When considering public health and health care systems and the services they provide, it is important to think about how these systems and services are integrated. Systems thinking tools are helpful to consider the various links, feedback loops, and decision points within a system to identify opportunities for improvement and increase efficiency.  Integrating Health Care and Public Health Systems Essay Sample

For this assignment, select a low- or middle-income country of interest and assess its health system. In a 1,000-1,250-word paper, address the following:

Describe the major components of the health system.
Discuss core services the health system provides and who manages them(government, private sector, a mix of both, etc.).
Discuss who is responsible for paying for those services or who funds the provided services.
Apply a systems thinking tool, such as a causal diagram or process map, to identify opportunities for how gaps in public health services can be bridged through a strong health system.
Conclude by considering how the convergence of communicable and noncommunicable diseases can be addressed more effectively through an integrated health system in the selected country.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 Benchmark – Integrating Health Care and Public Health Systems

Introduction

Healthcare systems face challenges when it comes to improving the safety and quality of care during the delivery of care. For example, low-income and middle-income countries face the challenge of under-performing and dysfunctional health systems. According to Maphumulo & Bhengu (2019), the use of healthcare services in low-income countries is very low and this allied to the inability to afford healthcare, lack of health insurance coverage, physical inaccessibility of care services, inadequate availability of supplies, and drugs, as well as the shortage of staff. This paper will analyze the health system of a low-income country, Kenya.

Major Components of the Health System in Kenya

The main component of the health system in Kenya includes the public system and the private sector. The public system is managed by the MoH and parastatal organizations while the private sector is managed by NGOs, private for-profit facilities, and faith-based organizations (FBOs). In Kenya, a network of more than 4,700 healthcare facilities provides care services, where the public sector accounts for approximately 51% of the healthcare facilities (Muga et al., 2015).

The public healthcare system is made of various healthcare levels and they include; “national referral hospitals, provincial general hospitals, district hospitals, health centers, and lastly dispensaries”. The National referral healthcare organizations are at the top of the healthcare system and they provide complex diagnostic, treatment, and rehabilitative care services. The provincial hospitals normally act as referrals from the district hospitals and they offer very specialized care. The provincial hospitals are intermediaries between the district level and the national central level. District healthcare organizations focus on providing healthcare services and produce their own budget requirements and expenditure plans according to the guidelines from the provincial headquarters (Muga et al., 2015).

The health centers in Kenya are responsible for providing ambulatory health services. The health centers normally provide curative and preventative care services, generally adapted to the needs of the locals and community members. Dispensaries on the other hand provide the first line of contact with patients in the healthcare system (Muga et al., 2015). However, in most regions, the health centers and hospitals happen to be the first line of contact for patients. dispensaries offer broader coverage of preventative care measures; this is the main objective of the health policy. The private healthcare organizations and FBO facilities complement the government healthcare services, which together cater for approximately 40% of the bed capacity in the country (Muga et al., 2015).    Integrating Health Care and Public Health Systems Essay Sample

Core Services the Health System in Kenya

The national referral hospitals provide complex diagnostic, treatment, and rehabilitative care services while the provincial hospitals provide specialized care. At the district level, the mission and district hospitals provide curative services. The health centers provide both curative and preventative care services at the sub-district level while the outreach services and dispensaries provide preventative and curative services to communities in the catchment areas. Basic curative and preventative care services for minor illnesses are often addressed at the household or community level using the community package.

The NGOs, FBOs, and private hospitals provide specific healthcare services. The private sector currently contributes more than 40% of the healthcare services in Kenya, providing mostly curative healthcare services (Muga et al., 2015).

 Funding of the Healthcare Services

The government of Kenya funds the healthcare sector by allocating funding to the ministry of health and the allied government departments. However, the government funding has not been adequate to fund healthcare in Kenya as indicated by the lack of enough drugs, shortage of staff, inaccessibility to healthcare services, and poor quality of care (Irimu et al., 2018). The major funding is allocated to tertiary and secondary care, at the expense of primary care units. This means that primary care in Kenya is under-funded despite providing the bulk of healthcare services to the populations.

The health insurance coverage in Kenya is the National Social Health Insurance Fund (NSHIF). This scheme is funded by members who pay monthly contributions. However, the public insurance fund only covers a part of pay for the inpatients. The insurance only caters to the bed charges in the major private hospitals, and there is a limit to what the insurance pays. Moreover, members are forced to select particular hospitals (Mbau et al., 2020). To access relatively high-quality services in Kenya, people pay for private insurance that caters for the healthcare costs, especially during hospitalization.

