HealthCare

Formal- Sector: Encompasses all jobs with normal hours & regular wages, & : recognised as income sources ; income taxes must be paid. — Informal- Part of an economy : not taxed, monitored by any form of government, / included in any gross national product (GNP), unlike the formal economy: : Black Market. Brain Drain - Emigration :Highly trained / qualified people from :Country .

This is important as will dictate the availability of health care in each country. It is measured using the following criteria:- The Human Development Index (HDI) is an overall indicator of a countries development. HDI is calculated by working out an average of 3: 1. Life expectancy 2. Education 3. Income per capita

HIGHLY skilled job that requires detailed and expert training IN LEDC’s: — Low Pay — Poor/dangerous working conditions — Shortage of essential medicines – Could be due to low availability of product or cost? ……leading to the Brain Drain

Formal- Sector :Encompasses all jobs: Normal hours & regular wages, & are recognised as income sources ; income taxes must be paid. Informal- Part of an economy that - Not taxed, monitored by any form of government, / included in any gross national product (GNP), unlike formal economy. Sometimes referred :Black market. Different kinds of clinical & non-clinical staff make each individual & public health intervention happen; the most important: the health systems input. Human resources bill: Usually biggest single item: recurrent budget for health. Health care systems : Labour intensive & require qualified &experienced staff :function well. Inadequate pay & benefits, together with poor working conditions- ranging from work : conflict zones to inadequate facilities & shortages of essential medicines and consumables- frequently mentioned in less developed countries ; most pressing problems facing : Healthcare workforce.

Bangladesh & Egypt have low pay. Publically employed physicians see private paying patients : Supplement income from regular jobs In Kazakhstan, ‘informal payments’: estimated : Add 30%: National health care bill. In Bahrain :Possibilities for doctors : work privately:Public institutions: neutralise an on going brain drain : Qualified staff from public sector. In China &Japan healthcare staff get income from sale : prescribed drugs: supplements income. In many low income and middle income countries, they have increased the pay to try to combat the brain drain. In Uganda, the public pay sector rose by 900% between 1990 and 1999. In Guinea-Bissau 700 ‘ghost’ workers were removed from the payroll of the Ministry of Finance following an inventory of healthcare workers. A 1993 survey in Cambodia revealed a poorly distributed and largely unregistered workforce. In Oman it is policy to recruit primarily a domestic workforce. In Hungary and Jamaica, new public health schools have been opened to train the population. Due to inadequate pay and benefits, many Jamaican nurses have migrated to the USA. Also healthcare staff have migrated from Egypt and India to the Middle East, USA and Europe. To try and stop this migration, service contracts have been introduced in the Philippines and Tanzania. Staff have to stay in service for a number of years.

Generally worse : EDC’s than MEDC’s LEDC’s = Less economically developed country MEDC’s- More economically developed county — Different systems: — Public — Private — Dual — social insurance payments — Important to note: High GDP doesn’t mean good healthcare access for ALL-regional disparities e.g. NYC GDP differential combined with private system hence why HDI is good. GDP = Gross domestic product (How much money a country makes)

Private health insurance available : Employer, Government / Private schemes. • 15.3% of population (45.7 million people) do not have health insurance. • Medicare is for elderly • Medicaid is for low income and children

Healthcare free at point of delivery; charges for prescription drugs (except in Wales), ophthalmic services & dental services unless exempt. Exemptions : Children, Elderly, & unemployed. About 85%: Prescriptions : Exempt.

All legal residents covered: public health insurance Funded: compulsory social health insurance contributions from employers & employees ; no option to opt out. All fees are paid on treatment ; then reimbursed.

Dual system Funded: Private & Public sectors. Public sector provide 80% of hospital care 20% primary care. Financed by combination: Taxes, employee medical benefits, compulsory savings ; form: Medisave. Patients expected: Pay part of their medical expenses & pay more for higher level : service. Government subsidises basic healthcare.

