Submitted by BHAGESH KUSHAGRA TANVI MONIKA

Introduction The

Descriptive Framework Functions of the Health System Health System-DEMAND ORIENTED Concept of Oversight Public Health Types of Outcomes Distribution of Health Outcomes

 Framework

for Consideration of Government intervention Basic Rationales Decision points for Government Intervention Robust Justification Framework for How to intervene Contestability & Measurability To Identify Policy levers Other Factors

metabolic efficiency of a living being. In humans, it is the general condition of a person in mind, body and spirit, usually meaning to being free from illness, injury or pain. Health is both an input and an outcome of broader social and economic development. Various other factors are their which helps in achieving good health:-

Health is the level of functional and

a) b) c) d) e) f)

Improvements in standard of living Social stability Education Housing Water supply and Sanitation Other Environmental factors.

Above factors can be ammended by the course of actions taken by the households, communities and governments etc.

 Good

health improves educational attainment, and fosters economic growth and political participation. While unhealthy behavior leads to Sickness, Malnutrition, and High fertility which are significant causes of poverty. Ill health and Poor health services are increasingly recognized as major dimensions of poverty in their own right. So to study it we adopted model used in the World Health Report 2000 (WHR 2000) to describe the actors, functions, and outcomes of a health system.

 In

this framework we examine three broad categories of actors-: People The State

a)

b)

c)

Private Sector Actors

 The

first three sets of functions considered Financing Management of non-financial inputs Health service delivery itself (private sector + public actors) The fourth main function, Oversight which is largely a responsibility of the State.

 The

health system also responds to demand. Demand for health services creates one of the most important Health sector markets. Many types of markets in the health sector besides health services are for Pharmaceuticals, Medical Manpower, Diagnostics etc.

 It

is related with Developing policy and providing Strategic direction to the health system. Requires mediation actions between different actors in the health sector to set a level playing field or facilitating actors to improve their performance. Developing networks with different providers and financiers in health is another oversight role, as is the strategic use of incentives to promote public policy objectives. Informing the public and providers about performance, quality, or pricing is another

 Monitoring

and evaluation of health sector performance is another important oversight function. Other non-governmental bodies may also be involved in oversight functions, such as when consumer organizations play a role in disclosing good medical practice and professional bodies are active in self-regulation. Peoples demand for services and information creates markets for different services (fetal ultrasound testing) and products (new drugs). Oversight activities influence each of the other actors and functions.

 Public

health involves the Programs and Institutions organized by society to protect, promote, and restore the peoples health.
Public Health Functions

Oversight Activities

Public Health Programs

 In

some cases, such as Tuberculosis and Malaria control, public health services also overlap with ambulatory care and hospital services.

 Health

Status

Financial Protection

Consumer Responsiveness

 How

can Indias health system meet its fundamental objectives in an Equitable, Effective, Accountable, and Affordable manner? This level of intermediate objectives may include the following parameters: a) Equity b) Efficiency/quality c) Macroeconomic efficiency d) Consumer choice e) Provider autonomy

Health System outcome is distributed among Geographic areas & Population particularly among poor, scheduled castes & tribes, women & young. In India all 3 types of health system outcome are important. Financial protection as the financial risks of ill health push people into poverty and deepen the levels of poverty . This report also examines requirement of options to reform Financing & Responsiveness of the health system in INDIA. Financing & consumer responsiveness contributes towards health outcome improvements while gains in

 Framework

provides basis to understand various health system functions & orienting key actors towards fundamental set of outcomes or objectives. For assessment of best options of government intervention understanding needs to be build & then to choose amongst alternatives. Public economics theory provides guidance on whether public sector intervention needed in health sector.

1.

Ensuring provision of public goods or services with large externalities. Alleviate poverty to be provided with safety net.

2.

3.

Market failure to be corrected, either where access to appropriate health services is limited or where insurance market has failed.
Report have studies included in it which helps clarification of choices by identification on how poor are affected by health services. Also it clarifies who all are being benefitted from public sector services & private sector failed where.

Government intervention impacting decision points based on combined concern of quality & traditional public economies and concern for equity.
Chart also clarifies that however health system have one set of objectives but activities at various points are not homogenous as economic goods & services. There are certain different processes when it comes to concerned related to public health. Services that are not individualized curative care than if there is concern for curative care. Within curative care distinction has been made about wheather or not a catastrophic cost is involved as same was used to distinguish ambulatory & impatient care.

A Robust justification for public oversight of health system (regulation of private providers & health insurance) has been provided in Public finance economics.
This includes justification for public financing of large externalities (communicable disease control, reproductive health programs, health promotion, trainings) & poor targeted public programs (rural health facilities, financing fee exemptions for the poor) related health services. Limitations to this approach are also there. Account for the historical context , social preferences & political processes needed. Also to move beyond question of whether government should intervene to the question how government should intervene

 Make
Buy Regulate

Inform

 Framework

lays out market condition for inputs ( factors of production) as well as health services ( products) in health sector while using 2 basic characteristics Goods & services.

Extent to which a market can be entered & exited freely referred by Contestability.
Typically it relates to entry barriers for new providers & existing providers protection mechanisms. Contestable goods have low barriers to entry & exit whereas non-contestable goods have high barriers such as sunk costs, monopoly power and geographic advantage. Extent to which it is easy to measure important elements such as inputs, processes, outputs and outcomes referred as Measurability.

 Policy

makers examines conditions off different aspects of health sector & asses necessary (make) government provision level, also conditions under which purchasing may be used instead (buy) with help of Framework.
of measurement of health outputs explained in this , Where difficulties may lie in dealing with markets of health service delivery. it helps to explain why it may be easier to contract out services for laundry and catering.

Difficulty

Also

 Where

outputs are more measurable & there is high contestability, than it is for ambulatory care. there may be high contestability , but the measurement of outputs in terms of quantity, quality & distribution is more difficult. of the factor market, which comprises the inputs to the health system is quite different.
is demonstrated in figure below how measurability is less of an issue, but contestability is more important.

Where

Story

It

 Buying

services is a more feasible option when measurability is greater, and buying inputs when contestability is greater. Informing and disclosing data concerning quality, prices, and effectiveness of health services increases both measurability and contestability. In some cases, this can make it more feasible to let the market provide the goods and services, or improves the potential for government to purchase services

 Policies

that increase the availability of information, enable health providers and organizations to use such information, and increase patients understanding of illness and health services. Monetization of social benefits, such as measuring and financing services provided to the poor, can also help improve contestability. Regulation can be used to increase measurability by changing reporting requirements and accountability mechanisms. It can also be used to influence barriers to entering the market.

 Beyond

the characteristics of measurability and contestability, other factors are important in understanding how health sector markets work. Questions of motivation and incentives of providers, financiers, and patients is important, as are the role of transaction costs, innovation, and experience with regulation and in various types of partnerships