SOCIAL PHILOSOPHY, SERVICE SYSTEMS, AND HEALTHCARE DELIVERY

ORGANIZATION

• social unit of people structured and managed to meet a need or pursue collective goal

• open systems

  • affect and are affected by their environment

• have management structure that determines relationship between different activities

• members subdivides and assigns roles, responsibilities and authority to carry out different tasks

ORGANIZATIONAL DESIGN

• way people consciously coordinate, develop and modify structure of an organization to optimize function

ORGANIZATIONAL STRUCTURE

• degree to which an organization enacts formal/informal rules of behavior, centralized/decentralized control of operations

ORGANIZATIONAL BEHAVIOR

• refers to way which people interact formally or informally within business organization

MANAGEMENT

• process of dealing with people

ADMINISTRATION

• process of actively running a business organization

ADVOCACY

• active support of a cause

COMPREHENSIVE HEALTH SERVICE SYSTEMS

• health service system that is publicly funded, universally available to citizens at little or no cost

• offers a complete range of health services

ENTREPRENURIAL HEALTH SERVICE SYSTEM

• two-part health service system

  • large for-profit and not-for-profit private component funded by private insurance, personal resources, philanthropy, and charity and the 

  • smaller government component covering categories of needy citizens and funded through payroll, taxes and federal and state general revenues 

COST-BENEFIT

• measurement of the relationship between costs and benefits

GATEKEEPER

• doctor who has initial contact with a patient and determines if a referral to a specialist is needed

PRIVATE HEALTH SERVICE

• service provided by a non-government owned entity that is either for profit or not for profit

PRIVATE SECTOR

• the nongovernment for-profit or not-for-profit business entities or organizations associated with all aspects of health services

PUBLIC SECTOR

• this is the portion of society controlled by national, state, and local governments

PUBLIC POLICIES

• government policies that express general principles that guide the management of public affairs

THIRD PARTY PAYERS

• the payment sources for health services received by but not entirely paid for by consumers

SOCIAL PHILOSOPHY

• involves the formal or informal adoption of ethical concepts to form a moral backdrop against which decisions about the allocation of relatively scarce resources are played out

HEALTH SERVICE

• any activity related directly or indirectly to delivery of health services

• includes planning delivering, measuring, and analyzing services and development as well as provision of health related products

SYSTEM

• integration of a number of interrelated parts that function in a concert

ELIGIBILITY

ACCESS AND CHOICE

COST-BENEFIT

3 questions of health systems

ELIGIBILITY

• who can get the service?

ACCESS AND CHOICE

• what service, product, or combination of services and products, provided at what point in time and by whom give the best outcome

COST-BENEFIT

• who pays for services and products, what is the cost, what is the outcome, and whether the outcome is worth the cost

PUBLIC HEALTH PROTECTION

BUILDING HOSPITALS

MANAGING HEALTH SERVICES

COLLECTION AND DISSEMINATION OF HEALTH SERVICE SYSTEM

FINANCING

5 key government health policy service areas

ACCESS

COST

QUANTITY

QUALITY

EFFICIENCY

5 universal questions for government health policy officials

POLICY

• defined as a broad statement containing goals and objectives that form a framework for organizing specific activities

DISTRIBUTIVE JUSTICE

SOCIAL JUSTICE

MARKET JUSTICE

3 philosophical issues of healthcare

DISTRIBUTIVE JUSTICE

• asks the question who should get what and is healthcare a right

SOCIAL JUSTICE

• debates if access to basic health services and whether they are a right

MARKET JUSTICE

• in a free market, those who can afford services can buy them. Those who cannot buy standard services find less costly alternatives or do without

COMMUNIST HEALTH SYSTEM

SOCIALIST HEALTH SYSTEM

COMPREHENSIVE SYSTEM

WELFARE SYSTEM

ENTREPRENURIAL SYSTEM

5 healthcare systems

COMMUNIST HEALTH SYSTEM

• control: government owns all resources, employs providers and controls healthcare access

• financing: funded by federal state and territorial taxes

• payer: government is the sole payer

• patient’s choice: limited with special access for some party members

SOCIALIST HEALTH SYSTEM

• control: decentralized, both federal and state responsibilities; state regulates non-government nonprofit and private insurers with health service access assured through legislation

• financing: funded by taxes and pooled employer/employee contributions, managed by nonprofit funds, minimal out-of-pocket costs for patients

• payers: government primarily pays

• patient choice: extensive

COMPREHENSIVE HEALTH SYSTEM

• control: central government oversees access to quality health services through single-payer system (NHS), with local authorities arranging and authorizing care; local accountability is required

• financing: funded by taxes and public/private insurance with minimal out-of-pocket costs

• payers: government primarily pays

• patient choice: access to hospitals and specialists is managed by local general practitioners

WELFARE HEALTH SYSTEM

• control: central government ensures access to quality services through legislation while provinces and territories can offer additional service; service delivery is managed by private sector, with mandated local accountability

• financing: funded by taxes and insurance with increasing out of pocket costs as private services expands

• Limited access to elective procedures, specialists, and special diagnostic tests.

