Mika/Notes/Public Health

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Trials

  • Randomise Me.

Worldwide facts

Nigeria

Health care

  • Total health care expenditure: 4.1% GDP
    • Federal government expenditure: 1.5% GDP
    • Per capita total expenditure: 50 USD
  • General structure: 3 tiers of government + private health care
    • Fed: University teaching hospitals
    • State: General hospitals
    • Local: Dispensaries
  • Insurance: National Health Insurance Scheme (1999/2004 amendment)
    • Free health care for all citizens
    • Governmental employees insurance scheme
    • Private firms contracting with private health care providers
    • covers children under five, permanently disabled persons and prison inmates.
  • Misc facts
    • Rate of growth of per capita food production: 0.25%(1970-90)


Health Facts

  • Life expectancy (M/F 2003): 48/49
  • Mortality before age of 5: 191/1000
  • Rank of health care systems: 187/191 (WHO 2000)
  • Prevalent diseases:
  • HIV/AIDS: 3.1% (worldwide rank 23)

Problems

  • Health care in Nigeria is influenced by different local and regional factors that impacts the quality or quantity present in one location.
  • Also, the Nigerian ministry of health usually spend about 70% of its budget in urban areas where 30% of the population resides.
  • It is assumed by some scholars that the health care service is inversely related to the need of patients.
  • Emigration of health care professionals


Ethiopia

Health care

  • Total health care expenditure: 4.9% GDP (2005)
    • Per capita expenditure: 4 USD
  • General structure: Health Sector Development Program (HSDP)
    • a primary health care unit, (a network of a health center and five health posts)
    • the hospital
    • regional hospital
    • specialized referral hospital.
  • 4 tier financing
    • the federal and regional governments
    • grants and loans from bilateral and multilateral donors
    • non-governmental organizations
    • private contributions.
  • Insurance:
  • Misc facts
    • Physician: Patients = <1 : 10,000
    • In November 2004, the government launched a five-year program to expand primary health care.

Health Facts

  • Life expectancy (M/F): 55/58
  • Probability of death before 5YO: 166/1000
  • Rank of health care systems (2000): 180/191
  • Prevalent diseases: Communicable diseases (Malaria, HIV/AIDS, TB)
  • HIV/AIDS:
    • In January 2005, it began distributing antiretroviral drugs, hoping to reach up to 30,000 HIV-infected adults.


Problems

  • Health care is disproportionately available in urban centers; in rural areas where the vast majority of the population resides, access to health care varies from limited to nonexistent.
  • According to the UN and the World Bank, Ethiopia at present suffers from a structural food deficit such that even in the most productive years,


Tanzania

Health care

  • Total health care expenditure: 5.5% GDP
    • Per capita total expenditure: 45 USD
  • General structure:
  • Insurance:
  • Misc facts
    • Rate of growth of per capita food production:

Health Facts

  • Life expectancy (M/F): 50/51
  • Mortality before age of 5: 118/1000
  • Rank of health care systems: 156/191 (WHO 2000)
  • Prevalent diseases:
  • HIV/AIDS:

Problems

South Africa

Health care

  • Total health care expenditure: 8.6% GDP (2005) or $869 per capita


  • General structure: parallel private and public systems
    • Public cover most of the populations
    • Wealthiest 20% uses private
  • Insurance:
  • Misc facts
    • Rate of growth of per capita food production:


Health Facts

  • Life expectancy (M/F): 50/53
  • Mortality before age of 5: 69/1000
  • Rank of health care systems: 175/191 (WHO 2000)
  • Prevalent diseases:
  • HIV/AIDS:


Problems


Morocco

Health care

  • Total health care expenditure: 1.1% GDP
  • General structure:
  • Insurance:
  • Misc facts
    • Rate of growth of per capita food production:


Health Facts

  • Life expectancy (M/F): 70/74
  • Mortality before age of 5: 37/1000 (2006)
  • Rank of health care systems: 156/191 (WHO 2000)
  • Prevalent diseases:
  • HIV/AIDS:


