WEEK 8

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American Military University *

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Health Science

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Dec 6, 2023

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Lesson 8: Global Health and Health Care Reform Common Health Issues Across Countries Regardless of economic status, nearly every country is faced with growing problems with noncommunicable or chronic diseases and complications due to obesity. A study found that 64% of total deaths in 23 countries were due to non-communicable diseases in people 70 years or younger, with tobacco use and obesity being prime drivers of mortality. Obesity has also become a growing pandemic across most countries. Health disparities are a common concern across countries as well. From the supply side, providers across many countries found that there was a spotty success in the use of health information technology in treating complicated patient populations. Currently, there is a greater and more concerted movement to strengthen health systems overall. The most common connotation of scaling-up of international health is the expansion of international health interventions, but it can also imply the expansion of financial, human, and capital resources to increase healthcare coverage of the populations considered. Universal Coverage A movement toward universal coverage (or universal access to health care) relies on political and social processes that promote interventions that improve equity, improve access, and create large pools for financial risks. Further, the methods for reform over time, regardless of system, are more likely based on reactions to previous or concurrent paradigms rather than collective or progressive accumulations of insights about a problem in the system or condition in the population. In the World Health Organization (WHO) report, it was determined that universal coverage is resource- intense and requires efficient use of inputs since it needs to assure that a core set of services is available to all in the society. In an assessment of three core components of universal coverage in nine countries, there were notable differences between countries in terms of:  depth of coverage (i.e., proportion of the population covered)  breadth of coverage (i.e., range of services covered in plans offered)  height of coverage (i.e., the proportion of costs covered by out-of-pocket expenditures) In a robust review of universal coverage internationally, it was noted that broader coverage (i.e., movements toward universal coverage) led to better access to services and better health outcomes, especially for those in lower socioeconomic strata. Reform Models There are no perfect healthcare systems since every intervention or reform entails a tradeoff in cost, quality, and access to care. Reform efforts and system changes need several components for successful outcomes. These are: 1. Effective and visionary leadership 2. Shared goals systems thinking rather than the simple achievement of individual goals 3. The appropriate use of technology in delivering interventions

 The History and Methods for Reform Since nearly the beginning of the twentieth century, there has been some formal movement or piece of legislation brought forth that would help to modify the healthcare system to improve access to and quality of care or to control costs of care. To understand the incentives and goals of the reform movements, we must understand the reasons underlying the need for reform.  The Goals of Reform The challenge facing analysts, politicians, and individuals is one of attempting to satisfy unlimited demands given limited resources in the economy. Expanded access requires additional funding since people enter the system previously having no, or uncoordinated, care. In defining a benefits package, opinions vary on how services should be prioritized, whether it is on principles of evidence-based medicine or economic evaluations. Once a society decides what should be covered, the financing decision remains.  Federal Reform Alternatives Proponents of universal health insurance coverage prefer the single-payer national insurance program. The main advantage of the single-payer system is its administrative simplicity. Critics say that the single- payer system adds more power and control of healthcare resources on the part of the government, which leads to improved efficiency and cost control. Employer-Based Health Insurance  EMPLOYER-BASED HEALTH INSURANCE Once the venerable insurance for the vast majority of Americans, employer-sponsored insurance had a substantial decline from 1999/2000 to 2010/2011. With these significant increases in employer-based insurance coupled with decreases in offers of insurance, this model of financial access to care is becoming less influential in the healthcare sector.  EMPLOYER-MANDATED HEALTH INSURANCE Historically, proponents of employer mandates have used this market-based principle to support their plan to provide insurance coverage to all working Americans and their dependents. In this model, a common way of implementing an employer mandate is where employers would be required to purchase a basic healthcare package for their employees as defined by lawmakers. If the employers choose not to do this, they could pay for a government-sponsored health plan through a new tax used to fund the insurance that the workers and their dependents require. Individual Mandates This is a legal requirement that individuals carry their own insurance protection regardless of employment status, much the way that automobile homeowner’s liability insurance works for all registered vehicles, or how people obtain homeowners or renter insurance plans. This type of mandate has the same goal as the employer mandate and single-payer option.

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