• patient choice: emoji access to elective

ENTREPRENURIAL HEALTH SYSTEM

• control: decentralized with federal state, and local government planning and legislating health services, health resources are privately owned and operated within legal frameoworks

• financing: funded by taxes, insurance, and charity with variable out-of-pocket costs

• payers: private entities bear most of the costs

• patient choice: limited depending on insurance coverage and ability to pay out-of-pocket

PRICE ELASTICITY

• sensitivity of demand to changes in price

INDUSTRY

• distinct group of productive or profit making enterprise

DEDUCTIBLE

• annual amount the individual must pay before the health care plan begins to pay according to the health insurance plan’s coinsurance stipulations

COINSURANCE

• after the deductible has been met a proportion of the cost is paid by the individual with the remainder paid by their health insurance plan

COPAYMENT

• the amount the individual must pay each time services or drugs or both are accessed

HEALTH CARE DELIVERY (ENTREPRENURIAL MODEL): BUSINESS AND ECONOMIC IMPACT

• Health care as a business model

• Workforce and economy

• characteristics of economic systems, used to depict the health care industry

  • scarcity

  • growth

  • distribution of services and goods

  • production

  • consumption

• Average consumer market vs health care market

• Average consumer market follows the law of supply and demand

  • (poor quality, less cost /demand)

• Health care market:

  • if of poor quality, higher cost (drives up cost)

5 FACTORS THAT AFFECCT EFFICIENCY OF ENTREPRENURIAL MODEL

• Third party payers (government and employers)

• Relationship between value and cost

• Failure of regulation

• Poor leadership and management

• Demand for more revenue

HEALTHCARE SERVICE: THE ATYPICAL MARKET

• consumer (patient) doesn't directly pay or know the cost of services

• is usually handled by employers or the government

• because patients aren't aware of the value, they don't change their demand based on price

• knowing there's constant demand, healthcare offer more services and amenities without concern for cost

• payment system doesn't link to the quality or effectiveness of care

  • providers are often rewarded even if they deliver inefficient or poor-quality services

HEALTHCARE: OWNERSHIP

• enterprise owned by the government are known variously as:

  • governmental

  • public

  • tax-supported facilities

• private entities can either be:

  • profit: formed to make a profit

  • not-for-profit: required to invest profits back into the not-for-profit business; associated with meeting the needs of a particular community/constituency

HEALTHCARE PAYMENT SOURCES

• private health insurance

• government

  • Medicare

  • Medicaid

  • Philhealth

• out of pocket

REDUCE COST, IMPROVE QUALITY, AND IMPROVE ACCESS

how to improve healthcare performance

LEADERSHIP

STRATEGIC PLANNING

CUSTOMER AND MARKET FOCUS

MEASUREMENT, ANALYSIS AND KNOWLEDGE MANAGEMENT

HUMAN RESOURCE MANAGEMENT

PROCESS MANAGEMENT

BUSINESS RESULTS

7 Characteristics in the Baldridge Criteria

LEADERSHIP

• reduce costs, improve quality, and improve access

STRATEGIC PLANNING

• how to set strategic directions and action plans

CUSTOMER AND MARKET FOCUS

• how to determine needs and expectations of customers, how to meet customer expectations and keep them coming back

MEASUREMENT, ANALYSIS, AND KNOWLEDGE MANAGEMENT

• how to effectively manage,analyze, use, and improve data and information

HUMAN RESOURCE MANAGEMENT

• how workforce is enabled to develop its full potential and their efforts aligned with strategic initiatives

PROCESS MANAGEMENT

• how key processes are designed, managed, and improved

BUSINESS RESULTS

• how the business performs

STRONG LEADERS

STRATEGIC PLANS

GOOD INFORMATION

QUALITY SERVICES/PRODUCT

FINANCIAL RESOURCES

5 Guides for Performance Improvement

STRONG LEADERS

• needed to improve quality of care through innovation (quality care)

STRATEGIC PLANS

• planning to meet organization goals ( vision, mission, goals, objectives, action plan)

• SWOT analysis

  • Strengths

  • Weaknesses

  • Opportunities

  • Threats

GOOD INFORMATION

• business and competition (benchmarking, best practices, evidence based)

QUALITY SERVICE/PRODUCT

• increase efficiency, evidence based practice, reduce medical errors to improve patient outcomes

FINANCIAL RESOURCES

• to maintain good workforce ( grants, subsidies, revenue), new tech, equipment

VISION

MISSION

GOALS

known as the 3 STRATEGIC PLAN

VISION

• An expression that does not merely state what products and services an organization intends to deliver.

• A statement that captures the organization’s human meaning and value.

• A picture of a preferred or desired state

• An image of our Desired Future

  • Peter Senge (Fifth Discipline)

• “Dreams in Action”

  • Peter Stoltz

TO INSPIRE

TO GUIDE

2 functions of a vision

CAPTURE DESIRED SPIRIT

CHALLENGING, COMPELLING, STRETCHING BEYOND WHAT IS COMFORTABLE

GETS PEOPLE’S ATTENTION

GIVES PEOPLE GOOSEBUMPS WHEN THEY READ IT

PROVIDES MOTIVATION AND FORCE DURING HARD TIMES

EASY TO UNDERSTAND, READ, AND REMEMBER

COMPACT ENOUGH TO BE USED FOR DECISION-MAKING

qualities of a powerful vision statement

MISSION

• synthesis of what members and customers see as the “business” of the organization

• includes what the larger environment sees what work you actually do.

• is built upon your core values

WHAT (customer’s needs, products, services)

WHY (purpose)

HOW (activities, technologies, methods)

WHO (customer/client groups)

4 basic elements of a MISSION

REFLECT VALUES, BELIEFS, PHILOSOPHY

BRIEF ENOUGH TO KEEP IN MIND

BROAD ENOUGH TO ALLOW FLEXIBILITY

ACHIEVABLE

SERVE AN ENERGY SOURCE AND RALLYING POINT

DEFINES FORCES THAT DRIVE VISION

REFLECTS DISTINCTIVENESS COMPETENCE OF THE ORGANIZATION

qualities of an effective MISSION