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Health Service Provision

Health Service Provision. José Ruales Regional Advisor in Health Systems PAHO/WHO. Functions and Objectives of the Health System. Health System. Access – Quality - Efficiency. Maintain and improve health. Stewardship. Values Needs Resources. Financing Insurance.

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Health Service Provision

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  1. Health Service Provision José Ruales Regional Advisor in Health Systems PAHO/WHO

  2. Functions and Objectives of the Health System Health System Access – Quality - Efficiency Maintain and improve health Stewardship Values Needs Resources Financing Insurance Protect financial risks Provision Satisfaction of expectations Participation

  3. Health Services: Definition • Services delivered by health personnel in a direct manner, or by other people under the supervision of these personnel, with the goal of: • Promoting, maintaining and/or recovering health • Minimizing disparities both in access to health services and in the level of population health • (PAHO/WHO 2003; Modification of the IOM 1996)

  4. Public or Collective Health Services Disease prevention and control Protection against environmental risks Injury prevention Promotion of healthy behaviors and mental health Quality assurance and accessibility of health services Individual or Personal Health Services Individual prevention Diagnosis Recovery Rehabilitation Palliative care Health Service Provision

  5. Challenges for Health Services in the Americas • Access to health services is not available for large segments of the population, • The supply of health services does not always adjust to expectations, social values and cultural preferences, • The provision of health services, for certain population groups, is of poor effectiveness and technical quality, • There is fragmentation, duplication, concentration in urban areas, weak information and referral systems, with inefficiency and inequity in the supply.

  6. Health Services in Social Protection Schemes • 7/7 aim to extend coverage and increase access by reducing exclusion and economic barriers • 4/7 increased equity in terms of access and use, but 3/7 increased inequity • 2/7 the elimination of economic barriers was insufficient among the dispersed and indigenous populations • 3/7 increased the demand without expanding the supply of resources or the infrastructure, which leads to overload and reduction of quality

  7. Challenge DEMAND Model of Other systemic Needs, expectations, demand and use of health services by people, families and communities care variables that are ACCESS Model of determinants organization & of health services management SUPPLY Response

  8. Health Service Supply • Concrete existence of services aimed at promoting, preventing, recovering and rehabilitating the target population’s health, both at the individual and collective level, under the conditions of the people and the environment. • Human Resources • Physical Resources • Technological Resources

  9. Health Service Demand • Formal (explicit) requirements for health services. • Utilization: Demand that is met through the supply of services to a target population in a specific time period. • Access: Probability of obtaining health care when needed.

  10. Comprehensive access • Conditions of effective coverage: • Availability • Elimination of barriers (geographic, cultural, economic and social) • Timeliness (moment and time) • Acceptability (satisfaction and respect) • Contact and real use (first contact or other) • Appropriate, effective services (procedures and levels) • Ex. Maternal-Newborn Care: Contraceptives, Skilled delivery care, Emergency obstetric and newborn care • Based on social protection

  11. Social Protection - Adequate access: • Timeliness • Quality • Dignity • Independent of ability to pay • Includes • Health service coverage • Coverage for the entire population • Financial solidarity

  12. Determinants of Access • Prior to using health services: • The need for care should exist • (pain, convincing, risk of death) • Should believe in services’ efficacy • (confidence in the provider) • Should have the ability to access services • (availability of income or insurance, time, transport) Source: Restrepo, JH, 2006

  13. Barriers to access: supply side Source: Restrepo, JH, 2006

  14. Barriers to access: demand side Source: Restrepo, JH, 2006

  15. Factors that influence access Socio-economic development Policies, plans and resources related to health Economic access Social protection in health Socio-cultural aspects Provision / Use of Services Cultural access Resources, organization and management of services Health situation Health needs and care Geographic access Geographic, environ-mental, road access Biological – demographic characteristics

  16. How the factors interact Social determinants of health Social protection in health scheme Perceived Need for health Equitable Unperceived Health outcomes Access Repressed Demand for health Expressed Inequitable Unmet Met Supply of Services

  17. Health Care Model • Content of health care and principal characteristics of the interaction between the service provider and service user. • Includes: • Pertinence of the supply of services to users’ needs and demands, • Accessibility and acceptability of services, • Services oriented to people, families and communities, • Role of people, families and the community in self-care, • Level of integration of services.

