcome: –May fail to met demand

15. Which system to you think is best? Why? Discuss this with you neighbour

16. Pressures on health care Recently, health care has become more of an issue in all developed nations. Reasons for this include: –Threats to national economy, health care costs lots of money –Ageing population – older people more likely to need care –Growth in medical technologies New drugs/inventions cost more money

17. Ideological Reform Ideological belief that competition in the ‘free market’ drives up standards and lowers costs Applied to healthcare in previously non- market models Wave of privatization and quasi-market based reforms

18. Health Care Reforms In National Health Care Systems –splitting purchasing and providing functions (PCT, Hospitals) –making providers compete for the receipt of (largely public) funds through negotiated contracts In countries where there was already a market structure: –Encouraging ‘smart’ purchasing –Opening more contracts to competition

19. Health Care Reforms But market strategies and competition did more always increase efficiency –Aims of New Zealand, Netherlands and US not achieved –Germany reduce some costs, but distorted incentives –Sweden gains in efficiency and diversity of provisions, but unclear if sustainable –UK some gains but competitive market impacted on stability of providers and growing inequality in access

20. Health Care Reforms Managed Competition was seen as being able to fix a range of problems But feasibility was not properly assessed Financing health care mainly through private insurance is neither equitable nor efficient Pressure on health care will continue to grow

21. Summary Health Care Systems are developed in relation to multiple factors Their design and management are subject to political ideologies Health care pressures can lead to changes in priority – but market-based reforms are not necessarily the answer