Module 6 Section 1

Question 1

UNIVERSAL HEALTH COVERAGE

Answer 1

• Recall from Module 03 that in 2015, the United Nations General Assembly adopted the 2030 Agenda for Sustainable Development, which included the 17 Sustainable Development Goals (S D Gs). Building on the principle of “leaving no one behind”, this new agenda emphasized a holistic approach to achieving sustainable development for all.
• The third S D G aims to promote the well-being and ensure healthy living for all individuals at all ages, meaning that Universal Health Coverage (U H C) is a key component of the S D Gs.

Question 2

According the WHO, UHC enables:

Answer 2

“all people to have access to the health services they need, whenever, wherever, and without financial hardship. U H C includes health promotion, prevention, treatment, rehabilitation, and palliative services.”

Question 3

VALUATING THE GLOBAL PREVALENCE OF UHC

Answer 3

In studies on the global prevalence of U H C, researchers often categorize a country as a provider of UHC if it meets two criteria: passed legislation and essential service coverage.

Question 4

PASSED LEGISLATION

Answer 4

A country meets this criteria if they possess healthcare legislation that explicitly states that the entire population is covered under a specified health plan.

Question 5

ESSENTIAL SERVICE COVERAGE

Answer 5

This criteria is based on the service coverage index which is rated on a scale from 0-100, and is a measure of essential health service coverage based on four components:

• Reproductive, maternal, newborn, and child health
• Infectious diseases
• Non-communicable diseases
• Service capacity and access

A high score indicates high coverage. For reference, in 2017, Canada scored 89.0, the highest of any country

Question 6

FUNDING HEALTH COVERAGE

Answer 6

It is important to note that there are four main methods used by countries to finance healthcare coverage. Some countries rely largely on one method, while others use a combination of methods.

Question 7

four main methods used to finance healthcare coverage

Answer 7

• employer based insurance
• private health insurance
• state coverage
• social insurance

Question 8

EMPLOYER BASED INSURANCE

Answer 8

Insurance is purchased by employers for their employees and financed through employer or joint employer-employee contributions. This insurance may be subsidized by the government.

Question 9

PRIVATE HEALTH INSURANCE

Answer 9

Individuals purchase private healthcare insurance to cover the cost of healthcare services. Some countries make private health insurance available to its citizens at a nominal cost.

Question 10

STATE COVERAGE

Answer 10

Healthcare insurance is provided and financed by the government through tax payments. Taxes such as income tax and sales taxes on goods are some examples that fund state based coverage. All the money is pooled by the government and used according to the country’s need.

Question 11

SOCIAL INSURANCE

Answer 11

Employers and employees, including self-employed individuals, pay contributions towards health services. These are usually legislated by law and cover the entire population. Wealthier people and companies often pay more into these funds (pots of money, also known commonly as sickness fund) than members of the middle and lower classes, but this is not always the case. Governments may contribute subsidies to provide increased funding

Question 12

HEALTHCARE MODELS

Answer 12

• The Beveridge Model
• The Bismarck Model
• The National Health
• Insurance Model
• The Out-of-Pocket Model

Each of these models rely on a combination of the four different types of healthcare funding to provide healthcare services to individuals. These models are beyond the scope of this course, and are here for your information only

Question 13

ACCESS AND QUALITY OF HEALTH SERVICES

Answer 13

Well-functioning healthcare systems facilitate sufficient access to high quality health services

Question 14

ACCESS TO HEALTH SERVICES

Answer 14

• Services are provided at little or no cost to the individual.
• Services provided are close in proximity to where the individual resides.
• Services available are comprehensive medical, dental, eyecare, mental health, and pharmaceutical.

