Pubh6003: Health Systems And Economics-Assessment 2: Case Study Public Health Systems

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Task

Assessment Description:

For Assessment 2, you will choose one country other than your own and research its public health

system.

Having the opportunity to research a particular country’s healthcare system will facilitate your

understanding of the interdependent relationship between economics, health care and public

health. You can begin to get an understanding of the way a country perceives health and well-being

by examining the areas to which resources are allocated, how efficiently they are managed, and how

effective they are in terms of health care outcomes.

Choose one country, other than your own, and research its public health system.

Part 1

 Explain how the public health system is both organised and funded.

As part of this, consider:

 The percentage of Gross Domestic Product spent upon health. How does this compare

with Australia (or other country)?

 Financing arrangements - where does the money come from? what is the mix of public

and private expenditure and services? Is there a proportion of development assistance

for health or any form of innovative financing?

 What are the underlying trends (demographic, changes in treatment, or technology)

which help to explain expenditure?

 Coverage – is there universal health coverage within this system? If so, how

comprehensive is it?

Part 2

 Analyse key elements of building blocks of the health system (as identified by WHO 2007;

2009) in this particular country

o E.g. are there key workforce shortages in a particular profession? How might

imbalances be addressed?

o E.g. Is the workforce appropriately trained to develop core competencies?

 

Part 3

 Explain how expenditures for prevention programs and public health services are estimated.

 Define the relationship between public health expenditure, resource allocation and equity.

 Explain how economic factors can hinder delivery of health programs in your chosen

country.

 Describe how economic levers are used, or could be used, to achieve better health

outcomes in your chosen country.

 Define the relationship between equity and resource allocation, and determine what effects

that relationship has on the provision of public health programs and services in your chosen

country.

 

Solution

 

Part 1: Public Health Organisation and Funding

GDP Ratio

This analysis offers a review of the UAE health sector. The use of this health sector as the main basis for analysis is the realisation that in the recent past the nation has expanded its influence globally. Today, it is ranked among the best nations to live in the Middle East region. The analysis findings are then compared and contrasted to the Australian health industry. In terms of the percentage of GDP spent on the health industry the UAE spent 2.6% of its GDP in the health industry (WHO, 2017). This is a slight increase from the traditional 2.4 in 1995. This demonstrates that in the last decade, the spending on the health industry by the government has hardly shifted. This is a contrast to the Australian government spending on the health industry. On its part, the Australian government spent 6.3% of the GDP on the health sectors as of 2014. This is an increase from 4.8 a decade ago (The World Bank, 2017). The above analysis demonstrates that historically and up to date, the Australian government has been spending a higher proportion of its GDP on ensuring that the health industry is effective.

Financing

In terms of the funding sourcing, the major contributors to the UAE health industry are the Federal and Emirati government. In this case, although the UAE has a federal government, each of the emirates has a localised government. In this context, it is the responsibility of each of the Emirati governments to ensure that the health industry is funded. Thus, the major source of funding is from the two levels of the government. The rationale of the government funding of the health sector is enshrined in the UAE vision 20121 goals. One of the goals is to create a happy living for the citizens. Once of the approaches’ through which the government aims to sustain this happy living has been through funding the health sector.  The second source of funding for the industry is through the private sector. The UAE government through the respective Emirates has made it mandatory for multinational corporations to offer their CSR contributions (Ras al khaimah, 2013). One of the approaches by such organisations is through supporting the health sector. The support by the private sector is achieved through two main areas of support. The first is through offering corporate mandatory insurance financing. As such, organisations ensure funding on the industry by paying for medical and healthcare bills for their respective employees. This relives off the burden of meeting such needs from the employees as well as from the government. The second area of funding by the private sector is through developing healthcare infrastructure (Babar, 2017). This has been the offering of one off support services by providing infrastructural support such as building and construction of healthcare facilities. This has been mainly for specialised healthcare centres such as cancer and fitness centres among others.

Trends

As already demonstrated above, the spending in the industry has gradually increased. This has been due to a number of factors. First, the nation is experiencing a rising old age ratio as compared to the young age population a decade ago. In this case, the high number of the aging and the associated health issues increase the ne for the government to advance more resources in meeting their health needs. The second major health issue and emerging trend is on lifestyle issues. Similar to other Middle East and Arabic nations, the UAE has been listed as one of the nations with a high rate of lifestyle related illnesses. These include ailments such as diabetes, high blood pressure, and obesity among others. While as these were linked to old age in the UAE in the past, it has since expanded its scope to include the younger population. This has forced the government top increase funding into the industry to prevent and help mitigate the already existing conditions in the nation (Younies, Elzenaty, Gantasala & Nwagwu, 2016). Finally, there has been a growing trend of increased technology changes and development in the nation. The emergence of new technologies such as artificial intelligence in diagnosis and treatment of the patients has forced the stakeholders to increase investments into acquiring this new technology. The initial capital and funds required for securing the emerging technologies have been the basis for the increased funding towards the industry in the UAE.

Coverage

The UAE government has offered a universal insurance service to the citizens. This initiate which is in line with the vision 20121 was rolled out in October 2014 and was completed towards the end of 2016. Although there are some minority groups that are yet to be covered by the universal healthcare services, the majority of the citizens, whom this analysis approximates at 80%, are under the universal care. Nevertheless, the industry through the government regulations has applied the ‘treat first’ policy (Barrett, 2017). This is a policy that requires all healthcare facilities in the nation whether private or public to handle all emergency cases without prior seeking for payment. Thus, all emergency patients are treated and then payment made latter either by the patients or by the government if the patients lack the financial capacity to foot their bills (Hussain, Malik & Al Neyadi, 2016). Through the enactment and the sue of the policy, the government has ensured that industry offers the fundamental services to all that need the services regardless of the social and economic status.