About 11% have private health insurance. • Private GP services very small. • Healthcare free at point: delivery; charges|: prescription drugs (except in Wales), ophthalmic services & dental services unless exempt. • Exemptions: Children, Elderly & Unemployed • About 85% of prescriptions :Exempt. • Most walk-in care provided: GP Practices & walk-in clinics & 24hr Nhs telephone line Free ambulance service & access : accident & emergency • In patient care through GP referral & follow contractual agreements. between health authorities, Primary Care Trusts & hospital. • Hospitals :Semi-autonomous self-governing public trusts.

All legal residents covered: Public health insurance funded: Compulsory social health insurance contributions from employers & employees ; no option to opt out. • Most people have extra private insurance : Cover areas : Not eligible :Reimbursement: Public health insurance system & many make out : Pocket payments & see Doctors. • Patients pay doctor's bills & reimbursed: Sickness insurance funds. • Government regulates contribution rates paid to sickness funds, sets global budgets & salaries: Public hospitals. • In-patient care: Provided : Public & private hospitals (not-for-profit and for-profit). Doctors: Public hospitals: salaried ; those: Private hospitals: Paid on a fee-for-service basis. Some public hospital doctors : allowed to treat private patients in hospital. A percentage of private fee payable: Hospital. • Most out-patient care :Delivered : Doctors, Dentists & medical auxiliaries working in : own practices.

Dual system funded by private and public sectors. Public sector provides 80% of hospital care 20% primary care. • Financed : combination: Taxes, employee medical benefits, compulsory savings Form: Medisave, insurance & out-of-pocket payments. • Patients expected to pay part of their medical expenses & to pay more : Higher level of service. Government subsidises basic healthcare. • Public sector health services cater :Lower income groups : cannot afford private sector charges. In private hospitals & outpatient clinics, patients pay the amount charged & hospitals & doctors on a fee-for-service basis.

Uganda – public pay: medical professionals rose 900% in ten years 1990-99. — Jamaica – new health schools opened recently: nurses move to USA: Better pay & Conditions — Philippines – Introduced minimum 6 month service costs: Encourage workers to stay — Why has this happened? Money! Patients pay more in states therefore more surplus cash available to pay doctors and nurses! Vicious circle.

— Healthcare: North Korea includes: National medical service |& health insurance system. North Korea has a national medical service and health insurance system which are offered for free. — In 2001 North Korea spent 3% of its gross domestic product : Health care. Beginning in the 1950s, the DPRK put great emphasis: Healthcare, & between 1955 &1986, number : hospitals grew from 285 to 2,401, & the number o: clinics – from 1,020 to 5,644. Hospitals attached: Factories & mines. A national telemedicine network; launched: 2010. Connects Kim Man Yu hospital Pyongyang with 10 provincial medical facilities. — North Korea's healthcare system suffered: steep decline since 1990s :Natural disasters, economic problems,& food & energy shortages. — By 2001, many hospitals & clinics : North Korea lacked essential medicines, equipment, running water & electricity —

South Africa, private & public health systems exist : parallel. • The public system serves the vast majority of the population, but is chronically underfunded and understaffed. • Wealthiest 20%: Population use:Private system & are far better served. In 2005, South Africa spent 8.7% of GDP on health care, / US$437 per capita. • Of that, approximately 42% was government expenditure. • About 79%: Doctors work: Private sector

Public sector uses :Uniform Patient Fee Schedule : Guide : billing:Services. • Being used : Provinces of South Africa; in Western Cape, Kwa-Zulu Natal, and Eastern Cape, ; being implemented phased schedule. Implemented :November 2000, the UPFS categories the different fees for every type of patient and situation. • Groups patients:Three categories defined : General terms, & includes:classification system : placing all patients into either one of these categories depending on the situation & any other relevant variables. • Three categories include full paying patients—patients who are either being treated by:Private practitioner: Externally funded, who are some types of non-South African citizens—, fully subsidized patients —patients:Referred: Hospital:Primary Healthcare Services —, & partially subsidized patients—patients who’s costs are partially covered based on their income. • Also specified occasions; which services are free of cost

Brazil: Constitutional right. • Provided: Both private & government institutions. • Health Minister administers national health policy. • Primary health care remains responsibility: Federal government, elements (such as the operation of hospitals):Overseen: individual states. • Public health care: Provided to all Brazilian permanent residents & foreigners: Brazilian territory through the National Health Care System, known : Unified Health System - SUS. • SUS : universal & free for everyone.