Question 15

QUALITY OF HEALTH SERVICES

Answer 15

• Healthcare professionals have the resources (e.g. medical technologies, drug therapies) they need to provide quality care.
• Evidence-based healthcare services and policies.
• Client-centered care.
• Timely service.
• Educated and efficient healthcare workers

Question 16

VIDEO: WHO’S UHC COMPENDIUM

Answer 16

Some believe U H C is simply too complex and too costly to implement effectively. However, it is important to consider the individual needs of each population, to be able to create tailored UHC that justifies the cost

Question 17

EXAMPLES OF THREE DIFFERENT UHC SYSTEMS

Answer 17

Single-Payer Coverage (U K)
- What is Covered?
Comprehensive care with NO copays at point of service
- Who is Covered?
All residents
Financing & Care Delivery
- Government finances health care with taxes & pays providers directly

Regulated Private Coverage (Netherlands)
- What is Covered?
Government-defined health benefits; deductibles for some services
- Who is Covered?
Everyone is required to have insurance unless they qualify for an exception
- Financing & Care Delivery
People pay premiums for regulated private health coverage; insurers pay health providers

Mixed Public-Private (France)
- What is Covered?
Wide range of services with some cost sharing; private insurance fills gaps
- Who is Covered?
All residents
- Financing & Care Delivery
Government finances non-profit funds that pay providers; most people buy additional private
insurance

Question 18

REQUIREMENTS FOR UHC

Answer 18

Although how each country strives to achieve U H C varies by location, S D G, and other factors, four underlying requirements must be met before a country can claim they have reached U H C.

Question 19

the requirements for UHC

Answer 19

Healthcare System
- A high quality and efficient healthcare system that is able to meet priority health needs.

Finances
- Financing that supports healthcare services and prevents financial hardship for medical care.

Access
- Access to effective technology and medicines to diagnose and treat medical conditions.

Health Workers
- Sufficient capacity of well-trained and motivated health workers to meet the needs of patients

Question 20

HEALTHCARE SYSTEMS

Answer 20

The upcoming slides will focus on the need for well-functioning healthcare systems and their role in achieving universal health coverage. A healthcare system is the organization of people, institutions, and resources that deliver healthcare services to meet the needs of a population. The configuration of health services varies from country to country, but a simple model can be used to illustrate the foundation of a well-functioning healthcare system

Question 21

A SIMPLE HEALTH SYSTEM MODEL

Answer 21

• The simple model of a health system includes three main branches: the structure, the provision, and the health outcomes.
• As depicted in the diagram, the structure, which encompasses the financing of the health services and the infrastructure (hospitals, clinics, health centres, etc.) leads to particular goals or health outcomes that are mediated by the provision of services (access to and quality of healthcare).

Question 22

example of a health system

Answer 22

For example, imagine there is a large amount of health funding, and lots of infrastructure within a health system. This strong structure leads to a better provision of health services, with greater access and a higher quality of health workers to deliver these services. Ultimately, in such a system, there would be better health outcomes, more health equity, and greater public satisfaction

Question 23

How would you describe a well-functioning healthcare system? What are the main characteristics?

Answer 23

Dr. Carpenter’s Response:
“A good healthcare system delivers quality services to all people, when and where they need them.”

Question 24

W H O

Answer 24

The W H O has recognized four characteristics of well-functioning healthcare systems:
- A robust financing mechanism.
- A well-trained and adequately paid workforce.
- Reliable information on which to base decisions and policies.
- Well-maintained facilities and logistics to deliver quality medicines and technologies

Question 25

how a well functioning healthcare system responds to a population's needs

Answer 25

1. Participating Making it possible for people to participate in decisions affecting their health. 2. Improving Improving the health status of individuals and communities. 3. Protecting Protecting people against the financial consequence of ill health. 4. Providing Providing equitable access to people-centered care. 5. Defending Defending the population against health threats.

Question 26

BARRIERS TO WELL -FUNCTIONING HEALTHCARE SYSTEMS

Answer 26

Dr. Carpenter's Response: - Some of the potential barriers to a well-functioning health system include: - Disproportionate focus on specialist curative care. - Fragmentation of competing programs, projects, and institutions. - Pervasive commercialization of health care delivery in poorly regulated systems. - Insufficient resources, including finances

Question 27

correlation between the wealth of a nation and its health expenditure?

