To regulate the quantity and distribution of services, the state has….
- licensed providers and facilities
- Controls the number and sizes of medical schools, number of doctors in areas, introduction of high technology
- provided incentives for health practitioners in rural areas
To regulate prices of services government has..
- negotiated salary scales
- set charges
- negotiated reimbursement rates
To regulate quality of health services, governments have…
- licensed practitioners
- registered and accredited facilities
- required providers to establish complaints procedures
- required provision of information for monitoring quality
- controlled training curricula
- set requirements for continuing education
Public health functions do…
- ensure safe water and food purity
- establish quarantine and border control measures to curb the spread of infectious diseases
- regulate roads and workplaces to reduce the threat of injuries
- legislate curb environmental and noise pollution
- set standards for food labeling, the level of lead in petrol and tar and nicotine in cigarettes
- regulate and license industries as well as oblige them to adopt different technologies on public health grounds.
How does the state get money from private companies and citizens?
By tax
What do the consumers get in return of the goverment for their tax.
Services and goods.
What are the problems of Health system reform
- Technological developments increase costs and make choices necessary
- rise in chronic diseases put pressure on services
- demographic developments
What are the basic pillars of the fundamental health system
Affordable
Accessible
Acceptable
Appropriate
What is the reason that the basic pillars does not fit the health system anymore
- ageing population
- changing society
- over medication
How is overmedicalistion arised
pharmaceuticals are private companies and get money for medicine they sell
what is the current idealogy
Slimmed down state through decentralization & increased private sector roll
Market pressures for public services - new public management:
- Competition for contracts from public purchasers
- Competitive tendering (several industries) of support services
New financial mechanisms:
Introduction of out-of-pocket fees for service use
Decentralization
Functions of MoH –> executive agencies
Authority of MoH –> district or local levels
Autonomy for hospitals
- increased rol of private sector.
What is the Influence on public health policy of this private sector roll
-Financial support of political parties and campaigns (money)
-participation in governmental committees and working groups (knowledge)
-establishment of sectional interest group of joint companies (power)
-establishment of industry funded think tanks
-financial support to research organizations
-Establishment of scientific organizations
-financial support to patient organizations
-PR firms for media
This is called lobbying
Private sector & norms
Self regulation - substitutes public policy:
Market standards: facilitate trade
Social standards
Types of social standards
- corporate social responsibility
- voluntary codes and reporting initiatives
- corporate philanthropic programmes
Why are they doing that?
- Concerns raised by consumer and stakeholders
- threat of public regulation
Doubts about the social standards?
- lack of transparency and accountability - no involvement of public in M&E
- Lack of timely and effective sanctions
- Erodes Universal rights
- Only concerns selected issues and groups of workers
Public-private partnerships (new relationships)?
Co regulation: public and private sectors negotiate on an agreed set of policy or regulatory objective - private sector implements
-joint planning and funding of health programmes - private sector implements
