Healthcare Systems

Future Predictions for Global Care

Jeffrey Braithwaite, Russell Mannion, Yukihiro Matsuyama, Paul G. Shekelle, Stuart Whittaker, Samir Al-Adawi, Jeffrey Braithwaite, Russell Mannion, Yukihiro Matsuyama, Paul G. Shekelle, Stuart Whittaker, Samir Al-Adawi

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781351683715
• Edition: 1
• Topic: Medicina
• Subtopic: Sanità, amministrazione e assistenza pubblica

In this book, we invited 146 authors with expertise in health policy, systems design, management, research, or practice, from each of the countries included, to consider health reforms or systems improvements in their country or region. The resulting case studies, of 52 individual countries and five regional groupings, cover 152 countries or territories, or three-quarters of the world's nations. Each chapter author was asked to think 5–15 years into the future and make a prediction on how their health system could be strengthened as a result of the successful unfolding of their case study.

The types of projects our authors have chosen to explicate into the future are wide-ranging. They vary from e-consultation services in Estonia, achieving universal health coverage in Argentina and Mexico, reforming long-term care in the Netherlands, reassessing care for the aging population and the frail elderly in Australia, streamlining the health system through Lean Thinking in Nigeria, using regulation to improve care in South Africa, developing a new accreditation model in Turkey, through to a critique of physician specialization in Russia and applying IT initiatives to improve care in China, Lebanon, Taiwan, Papua New Guinea, the United Arab Emirates, Venezuela and Wales.

Chapter writers recognized that the improvement work they were doing was part of a moving target. There was general agreement that the effective use of limited resources and overcoming hurdles and constraints were crucial to enhancing health systems in order to deliver better care over the medium term. While some initiatives required considerable funding, many were relatively inexpensive. These case studies demonstrate ways in which fruitful application of partnerships and creativity can make considerable gains in strengthening healthcare delivery systems.

Features

• 
  
  

• The third book in a series on international health reform
• Involves 146 contributing authors, five regional editors, a series editor and a highly skilled support team to explore sustainable improvement in health systems in the future
• Encompasses a time horizon of the next 5–15 years
• Covers 152 countries or territories, with 52 individual countries and an analysis of five regional groupings comprising 100 countries

Part I

The Americas

Paul G. Shekelle

The continents of North and South America and their proximate islands make up the World Health Organization region of the Americas—an area that exceeds 16 million square miles and extends 8700 miles from north to south. The geography encompasses every extreme: from arctic tundra in the north, through deserts and plains, vast mountain ranges, and large river basins, to tropical rainforests in the south. The combined population of the 35 countries and 24 dependent territories that make up the Americas is more than 1 billion. The population is as demographically, culturally, and economically diverse as the landscape and climate, and includes those in the wealthiest nations of the world, such as the United States and Canada, along with those in some of the poorest, such as Haiti.

Authors from nine countries from the region—Argentina, Brazil, Canada, Chile, Guyana, Mexico, Trinidad and Tobago, the United States, and Venezuela—have contributed to this book, and the overall message is that there is a broad range of possible future innovations and reforms. While the discussion is expansive and each chapter has its own particular focus, shifts in global trends in demographics, economics, and technology mean that there are a number of shared concerns. These include improved training and education (Trinidad and Tobago and Brazil), reforms to health system financing (Chile, Mexico, and Argentina), primary and mental healthcare (Venezuela and Guyana), and the importance of developing patient-oriented systems (Canada and the United States of America).

Concerning potential improvements in training and education, Walter Mendes, Ana Luiza Pavão, Victor Grabois, and Margareth Crisóstomo Portela describe a Brazilian distance education training program designed to improve patient safety and increase research, with an emphasis on collaboration. Claudine Richardson-Sheppard describes ways in which nurse education in Trinidad and Tobago could be improved with the introduction of competency-based training, particularly when it comes to leadership roles.

With regard to how care is paid for, Oscar Arteaga describes Chile’s struggle to create a more fully integrated health insurance system, while Hugo Arce, Ezequiel García-Elorrio, and Viviana Rodríguez home in on the goal of achieving universal healthcare coverage through the targeting of priority populations in Argentina. Jafet Arrieta, Enrique Valdespino, and Mercedes Aguerrebere describe how Mexico might use conditional cash transfers and universal healthcare coverage to tackle the growing burden of non-communicable diseases.

In Venezuela, Pedro Delgado, Luis Azpurua, and Tomás J. Sanabria present an innovation using training and technology to improve primary care in rural clinics. William Adu-Krow, Vasha Elizabeth Bachan, Jorge J. Rodríguez Sánchez, Ganesh Tatkan, and Paul Edwards describe a shift from institutional care to community care when it comes to treating patients with psychological disorders in Guyana.