  18. Trends in the model of care • Balance between personal services and public health services; curative, promotion and prevention services • Services oriented to families and the community • Promotion of self-care for the health of people, families and the community • Search for the integrality of services: • Comprehensive • Continuous • Longitudinal

  19. Model of organization and management • The manner in which the components of the health system are organized and managed with the goal of achieving the objectives proposed and facilitating its collective function.

  20. Trends in the models of organization and management • Organization of services based on primary care • Definition of a population base • Prioritization of the most vulnerable population groups • Emphasis on ambulatory care and care beyond traditional clinical environments • Decentralization of services • Management focused on quality and results • Organization and management of integrated health systems

  21. Fragmentation • Coexistence of many units or entities that are not integrated into the health service network. • does not allow the standardization of contents, quality, cost and provision • leads to providers not working in a coordinated or synergetic manner • generates increases in the costs of care • promotes inefficient allocation of resources in the system.

  22. Universities Tertiary Care Private, high complexity Social Security Professional Risks MOH Secondary Care Primary Care Private, low complexity NGOs Traditional Medicine Municipalities Segmentation of the system and Fragmentation of services

  23. STRATEGIES FOR CONFRONTING SEGMENTATION AND FRAGMENTATION Strengthening of the STEWARDSHIP / MANAGEMENT of the Sectoral Policy INTER-INSTITUTIONAL COORDINATION Leadership, Alignment and Harmonization of International Cooperation • Management of Integrated Service NETWORKS • Integration of the Programs in the System OPERATIONAL INTEGRATION

  24. Integration of the Population • Involves the availability and the timeliness of access • Guarantees the flow of users through all levels of care and complexity in order to ensure the continuity of care, • Develops referral and counter-referral mechanisms, between different health services and, when required, other social services.

  25. INTEGRATED HEALTH SERVICE SYSTEM • ESTABLISHMENT OF AN INTEGRATED NETWORK OF HEALTH CARE DELIVERY THAT • ALLOWS THE PROVISION OF CONTINUOUS CARE TO A SPECIFIC POPULATION • AT A SPECIFIC TIME AND PLACE AND WITH DEFINED COST AND QUALITY • IS RESPONSIBLE FOR THE HEALTH AND ECONOMIC OUTCOMES OF THIS POPULATION. Source: MENDES (2001)

  26. COMPONENTS OF INTEGRATED HEALTH SERVICE SYSTEMS • COLLABORATIVE MANAGEMENT OF CARE • MANAGEMENT OF POPULATION RISKS • MANAGEMENT OF POINTS OF HEALTH CARE DELIVERY • CLINICAL MANAGEMENT SOURCE: MENDES (2001)

  27. Levels of construction of networks Source: Rovere, M. 2004

  28. PHC Organization and management of networked services Segmentation of the resources, supply and population ORGANIZATION INTO A NETWORK Universities Tertiary Care Private, high complexity Social Security Professional Risks MOH Secondary Care Primary Care Private, low complexity NGOs Traditional Medicine Municipalities

  29. HOSPITAL NURSING CENTER DAY HOSPITAL HOSPITAL B HOSPITAL A HOME-BASED CARE SPECIALIZED AMBULATORY CARE BASIC HEALTH UNIT AMBULA-TÓRY A AMBULA-TÓRY B From fragmentation to integration in a network 3 HOSPITAL NURSING CENTER DAY HOSPITAL BASIC HEALTH UNIT 2 SPECIALIZED AMBULATORY CARE HOME-BASED CARE 1 SOURCE: MENDES (2001)

  30. From the INTEGRATION OF SOCIAL PROTECTION to INTER-SECTORAL INTEGRATION HEALTH SERVICE SYSTEM HEALTH SOCIAL PROTECTION CULTURE EMPLOY-MENT EDUCATION SOCIAL PROTECTION SYSTEM HOUSING SOURCE: MENDES (2001)

  31. José Ruales Regional Advisor in Health Systems PAHO/WHO rualesjo2@paho.org

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