Answer 27

Dr. Carpenter's Response: In general, poorer nations tend to spend less on health expenditure. As the wealth (S D G) of a nation increases, its health expenditure tends to increase.

Question 28

What does the graph indicate about the correlation between a nation’s expenditure on health and its life expectancy?

Answer 28

Dr. Carpenter's Response: Countries that spend less on health expenditure tend to have lower life expectancies for their populations. As a country’s expenditures on health increase, the life expectancy of its population tends to increase. The U. S. is an outlier of this general trend

Question 29

FIRST NATIONS HEALTH AUTHORITY: BRITISH COLUMBIA

Answer 29

- When exploring models, specifically a well-functioning model of healthcare systems, it is important to also consider how culturally sensitive a model is. Recall from Module 03 that self-governance over essential services is a protective factor for Indigenous populations. - In 2013, Indigenous Health Authorities in British Columbia established a model and funding structure that secured self-governance and Indigenous control over healthcare across B C’s native regions. An agreement was made by the federal and provincial governments, and Indigenous leadership to develop the First Nations Health Authority (F N H A).

Question 30

Learn about the governance of the F N H A.

Answer 30

- The F N H A gained governance over primary care, mental health and addictions, administration of non-insured benefits, and the responsibility for coordinating health programs and services with the provincial health ministry. - The federal and provincial governments constructed a long-term sustainable funding plan worth 4.7 billion dollars over 10 years to ensure the development of a holistic and well-functioning system

Question 31

F N H A FUNDING STRUCTURE: 3 BLOCKS

Answer 31

The F N H A funding was structured into 3 blocks to ensure adequate coverage of healthcare for Indigenous Peoples across British Columbia. 1. Protection Primary Healthcare & Public Health Protection: Health promotion and disease prevention, environmental health, etc. 2. Benefits Supplemental Health Benefits: Medical transportation, short-term crisis intervention, mental health counselling, dental care, prescription drugs, medical supplies, vision care, etc. 3. Support Health Infrastructure Support: Health system capacity, human resources, facilities, health system transportation needs, etc.

Question 32

What do you think are the core features of Indigenous driven health models?

Answer 32

Dr. Carpenter's Response: - The core features to Indigenous driven models are: - Decision making that is shared between the federal and provincial governments, and Indigenous leadership. - Developing relationships and partnerships with stakeholders in the community. This can include aid from health regulatory bodies in the establishment and commitment to cultural safety and humility in health services. For example, B C Patient Safety & Quality Control partnered to establish cultural safety and humility as a dimension of quality of health services. This led to mandatory Indigenous cultural safety training for health benefit accessors, mental health providers, and others working in First Nation communities

Question 33

some of the improvements in health service allocation and use in B. C.’s Indigenous communities.

Answer 33

- PARTICIPATION Improved participation at immunization clinics. - TRAINING Mandatory cultural safety training for staff and greater access to training programs in remote regions. - ACCESS Improved access to health services through remote delivery models and electronic health services. - TIME Decreased overall service times. Note: Ontario is the only other province that has instituted structural reform of the health care system for Indigenous Peoples. Ontario's reform includes a system of Aboriginal Health Access Centers managed in partnership between the provincial government and Indigenous organizations. This strategy has led to local and regional self-governance structures as opposed to the province-wide reform implemented in B C

Question 34

INTERACTION: S D G PER CAPITA ACROSS THE GLOBE

Answer 34

- You now understand simple health models, and what U H C is. You can also now appreciate that there are many different ways to have well-functioning health systems and to implement and work towards U H C. - Most countries that provide universal health coverage tend to be high-resource countries, such as Canada. However, there are also some low-resource countries that have U H C.