Part 2: Health System Key Elements

Every industry has both its hardware and the software components that sustain and drive its operations. This is the same scenario in the UAE healthcare industry. On the one hand, the hardware component for the industry is funding and the development of infrastructure as well as materials and medical equipments installations. In this case, the industry, as already demonstrated above is expanding its hardware components. The second category is the software components that comprise of the employees’ and the HR workforce that offers the required services. Unfortunately, an evaluation of the UAE industry demonstrates two main problems with the HR workforce (Al-Yateem, Banni Issa & Rossiter, 2015). The first challenge is on the shortage of such skills. In 014, it was estimated that the UAE alone had an over 80% of its skilled healthcare professionals as foreigners. This meant that only 20% of the skilled professional s was local Emirati citizens. As such, it is clear that internally, the nation is unable to produce enough labour skilled professionals to cover the opportunities in the healthcare industry. This has forced it to import skills and expertise into the sector. The second dimension of the shortage is actually in terms of the exiting professionals are compared to the population size. For instance, in 201, it was estimated that UAE had 2.7 Nurses for every 1000 citizens. This is a very low figure and was in fact the lowest ratio across the GCC countries (Woodman, 2015).  As it stands, the UAE overall population is projected to hit 14.5 Million in 2018. With the projected population rise, it is anticipated that the current shortage would be magnified.  The second challenge in the hr healthcare workforce is with respect to training. In this case, the overall society and market is not receptive to the medical profession. As such, it has been argued that over the years, the industry has been unable to train and produce enough graduates. This has dented the nation’s hope of bridging the current shortage in the foreseeable future.  The above two challenges are critical as they affect on the HR skills available. The healthcare industry, being a service industry relies solely on the effectiveness, expertise, and the availability of the professionals. Nevertheless, this is a challenge that can be resolved and mitigated (Watfa, 2012).

One of the approaches’ towards mitigating this strategy is through creating incentives. Currently, there is a skills and expertise shortage. With the vision 2021 actualisation, it is expected that more healthcare facilities would be built. This will create a further market gap. The only approach would be to offer incentives to the professionals. This would work in two ways. On the one hand for the domestic professionals, they would be retained in the market and the nation would avoid the risk of brain drain of such professionals into the western nations. Secondly, through offering incentives, it would be possible to attract more professionals from across the globe (Koçkaya & Wertheimer, 2016). This would help the nation to overcome the current deficit. However, this is just a short and medium term mitigation measure. In the long term the focus should in creating an enough workforce locally.

The government could create the long term solution through creating a training policy. In this case, the government should set a minimum number of trainees’ joining the training institutions on a yearly basis (Bagheri, 2013). This can be actualised through a regulation on the numbers and the funding of such programs. As such, this would ensure that the medical filed programs are fully funded and incentives offered to the trainees. This would be at the expense of the other programs and professionals that the government would deem less important and less strategic to the nation. Through offering additional and special funding to the medical practitioners and trainees it would create a higher number of professionals in the long run period. Additionally, through the Ministry of Health, the government should in partnership with other partners such as in public private partnership encourage, fund, and organise professional forums and training opportunities. This would raise the status of the profession and as such attract more potential trainees into the future.

 

Part 3: Allocation and Equitability

One of the challenges in the historical management of the healthcare industry has been in the equitable distribution of the resources. In this case, the equitability in allocating resources is achieved through addressing all the healthcare needs based on their magnitude and their potential implications in the industry. Unfortunately, this has not been achieved in the UAE healthcare industry. On its part, the industry has addressed and allocated the largest proportion of the resources in two main areas. The first are is in the construction and building of new healthcare facilities. In this regard, the UAE government guided by vision 2021 aims at ensuring that there are available healthcare facilities in the neighbourhoods. Secondly, the government has invested in offering and securing technologies required in the healthcare services operations (Allianz, 2017). These two areas of investments are critical. However, they are not the only necessary areas. One of the needy areas that have been underfunded is in developing and training domestic professionals. In this case the government has resulted to constructing facilities and importing professionals from outside the nation. The fact that there are many willing professionals working in the UAE and the probability of acquiring more professionals at will has reduced the government’s willingness to invest in developing a domestic workforce. This has been attributed to reasons such as the high cost of training qualified professionals and the potential demand for higher remunerations and pay by a domestic workforce as contrasted to a foreign workforce (Todorova, 2014). This has made the training and development is one of the most underfunded sectors in the industry. This has created funding and resources allocation inequality.

The second evidence of inequality in the funding process is in terms of the focused on medical areas. In this case, the government has been keen to addressing the acute illnesses such as cancer and other common ailments such as obesity and diabetes among others. In this case, much of the funding has been channelled towards the management and the treatment of these cases. Overall, it is estimated that of the budgetary allocations offered for non-infrastructural uses, over 70% of the allocations are aimed at treating such disease. This means that only a partly less than 30% of the available resources are sued for preventative strategies and measures. This has created a repeated recurrence of the problems. In this case, the fact that the problems are not addressed at the causative stage, it has an increasing case of lifestyle illnesses. The inequality could be addressed through proper regulations and management. As such, rather than focusing on treating the conditions, an equitable allocation would be critical at the preventative stage such as t sensitisation and in developing fitness and wellness centres.

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