America's Affordable Health Choices Act

Hello class!!

Sorry for the late post but, better late than never in this never ending flu season.

Here is the link to the pdf of the summary of the health care reform bill.

Please press on the link, download the document and read away. We will discuss this on Wednesday.

Have a great week!

Dr. Assi

Terms discussed in the lesson

Some important terms we discussed in the last lecture :

Cream Skimming - also called "Cherry Picking" - when an insurer knows more about consumers' expected costs than the consumers themselves and uses marketing or plan design to enroll a healthier-than-usual population. This, in the Israeli setting, was done by the smaller sick funds that only accepted young and healthy patients to their ranks. This created continuous deficit in the General Sick Fund, and, was one of the driving forces for the National Health Law of 1995. Cream Skimming is a general term from the world of insurance.

Adverse Selection - when unusually high-cost people select an insurance plan. When adverse selection occurs, the average expected cost of people in a plan is higher than the insurer planned. The insurer loses money. If the insurer then raises the premium, the higher premium causes relatively lower cost people to drop the policy, which pushes up the average cost of those remaining. The insurer loses money again and raises the premium again. Again, this forces lower cost people to drop out. This vicious cycle (sometimes called the "Premium Death Spiral") continues until only the highest cost people are left in the policy. Most people have then dropped out and are uninsured. Adverse Selection raises general premiums for health care insurance, so, many people cannot afford insurance, and they are left uninsured. One strategy to prevent adverse selection is waiting periods for eligibility (this strategy is used in Israel to prevent overt medical immigration).

Capitation - a payment method for health care services. The physician, hospital, or other health care provider is paid a contracted rate for each member assigned, referred to as "per-member-per-month" rate, regardless of the number or nature of services provided. The contractual rates are usually adjusted for age, gender, illness, and regional differences.

Capping - Sick Funds pay hospitals a specified amount of money in advance for services that will be provided in the future for a fixed amount of patients insured by the sick fund. Hospitals enjoy steady income, sick funds enjoy prices that are lower than the "Per Diem" rates set by the government.

American health care system - 1

Hi!
We will be speaking on the American health care system tomorrow!
Please enjoy this wonderful Michael Moore trailer from the movie Sicko.
Until tomorrow!

Online introduction to health care economics - easy

This online course by the Office of Health Economics is intended as an introductory course on the issues of health care economics. As I told you repeatedly in the course - health care has many "market failures" that prevent this market from being a real free market. These market failures caused many countries in the developed world to choose a single payer or national health care system. Others have chosen strict governmental oversight on mandatory insurance.
We will be talking about some of the same issues from a different perspective in the course.

Health care economics are in the news every day in almost every country, and a general knowledge in this field is important for doctors especially if they want to be agents of positive change.

Please read this easy overview to understand more!
Can also be downloaded as a PDF.

Another video by Hans Rosling

This TED video from 2007 shows how the seemingly impossible is possible.
This guy never fails...

New links, the Israeli health care system

Hello All!
I updated the links on the web companion with some links for good information on the Israeli health care system.

• WHO Europe overview of the Israeli health care system (2003). Long, thorough, and only 156 pages :-)
• An interview with Prof. Glick about the Israeli health care system (1999).
• Online publication by Barbara Swirski and Lisa Gold. An overview of the history of the Israeli health care system with highlights of the unique parts of it and a comparison to the US heath care system (1999 also...). Readable, not to long and interesting.

And to read about some of the problems, inequality, and social injustice in the system and the society -

• Adva center for social justice in Israel.
• PHR Israel - section on residents of Israel
• Israeli Medical association English web-sight

Enjoy the weekend!

Inverse Care Law

The Inverse care law is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served. Phrase coined by Julian Tudor Hart in a Lancet paper in 1971, the term has since been widely adopted.

The law states that: "The availability of good medical care tends to vary inversely with the need for it in the population served. This ... operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced." (Hart, 1971).

