Social Democracy and Progressive Health Policy (Version 1.0)

1. Social Democracy and Progressive Health Policy(Version 1.0) Associate Professor Phua Kai Lit Monash University Malaysia July 2015

2. Lecture Objectives • What is Social Democracy? • Health Policy • Price • Quality • Timeliness and travel distance • Underserved social groups • Universal Access and Cost Control • Conclusions – Aims and Challenges

3. What is “Social Democracy”? • Democracy = rule by the people • Social Democracy = a democratic government that serves mainly to promote the welfare or well-being of the people • Social Democratic governments have been important in building the “Welfare State” in northern Europe (e.g. Sweden, Finland) and western Europe (e.g. Britain, Germany)

4. Health Policy • “Health policy” refers to plans and actions taken by the government to protect and improve the health of the people • It is important to always keep in mind that many other things can affect health (besides access to primary care and hospital care) e.g. nutrition, clean water supply, proper sanitation, safe working conditions, housing, good environment, social ties. • Public health activities such as immunisation against various diseases, and laws regulating working conditions and the environment also affect health.

5. Health Policy • A narrow definition of health policy will be used in this presentation i.e. government action to ensure access to primary care and hospital care of reasonable price and good quality in a timely manner (to protect/promote health of the people). • Access to long term care (such as nursing homes) will not be discussed. • Price – citizens are protected against “catastrophic healthcare costs” that force them to borrow heavily or even become bankrupt • Quality – healthcare of acceptable quality • Timeliness – patients do not have to wait too long to be treated. Also patients need not travel far.

6. Price • The price of primary care (care provided by GPs) • The price of hospital care – this is of major importance as hospital bills (arising from major procedures or prolonged hospital stays) can result in great financial stress • The price of medical drugs and devices • Solutions: financing/organisational schemes such as a National Health Service (NHS) or National Health Insurance(NHI). NHS is tax-funded while NHI is funded through contributions from employers, employees and possibly the government too. • NHI is a form of prepayment and risk-pooling to avoid massive healthcare bills. • The government establishes a drug “formulary” and negotiates prices with drug companies

7. Quality • Quality in healthcare – perceptions of quality can differ between professionals such as doctors and groups such as patients • To healthcare providers, quality means correct diagnosis and appropriate treatment. There is also safety i.e. prevention of hospital-acquired infections, complications, re-admissions, and iatrogenesis (unintended harm caused by medical interventions) • To patients, “quality” can include waiting time, satisfactory doctor-patient interaction and good “hotel services” in hospitals

8. Quality • Correct diagnosis and appropriate treatment can be improved by good training of healthcare providers, better facilities, more reasonable workloads, monitoring staff performance on the job • Patient safety can be improved by quality measures in hospitals e.g. systems of infection prevention • Patient perceptions of quality can be improved by reducing waiting time, better training of doctors with respect to doctor-patient interaction. • Spending on “hotel services” should be held down to control healthcare costs. Patients who want better hotel services should be made to pay more.

9. Timeliness • Waiting time for treatment can be reduced by: increasing the number of healthcare providers, providing better facilities, reducing travel time for patients i.e. better siting of clinics and hospitals, provision of a Flying Doctor service

10. Underserved Social Groups The term “medically underserved” means groups of people who are receiving less healthcare than they actually need (based on their morbidity and disability rates) Typically, underserved groups include: the poor, rural dwellers, slum dwellers, immigrants (especially illegal immigrants), minority and indigenous groups. They can also include the mentally ill or the elderly.

11. Universal Access and Cost Control Issues “Universal access” means equitable access to primary care and hospital care for all residents of a country. The main challenge arising from attempts to increase access is rising healthcare costs (which result in cost control issues) Healthcare costs increase with: adoption of better technology, coverage of more people, more intensive coverage, more extensive coverage of disease (e.g. covering for mental health problems), ageing population, building of more facilities, increase in number of providers (especially specialist doctors)

12. Conclusions – Aims and Challenges The following seem to promote equity in terms of improving access to basic primary care and hospital care: Sufficient numbers of healthcare providers such as doctors, nurses, pharmacists etc Improving the geographical distribution of providers – this is a perennial challenge as few providers like to live in remote areas. This is being overcome with the help of IT (telemedicine – teleconsultations, for example). Better siting of facilities such as clinics and hospitals and through a good patient referral system Better pricing of medical drugs (government negotiates lower drug prices with private companies) Good financing system e.g. through an NHS-type financing system or through a “single payer” payment system such as Medicare in Canada

13. Examples of progressive health systems under Social Democratic governance • The National Health Service (NHS) in the United Kingdom. There are actually 4 NHS systems i.e. England, Scotland, Wales and Northern Ireland. The approval rating of NHS England is 80% (after almost 70 years of existence!) • Medicare in Canada (a system of national health insurance)

14. Thank You