The Comparative Study of Health Care Delivery Systems

1
The Comparative Study of Health Care Delivery
Systems

• James G. Anderson, Ph.D.
• Purdue University

2
Sociological perspective

• Health care delivery systems have broad social
  functions not just the treatment of disease
• They deal with conflicts and dilemmas in the
  larger society
• Organization and priorities reflect political and
  economic priorities
• Physicians have extra-medical responsibilities

3
Sociological perspective

• Growth of medical knowledge/technology has
  similar affects on the HC delivery system despite
  different ideologies
• Government sponsorship and control may radically
  alter the distribution of services
• The boundaries of medical care systems are
  unclear and expand over time (medicalization)

4
International Knowledge, Technology and Manpower

• Science/technology transcend national boundaries
• Medical care is dependent on knowledge/technology
• Developing nations adopt an approach ill-suited
  to their needs (i.e., high technology,
  stratified, limited access, leads to MD loss)

5
Patterns of Mortality/Morbidity and National
Development

• In underdeveloped nations, malnutrition,
  intestinal, respiratory and infectious diseases
  are the problems.
• In underdeveloped nations preventive/public
  health and control of fertility bring greater
  gains than curative medicine that consumes scare
  resources
• In developed nations, chronic degenerative
  diseases, accidents, mental illness are problems

6
Health care Delivery Systems in Modern Nations

• Government involvement in financing,
  administering and regulating the system
• Government assumes high proportion of medical
  costs
• Greater emphasis on ambulatory care
• Government mediates professional dominance
• Imposition of cost controls

7
The Social Functions of Health Care

• Growth and extension of the medical domain.
• Medicine takes over functions of religion and
  family
• HC institutions insulate society from problems of
  mental illness, aging, dying
• Variability in physician utilization reflects
  accessibility and social ideologies

8
Health Care and Community Structure

• The formal health care system is part of the
  community of formal and informal organizations
  and agencies (i.e., religious, self-help, kinship
  networks, etc.)
• Decision making is influenced by the availability
  of facilities as well as by cultural beliefs

9
Comparative Effects of health Care Delivery
Systems

• Morbidity/Mortality indices reflect a wide range
  of influences related to technology, life style,
  nutrition, public health. Medical care may have
  only a small effect.
• Infant mortality and birth weight are health
  status measures influenced by SES, race,
  education, age at delivery, nutrition, and
  parenting

10
Comparative Study of Payment Systems

• Payment systems are determined by social-cultural
  contexts
• In the USA, prepayment results in lower
  hospitalization rates and surgical intervention
• Differences are due to physician incentives,
  patient composition, availability of treatment
  resources
• Payment systems affect the behavior of MDs

11
Professionalism and Roles

• Growing bureaucratization of the MDs role
• Service bureaucracies
• Division of labor between MDs and other health
  care workers
• Underdeveloped nations must rely heavily on
  ancillary personnel

12
Convergence of Health Care Delivery Systems

• Growth of medical technology is leading to common
  organizational arrangements
• Most nations develop modern medicine to serve an
  elite and national pride
• Health services for the poor are limited
• Developed nations are struggling with cost
• Public expectations continue to grow