In spite of recent advances in treatment and care available in most developed countries, the HIV/AIDS pandemic continues to spread throughout the developing world. • Structural inequalities continue to fuel epidemic : all societies, & HIV infection increasingly been concentrated in poorest, most marginalized sectors of society in all countries. • The relationship between HIV/AIDS & social & economic development has therefore become: central point in policy discussions about the most effective responses to epidemic. • Important progress has been made :recent United Nations initiatives. Maintaining long-term commitment to initiatives : Global Fund Fight AIDS, Tuberculosis & Malaria ; especially important : wake of September 11 & ensuing events; threaten to redirect necessary resources to seemingly more urgent security concerns.

The costs of antibiotic-resistant infections: • Financial Cost: Medical costs per patient suffering from: antibioticresistant (ABR) infections ranges from $18,588 to $29,069. Costs per patient total over $20 billion in health care system costs each year in the U.S. • Social Cost: Duration:Hospital stays; patients with ARIs was extended by 6.4-12.7 days. During this time : Patients: Unable to work & lose wages. These costs to U.S. households total over $35 billion each year. • Cost of Death: Study: ARIs in hospitals showed: Death rate for patients with ARIs was two-fold higher than the death rate for patients without ARIs. Pre- mature death: Patients with ARI : Emotional & financial burden : society & healthcare system.

Health geography make: Important contribution to future global and national plans & policies. Can include: Advising :Planning : Healthcare staffing : Southern African countries devastated : the HIV/ AIDS Crises. Analysing the global correlation between income and welfare. Monitoring the effects of climate change on the emergence of new infectious diseases. Investigating the optimum pattern of healthcare provision in primary healthcare trusts.

None of these changes will affect how you access NHS services in England. • The way you book your GP appointment, get a prescription, / are referred to a specialist will not change. • Healthcare will remain free at the point of use, funded from taxation, & based on need & not the ability to pay.

The NHS in England is undergoing some big changes, most of which will take effect on April 1 2013. This will include the abolition of primary care trusts (PCTs) and strategic health authorities (SHAs) and the introduction of clinical commissioning groups (CCGs). However, none of this will have an effect on how you access front-line services and your healthcare will remain free at the point of use.

Since launch: 1948, NHS: grown: become world’s largest publicly funded health service. It is also one of the most efficient, most egalitarian & most comprehensive. NHS employs more than 1.7m people. Of those, just under half are clinically qualified. NHS deals with over 1 million patients every 36 hours. Exception some charges: prescriptions & optical & dental services, NHS remains free at the point of use for anyone who is resident in the UK.

Ageing Population – developed countries e.g. France & UK as it is only an issue in MEDC’s (stage 5 DTM). It will increase demand here for two reasons: 1) more elderly people generally: Mean more medical assistance e.g. cataract, heart problems, cancer. 2) Less working age people therefore less taxes: Support public health systems e.g. NHS in UK.

People:Getting fatter almost everywhere in the world. — The World Health Organization predicts : There will be 2.3 billion overweight adults in the world by 2015 & more than 700 million of them will be obese. — Figures for 2005 show 1.6 billion adults were overweight and 400 million were obese.

Positive: Reduction of cold- related Effects deaths: temperate climates Unsafe drinking water Increase: Food Production : some high- latitude regions. Negative: Changes:Disease Patternss Effects Lack: Secure: Shelter. Inadequate food shelter Unsafe Drinking water.