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Bridging Gaps in Public Health Services

The gaps in public health services in Kenya can be bridged by focusing on primary care activities that promote preventative care and health promotion. Community health workers (CHWs) can provide the necessary health promotion and collaborate with the government to provide preventative care to communities (McCollum et al., 2016). Secondly, health information such as electronic health records can promote efficient care coordination, reduce healthcare costs, and improve the quality of care. Moreover, governance accompanied by accountability and coordinated management of healthcare services is likely to ensure that the funds allocated to healthcare are used for the correct purposes. Finally, the government needs to increase funding for healthcare, and especially primary health care. Increased health insurance coverage through increased funding of health insurance is likely to increase access to healthcare.

Addressing Communicable Diseases through an Integrated Health System

The co-occurrence of communicable and non-communicable diseases brings in various challenges to the healthcare system. The healthcare system in Kenya is fragmented. Secondly, the government funds the secondary and tertiary facilities, without prioritizing the primary care.

A primary healthcare approach can be effective in addressing the convergence of non-communicable and communicable diseases in Kenya. A primary healthcare approach holistically addresses the health needs and preferences of people, families, as well as their communities (White, 2015). A primary healthcare approach addresses the wider determinants of health and comprehensively addresses all the interrelated elements of the mental, social, and physical health and well-being. Moreover, a primary healthcare approach ensures that individuals are provided with comprehensive care that ranges from health promotion, preventative, treatment, rehabilitation, as well as palliative care (Ramalho et al., 2019). Therefore, if Kenya adopts a primary healthcare approach, it would be able to combat both communicable and non-communicable diseases. Through the primary healthcare approach, many chronic diseases can be prevented through health promotion and preventative care.  Integrating Health Care and Public Health Systems Essay Sample

References

Irimu, G., Ogero, M., Mbevi, G., Kariuki, C., Gathara, D., Akech, S., Barasa, E., Tsofa, B., & English, M. (2018). Tackling health professionals’ strikes: an essential part of health system strengthening in Kenya. BMJ global health, 3(6), e001136. https://doi.org/10.1136/bmjgh-2018-001136.

Maphumulo, W. T., & Bhengu, B. R. (2019). Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis, 42(1), e1–e9. https://doi.org/10.4102/curationis.v42i1.1901.

Mbau, R., Kabia, E., Honda, A., Hanson, K., & Barasa, E. (2020). Examining purchasing reforms towards universal health coverage by the National Hospital Insurance Fund in Kenya. International journal for equity in health, 19(1), 19.

McCollum, R., Otiso, L., Mireku, M., Theobald, S., de Koning, K., Hussein, S., & Taegtmeyer, M. (2016). Exploring perceptions of community health policy in Kenya and identifying implications for policy change. Health policy and planning, 31(1), 10–20. https://doi.org/10.1093/heapol/czv007.

Muga, R., Kizito, P., Mbayah, M., & Gakuruh, T. (2015). Overview of the health system in Kenya. Kenya service provision assessment (KSPA 2004) survey URL: https://dhsprogram. com/pubs/pdf/spa8/02chapter2. pdf [accessed 2018-03-20][WebCite Cache ID 6y3kFHBkt]..

Ramalho, A., Castro, P., Gonçalves-Pinho, M., Teixeira, J., Santos, J. V., Viana, J., … & Freitas, A. (2019). Primary health care quality indicators: An umbrella review. PloS one, 14(8), e0220888.

White F. (2015). Primary health care and public health: foundations of universal health systems. Medical Principles and practice: international journal of the Kuwait University, Health Science Centre, 24(2), 103–116. https://doi.org/10.1159/000370197.

Week 3 of PHN-655.

Assignment    Benchmark – Integrating Health Care and Public Health Systems.

Instructions.

When considering public health and health care systems and the services they provide, it is important to think about how these systems and services are integrated. Systems thinking tools are helpful to consider the various links, feedback loops, and decision points within a system to identify opportunities for improvement and increase efficiency. Integrating Health Care and Public Health Systems Essay Sample

For this assignment, select a low- or middle-income country of interest and assess its health system. In a 1,000-1,250-word paper, address the following:

1.Describe the major components of the health system.

2.Discuss core services the health system provides and who manages them (government, private sector, a mix of both, etc.).

3.Discuss who is responsible for paying for those services or who funds the provided services.

4.Apply a system thinking tool, such as a causal diagram or process map, to identify opportunities for how gaps in public health services can be bridged through a strong health system.

5.Conclude by considering how the convergence of communicable and noncommunicable diseases can be addressed more effectively through an integrated health system in the selected country.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Lopes Write. Refer to the Lopes Write Technical Support articles for assistance.