Problems

Thailand

Health care

  • Total health care expenditure: 3.5% (2002) or 346 USD
    • 57.1% from public sector


  • General structure:
  • Insurance:
    • introduced universal coverage reforms in 2001
    • Means-tested health care for low income households was replaced by a new and more comprehensive insurance scheme, originally known as the 30 baht project, in line with the small co-payment charged for treatment. People joining the scheme receive a gold card which allows them to access services in their health district, and, if necessary, be referred for specialist treatment elsewhere.
    • The bulk of finance comes from public revenues, with funding allocated to Contracting Units for Primary Care annually on a population basis. According to the WHO, 65% of Thailand's health care expenditure in 2004 came from the government, 35% was from private sources
    • The then Public Health Minister, Mongkol Na Songkhla, abolished the 30 baht co-payment and made the UC scheme free.


  • Misc facts
    • Rate of growth of per capita food production:
    • 85% have access to potable water
    • 99% have access to sanitation


Health Facts

  • Life expectancy: 69:75
  • Mortality before age of 5: 8/1000
  • Rank of health care systems: 156/191 (WHO 2000)
  • Prevalent diseases: HIV/AIDS, H5N1 (avian), bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies, and leptospirosis.
  • HIV/AIDS: Full governmental support on antiretroviral treatment.


Problems

China

Wikipedia

Health care

  • Total health care expenditure: 4.5% GDP
    • Per capita total expenditure: 345 USD
  • General structure: 3 tiered
  • The low 2 tiers make up rural collective health system that provide most the country's medical care.
    • barefoot doctors at village medical centers: preventive and primary care services (2/1000 pts)
    • assistant doctors at outpatient clinics in township health centers (10,000-30,000 pts/center)
    • senior doctors at county hospitals (3rd and 4th tiers)
    • paramedical personnels in urban areas in factories and neighborhood health stations
    • professional care at district hospitals

- To ensure a higher level of care, a number of state enterprises and government agencies sent their employees directly to district or municipal hospitals, circumventing the paramedical, or barefoot doctor, stage.

  • Insurance: The New Rural Co-operative Medical Care System (NRCMCS)
    • is a new 2005 initiative to overhaul the health care system, particularly intended to make it more affordable for the rural poor.
    • the annual cost of medical cover is 50 yuan (US$7) per person. Of that, 20 yuan is paid in by the central government, 20 yuan by the provincial government and a contribution of 10 yuan is made by the patient.
    • As of September 2007, around 80% of the whole rural population of China had signed up (about 685 million people).
    • The system is tiered, depending on the location.
    • A small hospital or clinic in their local town: the scheme covers 70-80% of their bill.
    • A county one: about 60%.
    • Specialist help in a large modern city hospital: about 30%
  • Misc facts
    • Rate of growth of per capita food production:

Health Facts

  • Life expectancy (M/F): 72/75
  • Mortality before age of 5: 24
  • Rank of health care systems: 144/191 (WHO 2000)
  • Prevalent diseases: Chronic diseases
  • HIV/AIDS:


Problems

  • A system that keeps basic wages low, but allows doctors to make money from prescriptions and investigations, leads to perverse incentives and inefficiency at all levels.
  • As in many other countries, to develop systems of health insurance and community financing which will allow coverage for most people is a huge challenge when the population is aging and treatments are becoming more sophisticated and expensive. Several different models (i.e. Basic Health Services Project 1998-2007) have been developed across the country to attempt to address the problems.

