Management & Health Delivery Systems (MGMS-101)

1. Management & Health Delivery Systems(MGMS-101) By Dr. HodaZaki Prof. Hospital Administration Chair Department of Health Administration &Behavioral Sciences High Institute of Public Health University of Alexandria Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

2. Course Description • This course provides an overview of organization of institutions that provide health care , the people who provide health care as well as dimensions for evaluation of health systems include quality, efficiency , acceptability and equity. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

3. Intended Learning Outcomes (ILOs) By the end of this lecture the student will be able to : • Define the health care systems. • Identify the goal of the health care systems. • Know the structure of health care delivery system. • Know the levels of health care . • Know the institutional providers of health care: • Ambulatory health services • Hospital • Public Health Services Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

4. What is Health? Health is “state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity” (World Health Organization) Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

5. What is health care & who’s involved? Disease Self Help Self Care Management Patient Professional Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

6. Moving the site of care Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

7. Contemporary Health Care rests on a successful partnership betweenPatients, Clinicians, and Delivery Systems Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

8. What is a “System” ???? A network of integrated components designed to work together coherently. . Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

9. What is a healthcare system? • Health system • Health care system • Health care delivery system all are synonymous Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

10. What is a healthcare system? HEALTHCARE SYSTEM: A networkof integrated components designed to work together coherently . Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

11. What is the Health Care Delivery System? A mechanism for providing services that meet the health-related needs of individuals. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

12. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

13. Definition of health care system organizationof people, institutions, and resources to deliver health care services to meet the health needs of target populations. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

14. WHO Definition of health care system "A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

15. Goals of health care system According to the World Health Organization, (WHO) The goals of healthcare system are: • good health of population • responsiveness to the expectations of the population • fair financial contribution Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

16. Structure of Healthcare Delivery System • Public sector - financed through a tax-based budgeting system at both national & local levels . - health care is delivered free at the point of service. Why is it important to know the health sector as a Medical Equipment specialist? • Private sector - profit & non-profit providers. - market-oriented, health care is paid through user fees at point of service . Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

17. Levels of Health Care and Referral System • Three levels of Health Care: • Primary level of Care • Secondary level of Care • Tertiary level of Care Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

18. Levels of Health Care and Referral System • Primary level of Care:it Includes • preventive measures such as immunization, health education, • simple diagnostic & therapeutic procedures. - provided by center physicians, public health nurses, rural health midwives, health workers - first contact between the community members and health facility. Examples: rural hospitals , health centers, family health centers. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

19. Levels of Health Care and Referral System • Secondary level of Care: it Includes more complex services than primary level such as minor surgeries and some simple laboratory examination. - given by physicians with basic health training. - either privately owned/government operated. - it considered a referral center for the primary health facilities. Example: district hospitals Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

20. Levels of Health Care and Referral System • Tertiary level of Care: • provides services for complicated cases & those who require intensive care.itincludes highly specialized & most complex services such as burn treatment , open heart surgery , transplantation - rendered by specialists in health facilities including medical centers, general & specialized hospitals. - It considered a referral center for the secondary care facilities Examples: central hospitals , University hospitals,…. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

21. Tertiary level of Care Secondary level of Care Primary level of Care Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

22. The Institutions Providing Health Care • Ambulatory health services • Hospitals • Public Health Services Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

23. Ambulatory Health Services Definition: Ambulatory health services is the services provided to no-institutionalized patients ( walking patients) . Levels of ambulatory health services: Primary level Secondary level : such as ambulatory surgery ( due to advance in technology ex., the use of fiber optic, Endoscopies) Settings of ambulatory health services: • Solo practice • Group practice • Outpatient clinics /department (OPD) • Ambulatory surgery centers • Emergency rooms (ER) Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

24. Solo Practice • Solo practice is a services provided by solo practitioners who are : • physicians trained in general & family practice who provide primary care . • Specialized physicians who provide secondary care. • Solo practitioner is a self employed physician, he does not depend on organization or sharing resources or income with others. • solo practitioner usually have a strong relation with their patients. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

25. Group Practice Group practice is affiliation of three or more providers usually physicians who share income, expenses, facilities, equipment, medical records, and support personnel in the provision of services through a formal legal organization. WHY GROUP PRACTICE (benefits of group practice)???? Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

26. Outpatients Department (OPD) OPD is established in order to : • Decrease the overcrowding in hospitals. • Decrease the cost of services: compare the cost of one day in the hospital & cost of one visit to OPD. Function of OPD: • Provide primary care & specialized services. • Follow up of patient after hospitalization. • Training for medical students & house officers . Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