Julian Tudor Hart is one of my personal heros and a great inspiration in my path in medicine. He is a leader in social medicine and a retiered general practitioner that served a mining community in welsh for many many years.
I had the pleasure to hear him speak in the past and talk to him and read some of his books. He published many research papers in the best medical journals, most from his rural practice.



His web sight
Watch the video.

Medical tourism and globalization

Today I briefly mentioned the term Medical Tourism while speaking on the private hospitals of India.
Medical Tourism (also called medical travel, health tourism or global health care) is a term that describes the growing market of international travel for health related procedures, therapies, and surgeries. The rising costs of treatments, especially in USA, encourage people to use the global village while shopping around for better prices.
This is a rapidly expanding market and facilities with 5 star amenities are constructed in countries like India, Thailand, and many other destinations. Many combine a vacation with the procedure.

The history of Medical Tourism is ancient and evidence for long journeys for healing abound. In Greek times many traveled to the sanctuary of the healing god Asklepios. Many more travel to distant sights of mineral springs, or steaming caves all in the search for help.
This phenomenon worries many in the US and puts further strain on failing health care systems around the world.

For a story on Medical Tourism in the Time. And another.
One of the most important books on globalization is "The World is Flat" by Thoma Friedman. Medical tourism is truly a phenomenon of the flattening of the world (and of some noses in plastic surgery).

In a world that ships melons over oceans, what is another hip surgery?
For an ABC video about medical tourism to India.

The solid facts

Hello!
During the course we are speaking alot about social determinantes of health.
The field of social epidemiology is a growing field in social studies and public health and includes an evidence based discussion about the social determinantes of health.
Some of the best researchers published a short and interesting document called the "Solid Facts". This is a document that shortly descrives the 10 mot important social determinantes of health which have good evidence after long and large stuies.
Please don't be afraid! The document is short - just few pages and gives an "abstract like" descripion of every factor - like social inequality. It is only about... 10 pages (and many pictures).

It can be downloaded here for free and is an important account for any doctor.

The same group issued an accompanying book further expanding what is known today in the fiel of social epidemiology. So, if you need some more info after reading the document, this is a good starting point.

Some definitions from introduction lecture + links

What is a health care system? The short definition by the WHO is :
"A health system consists of all the organizations, institutions, resources and people whose primary purpose is to improve health."

"A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. And it needs to provide services that are responsive and financially fair, while treating people decently."

It is important to know that in most industrialized countries, the health care industry is one of the only industries projected to grow continuously, and quickly becoming one of the largest industries. It affects every person, and is perhaps the industry least affected by modern management.

For the WHO web sight on health care systems

The basic building blocks are :

• Service delivery.
• Medical products vaccines and technology.
• Health workforce.
• Health system financing.
• Health information system.
• Leadership and governance (stewardship).

Stewardship
What is Stewardship in health care systems?
"Stewardship is the careful and responsible management of something entrusted to one's care. In the context of health systems, it involves influencing policies and actions in all sectors that may affect the health of the population. The stewardship function therefore implies the ability to formulate strategic policy direction, to ensure good regulation and the tools for implementing it, and to provide the necessary intelligence on health system performance in order to ensure accountability and transparency."

Equity -
Equity in health and access to health care are central themes in health system stewardship. Addressing inequity requires a comprehensive approach and action on wider social determinants on health.

Why health systems matter in addressing health inequities?

• They can act to promote health equity both directly - through investing in population health interventions and health care delivery, and 'indirectly' - through individual and community empowerment and by protecting lower income groups from further impoverishment due to poorer health; and
• They can act to promote health equity through influencing investment decisions and public policies across government - in a way that address the social determinants of health and reduces health inequities.

The WHO world health report from 2000 is an extensive overview of health systems, definitions, and trends.

Amsa's international health care systems primer is a short, readable informative document on health systems but only describes systems from the developed world.