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Indonesia

WHO Indonesian Health System

Health care

  • Total health care expenditure (2006): 2.2 % GDP
    • Per capita total expenditure (2006): 87 USD
  • General structure:
    • three-tiered system of community health centers
    • public : private = 3:1
    • Each sub-district in Indonesia has at least one health centre headed by a doctor, usually supported by two or three sub-centres, the majority of which are headed by nurses.
    • Health centres mainly provide eight programs.
    • Most of the health centres are equipped with four-wheel drive vehicles or motorboats to serve as mobile health centres and provide services to underserved populations in urban and remote rural areas.
    • At the village level, the integrated Family Health Post provides preventive and promotive services.
    • These health posts are established and managed by the community with the assistance of health canter staff. To improve maternal and child health, midwives are being deployed to the villages.
  • Insurance:
  • Misc facts
    • Rate of growth of per capita food production:
    • Physician : Patients = 16 : 100,000


Health Facts

  • Life expectancy (M/F): 66/69
  • Mortality before age of 5: 34/1000
  • Rank of health care systems: 92/191 (WHO 2000)
  • Prevalent diseases: HIV/AIDS dengue fever, dengue haemorrhagic fever (DHF) and avian influenza.
  • HIV/AIDS:

Problems

Malaysia

Health care

  • Total health care expenditure: 4.3% GDP
    • Per capita total expenditure: 500 USD
  • General structure: private and public
    • Doctors are required to perform 3 years of service with public hospitals throughout the nation, ensuring adequate coverage of medical needs for the general population.
    • Foreign doctors are encouraged to apply for employment in Malaysia, especially if they are qualified to a higher level.
    • With a rising and aging population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of telehealth.
    • Over the last couple of years they have increased their efforts to overhaul the systems and attract more foreign investment.


  • Insurance:
  • Misc facts

Health Facts

  • Life expectancy (m/f): 69/74
  • Healthy life expectancy at birth m/f (2003): 62/65
  • Mortality before age of 5: 12/1000
  • Rank of health care systems: 49/191 (WHO 2000)
  • Prevalent diseases:
  • HIV/AIDS:

Problems

  • There is still a shortage in the medical workforce, especially of highly trained specialists. As a result certain medical care and treatment is available only in large cities.
  • Recent efforts to bring many facilities to other towns have been hampered by lack of expertise to run the available equipment made ready by investments.
  • The majority of private hospital facilities are in urban areas and, unlike many of the public hospitals, are equipped with the latest diagnostic and imaging facilities


Costa Rica

Costa Rica Health Care

Health care

  • Total health care expenditure: 7% GDP
    • Per capita total expenditure: 743 USD
  • General structure:
    • universal health care to its citizens and permanent residents.
  • Insurance:
    • Caja Costarricense de Seguro Social (Public health care)
    • Private Insurance
    • Many drugs are provided without prescription as pharmacists can diagnose things.
  • Misc facts
    • One of mdical tourism destination sites because of low cost medical care.


Health Facts

  • Life expectancy (M/F): 76/80
  • Mortality before age of 5: 12/1000
  • Rank of health care systems: 36/191 (WHO 2000)
  • Prevalent diseases:
  • HIV/AIDS:

Problems


Reference Countries

Japan

  • Total population: 127 million
  • PPP: 32,840
  • Life expectancy at birth m/f: 79/86
  • Healthy life expectancy at birth m/f (years, 2003): 72/78
  • Probability of dying under five (per 1 000 live births): 4
  • Total expenditure on health per capita: 2,514
  • Total expenditure on health as % of GDP: 7.9
  • Median Age: 42
  • HIV/AIDS: <0.1% (2003)
  • Total Fertility Rate: 1.21/woman (2009)

U.S.

  • Total population: 302 million
  • PPP: 44,070
  • Life expectancy at birth m/f: 75/80
  • Healthy life expectancy at birth m/f (years, 2003): 67/71
  • Probability of dying under five (per 1 000 live births): 8
  • Total expenditure on health per capita: 6,714
  • Total expenditure on health as % of GDP: 15.3
  • Median Age: 36.7
  • HIV/AIDS: 0.6% (2007)
  • Total Fetility Rate: 2.05%

(2006 unless indicated. Source: WHO 2008)