27. Ambulatory Surgery Centers • It is one-day surgical care , the patient is discharged 1 to 3 hours after surgery when recovery from anesthesia is sufficiently complete. • Settings of ambulatory surgery: • Freestanding ambulatory surgery centers: they are independent of hospital. • Hospital- based ambulatory surgery centers they are affiliated to hospital. • Office- based ambulatory surgery centers where physicians perform surgery in their offices. What are the disadvantages of office-based ambulatory surgery ??? Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

28. Emergency Rooms (ER) • ER provides services for urgent cases. • ER require sophisticated facilities & highly trained personnel. • ER must accessible 24 hours a day. • People needing emergency care either transport themselves or call an emergency number for ambulance . • Specialized ambulance services including mobile coronary care units & shock –trauma vans . Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

29. Hospitals Definition of Hospital (AHA,1967): Any institution which has at least six beds ready for use beyond 24 hours by patients requiring diagnosis, treatment or care of illness, injury or pregnancy and satisfying the following minimum requirements: • Nursing service around the clock. • Organized medical staff governed and approved by the administration bylaws, rules and regulations. • Well designed physical plant that insures the safety and welfare of the patients. • Records of clinical work on all patients accepted for care. • Clinical laboratory services. • Diagnostic X-ray services. • Treatment facilities for surgery and obstetrics. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

30. Classification of Hospitals Hospitals are classified according to: • The type of services provided (general or special hospitals). • Administrative ownership (governmental and non-governmental hospitals). • Length of stay (short term – long term hospitals). • Bed capacity /number of beds: small & large hospital . • State of accreditation (accredited hospitals, non-accredited hospitals) Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

31. Classification of hospitals according to type of services provided General hospitals Hospitals that are organized, equipped and staffed to cover a wide range of medical specialties for both sexes and all age group. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

32. Classification of hospitals according to type of services provided (Cont.) Specialized hospitals Hospitals that are organized, equipped and staffed to cover the health care needed for: • A special disease e.g. T.B., leprosy, or cancer hospitals. • A special disease category e.g. cardiology, fever, orthopedic, and ophthalmic hospital. • A special group of population e.g. children, geriatric, or women hospital Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

33. Classification of hospitals according to administrative ownership • Governmental /Federal Hospitals • Non-Governmental Hospital: • Voluntary non-profit hospitals • Private profit hospitals Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

34. Characteristic of Governmental/Federal Hospital • These hospitals are people’ hospitals. • They are not run for profit. • They mainly admit free patient, may admit part-payers. The payment is for better accommodation but not better medical care. • The administrator and other employees of the hospital are civil employees. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

35. Characteristic of Governmental/Federal Hospital (Cont.) • These hospitals usually provide free programs for outpatients and emergency care. • Most governmental hospitals are involved in education, research and training of health personnel. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

36. Voluntary non-profit hospitals These are owned and operated by community bodies interested in the health and welfare of the people e.g. ,organized community bodies , religions bodies, and private corporation organized not for profit . Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

37. Characteristic of Voluntary non-profit hospitals • They are administrated and controlled by administrative board • They are socially oriented. • They are usually admit full payers, part-payers and also free patients. • They are financed from the fee collected from patients, gifts and donation and governments subsidies which are usually provided to keep the fees down and to support free cases. • They usually operate outpatient and emergency care (free, part-payers and full payers programs). Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

38. Private-profit hospitals • These hospitals are owned and operated by private persons (doctors or lay people). Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

39. Characteristic of private hospital • They are business institutions operated primarily for profit making, so they pay taxes. • They only admit pay-patients, whether the cost of care is paid directly from patients’ pocket or through a third party ( e.g. a health insurance organization). • In most cases, these hospitals don’t have organized programs for emergency care and perhaps for outpatient care. • They are not involved in teaching research or training of professionals. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

40. Classification of hospitals according to length of stay Short stay hospitals: 90 % of all admitted patients stay less than 30 days. Long stay hospitals: 90% of all admitted patients stay 30 days or more. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

41. Classification of hospitals according to bed capacity The size of the hospital is usually expressed in terms of its bed capacity, which is “the number of beds normally set up, equipped and staffed for use by in-patients beyond 24 hours except newborn bassinets”. Small hospital has 50-100 beds. Large hospital has more than 100 beds. Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

42. Classification according to state of accreditation Accredited hospitals: these are hospitals which meet or exceed the standards set by the Joint Commission on Accreditation of Healthcare Organization (JCAHO). Non-accredited hospitals: these are hospitals which do notmeet the standards set by (JCAHO). Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration

43. Thank you Prof.Dr.Hoda Zaki (MD PHD) Prof. Hospital Administration