In Robert H. Brook and Mary E. Vaiana’s radical vision of the future, the U.S. health system has been completely reoriented and adopts a patient-focused approach, with all social and health services integrated. Anne W. Snowdon, Charles Alessi, John Van Aerde, and Karin Schnarr also look forward to a more personalized health system in Canada, where all medical information is accessible and transparent, and health decisions can be made by the informed consumer.

Thus, in the Americas, a wide range of potential future innovations is envisioned, at different stages of development, and influencing care from specialized populations to the entire country. These aggregate to a set of remarkable visions, some of which are more speculative, and others more grounded in the present.

1

Argentina

Achieving Universal Coverage

Hugo Arce, Ezequiel García-Elorrio, and Viviana Rodríguez

CONTENTS

Argentinian Data

Background

Healthcare Organizations

Human Resources

Twenty-First-Century Health Initiatives

Proposed Health System Reforms

Achieving Universal Coverage

Conclusion

Argentinian Data

• Population: 43,847,430 • GDP per capita, PPP: $19,934.4 • Life expectancy at birth (both sexes): 76.3 years • Expenditure on health as proportion of GDP: 4.8% • Estimated inequity, Gini coefficient: 42.7%

Source:All data are from the World Health Organization and World Bank. Latest available data used as at October 2017.

GDP = Gross Domestic Product

PPP = Purchasing Power Parity

Background

Argentina, like most countries, is in the process of epidemiological and demographic transition. Argentina’s population is largely urbanized (about 80%), and around 32.2% of the population is impoverished. Urbanized areas are served by both ambulatory and hospital services—including public and private, for profit and non‑profit (Table 1.1).

TABLE 1.1
Healthcare Organizations

Source:Ministerio de Salud [Argentina]. (n.d.). Sistema Integrado de Información Sanitaria Argentina. Retrieved from https://www.msal.gob.ar.

Note:n/a = not applicable.

^aAll types of organizations with and without admission services, with the exception of centers for geriatric care.

^bMight include some mental health and addiction centers.

During the last 2 years, there has been a marked increase in epidemic outbreaks of dengue, Zika, chikungunya, and even yellow fever due to the increase in population and displacement of their common source, the Aedes aegypti mosquito, whose natural reservoir is the jungle of the Mato Grosso. Preventive strategies are multipronged and include education as well as the elimination of the insects and their habitats. Low-income populations in the north and center of the country, where Triatoma infestans (vinchuca) transmit Chagas disease, are particularly vulnerable. Malaria cases, however, are uncommon in the north of the country, as a result of an intense campaign deployed in the 1940s and 1950s.

Chronic non‑communicable diseases (NCDs), such as obesity, diabetes, hyperlipidemias, hypertension, and chronic obstructive pulmonary diseases (COPDs), are simultaneously becoming increasingly common in urban populations. This has forced a shift in urban primary care services’ traditional emphasis on acute and infectious disease control to the management of chronic conditions.

High maternal mortality rates persist in Argentina, due to the prevalence of unchecked chronic conditions, adolescent pregnancies, and illegal abortions, and despite the fact that more than 97% of births occur in hospitals. In 1990, as a signatory to the United Nations (UN) Millennium Development Goals, Argentina committed to reducing its maternal mortality rate by 75%, aiming to reach 1.3 deaths per 10,000 live births by the year 2000. However, the rate is currently 3.2%, with abortion a leading cause of maternal death, especially among teenagers. An estimated 500,000 illegal abortions are carried out every year.

Healthcare Organizations

Argentina has 3300 acute care hospitals, of which 1300 are public and 2000 are private. There are approximately 134,000 beds: 73,500 (55%) public beds and 60,500 (45%) private beds. However, over the past 25 years, the total number of beds per 1000 inhabitants has decreased: from 4.5 in 1995 to 3.1 in 2016. These figures do not take into account the numbers of geriatric patients currently hospitalized, which increases the number to 4.9 per 1000 (Arce, 2010). Several studies indicate that despite superior capacity, public hospitals account for less than 40% of the current system’s resources. There are also 1800 geriatric institutions with about 80,000 beds where the public patients account for less than 12% of the total. There has been a notable increase in the number of outpatient clinics over the last three decades: in total, there are 18,800 establishments with 8,800 public centers primarily concerned with general primary care, and 10,000 private diagnostic and specialis...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Contents
• Preface
• Acknowledgements
• About the Editors
• About the Contributors
• Contributors
• Introduction
• Part I The Americas
• Part II Africa
• Part III Europe
• Part IV Eastern Mediterranean
• Part V South-East Asia and the Western Pacific
• Discussion and Conclusion
• References
• Index