Cite 4 current article from 2015-2020 including the one I attached. Thanks.

Please use one of the health system provided in this article and cite this also.

Five Capitalist Democracies & How They Do It

Each has a health care system that delivers health care for everyone — but with remarkable differences.

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Health Care Systems — The Four Basic Models

UNITED KINGDOM  uk flag

An interview with an expert on the UK’s system +

Percentage of Gross Domestic Product (GDP) spent on health care: 8.3

Average family premium: None; funded by taxation.

Co-payments: None for most services; some co-pays for dental care, eyeglasses and 5 percent of prescriptions. Young people and the elderly are exempt from all drug co-pays.

What is it? The British system is “socialized medicine” because the government both provides and pays for health care. Britons pay taxes for health care, and the government-run National Health Service (NHS) distributes those funds to health care providers. Hospital doctors are paid salaries. General practitioners (GPs), who run private practices, are paid based on the number of patients they see. A small number of specialists work outside the NHS and see private-pay patients.

How does it work? Because the system is funded through taxes, administrative costs are low; there are no bills to collect or claims to review. Patients have a “medical home” in their GP, who also serves as a gatekeeper to the rest of the system; patients must see their GP before going to a specialist. GPs, who are paid extra for keeping their patients healthy, are instrumental in preventive care, an area in which Britain is a world leader.

What are the concerns? The stereotype of socialized medicine — long waits and limited choice — still has some truth. In response, the British government has instituted reforms to help make care more competitive and give patients more choice. Hospitals now compete for NHS funds distributed by local Primary Care Trusts, and starting in April 2008 patients are able to choose where they want to be treated for many procedures.  Integrating Health Care and Public Health Systems Essay Sample

JAPAN jp flag

An interview with an expert on Japan’s system +

Percentage of GDP spent on health care: 8

Average family premium: $280 per month, with employers paying more than half.

Co-payments: 30 percent of the cost of a procedure, but the total amount paid in a month is capped according to income.

What is it? Japan uses a “social insurance” system in which all citizens are required to have health insurance, either through their work or purchased from a nonprofit, community-based plan. Those who can’t afford the premiums receive public assistance. Most health insurance is private; doctors and almost all hospitals are in the private sector.

How does it work? Japan boasts some of the best health statistics in the world, no doubt due in part to the Japanese diet and lifestyle. Unlike the U.K., there are no gatekeepers; the Japanese can go to any specialist when and as often as they like. Every two years the Ministry of Health negotiates with physicians to set the price for every procedure. This helps keeps costs down.

What are the concerns? In fact, Japan has been so successful at keeping costs down that Japan now spends too little on health care; half of the hospitals in Japan are operating in the red. Having no gatekeepers means there’s no check on how often the Japanese use health care, and patients may lack a medical home.

GERMANYde flag

An interview with an expert on Germany’s system +

Percentage of GDP spent on health care: 10.7

Average family premium: $750 per month; premiums are pegged to patients’ income.

Co-payments: 10 euros ($15) every three months; some patients, like pregnant women, are exempt.

What is it? Germany, like Japan, uses a social insurance model. In fact, Germany is the birthplace of social insurance, which dates back to Chancellor Otto von Bismarck. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 200 private, nonprofit “sickness funds.” As in Japan, the poor receive public assistance to pay their premiums.

How does it work? Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Like Japan, Germany is a single-payment system, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they may pay a higher co-pay if they do.

What are the concerns? The single-payment system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. (Then again, German doctors pay much less for malpractice insurance, and many attend medical school for free.) Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds.

TAIWAN tw flag

An interview with an expert on Taiwan’s system +

Percentage GDP spent on health care: 6.3

Average family premium: $650 per year for a family for four.

Co-payments: 20 percent of the cost of drugs, up to $6.50; up to $7 for outpatient care; $1.80 for dental and traditional Chinese medicine. There are exemptions for major diseases, childbirth, preventive services, and for the poor, veterans, and children.

What is it? Taiwan adopted a “National Health Insurance” model in 1995 after studying other countries’ systems. Like Japan and Germany, all citizens must have insurance, but there is only one, government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada’s — and the U.S. Medicare program.

How does it work? Taiwan’s new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen has a smart card, which is used to store his or her medical history and bill the national insurer. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country’s single insurer, Taiwan’s health care system has the lowest administrative costs in the world.

What are the concerns? Like Japan, Taiwan’s system is not taking in enough money to cover the medical care it provides. The problem is compounded by politics, because it is up to Taiwan’s parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted.

Integrating Health Care and Public Health Systems Essay Sample