Barriers to Health Care Assignment
Despite the economic growth and progress in health of the past decade, poverty and inequity within and among countries remain a challenge for the Region of the Americas. Some 29% of the Region’s population is still below the poverty line, and 40% receives less than 15% of total income, with marked differences among the countries (). The wealthiest 10% of the population receives 14 times the average income of the poorest 40% in Latin America and the Caribbean (LAC) (). Furthermore, an estimated 30% of the population has no access to health care for financial reasons, and 21% is kept from seeking by geographic barriers Barriers to Health Care Assignment
At the same time, exclusion and lack of access to quality services persist for large sectors of the population. The prevailing models of care, based more on hospital care for episodes of acute illness than on disease prevention and health promotion, often with excessive use of technologies and poor distribution of medical specialists, do not necessarily meet the health needs of individuals and communities. Investments to reform and improve health systems have not always been designed to deal with new challenges related largely to the demographic and epidemiological transition or the expectations of the population.
The result is a lack of universality and equity in access to quality services and appropriate coverage, which entails a substantial social cost and impoverishes the more vulnerable population groups. The evidence shows that when there are access barriers to services (whether economic, geographic, cultural, demographic, or other), a deterioration in health implies not only greater expenditure but a loss of income as well. The absence of mechanisms to protect against the financial risk of ill health creates and perpetuates a vicious cycle of disease and poverty. Barriers to Health Care Assignment
Inadequate financing and inefficient allocation and use of the available health care resources are major obstacles to progress toward equity and financial protection. Indeed, average public health expenditure in the Region of the Americas is around 4% of gross domestic product (GDP)–a very low level compared to the 8% allocated to this budget line by the countries of the Organization for Economic Co- operation and Development (OECD) (
). Direct payment (or out-of-pocket expenditure) at the point of service, the most inefficient and regressive form of financing, yields an unstable flow of financial resources and constitutes an access barrier that impedes or delays care and makes it more expensive for both patients and the system. Furthermore, it has a relatively greater impact on the poor, as even the smallest payment can represent a substantial portion of their budget. Only six countries in the Region of the Americas have direct expenditure levels of under 20% of total health expenditure, the figure that, according to the World Health Organization (WHO) protects their populations against the risk of impoverishing or catastrophic health expenditures.Barriers to Health Care Assignment
Efficient allocation of public expenditure is a prerequisite for reducing inequities. Implementing the people- and community-centered model of care requires greater efficiency through the priority allocation of new resources to the first level of care and networks to increase the availability of quality services and speedily address unmet health needs. A series of mechanisms must be implemented simultaneously to transform the model of care and the health services structure. Particularly important are payment systems that foster integrated care and the continuity of care
The segmentation and fragmentation that characterize the majority of the Region’s health systems give rise to inequities and inefficiencies that compromise universal access, quality, and financing. Weak health system regulatory capacity, excessive vertical in some public health programs, lack of integrated service delivery, and, occasionally, union pressure to protect privileges and lack of political will to make the necessary changes exacerbate and perpetuate this problem. Barriers to Health Care Assignment
The strategy for universal access to health and universal health coverage of the Pan American Health Organization (PAHO) redefined the concept of coverage and access to health and stressed the values of solidarity, equity, and the right to health; it also recognized financing as a necessary, though insufficient, factor in reducing inequities and increasing financial protection for the population. The core value in the strategy’s definition of “access,” embraced as a priority for society as a whole, is “the right to health,” which requires adequate, allocated, and efficiently managed financing. This vision stands in sharp contrast to the traditional view, in which access depended on an individual’s and household’s ability to pay and went hand in hand with the proposals to adopt direct payments and the promotion of policies that had led to the fragmentation of health systems in previous decades. At the same time, the strategy acknowledges the need to foster the necessary changes through political and social action that puts health squarely at the center of the policy agenda.Barriers to Health Care Assignment
Strategic Line 3 of the PAHO strategy proposes “Increasing and improving financing, with equity and efficiency, and advancing toward the elimination of direct payment that constitutes barrier to access at the point of service.” Three interrelated lines of action flow from this:
- Increase financial protection by eliminating direct payment, which constitutes an access barrier, thus preventing exposure to catastrophic expenditures or those that lead to or exacerbate poverty. The replacement of direct payment as a financial mechanism should be planned and progressively achieved through prepaid pooling mechanisms, using sources of funding that guarantee their stability and sustainability.
- Increase public health expenditure to the benchmark of 6% of GDP, which implies a commitment by society as a whole to increase the fiscal space reserved for health in terms of new public sources of financing, with the search for equity as the main objective. Barriers to Health Care Assignment
- Boost efficiency in the health system by adopting a series of measures that specifically impact its financing and organization, such as aligning payment mechanisms with health system objectives and rationalizing the introduction of new medicines and other technologies that contribute significantly to rising health expenditures.Barriers to Health Care Assignment
This chapter is a response to the need for an extensive overview of the health system financing situation in the countries of the Region and the challenges they face. Following this introduction, which outlines the theoretical framework in relation to PAHO’s current regional strategy and its financial scope, health financing in the Region will be examined in a conceptual and descriptive section, with special attention to financial protection. The third and final section completes the analysis and describes the immediate challenges facing the countries in terms of the need to equitably and efficiently increase financing.
Without good health, it’s difficult to enjoy the rest of what life has to offer. That’s why keeping yourself healthy or getting healthier should be one of your top priorities. However, not all of us are able to access healthcare effectively. It largely depends on where we live and who we are.
This lesson will explore a few of the barriers to effective healthcare services and offer possible solutions for each barrier.
Physical and Psychological Barriers
Barbara is an elderly woman in her 80s. She no longer has good mobility and thus has a physical barrier to getting proper healthcare. She finds it difficult to get out of the house and also cannot drive a car. In order to access the healthcare she needs, she might consider living in an assisted living community, where she can be helped by staff members or be transported to a local clinic or hospital. An assisted living community may have doctors who can come to Barbara if she has trouble leaving her home. If she doesn’t want to live in such a community, Barbara can employ the likes of specialized transportation services that help eligible individuals get from point A to point B. They’ll come to her home, pick her up, and drop her off as needed. Barriers to Health Care Assignment
Living next door to Barbara is a man named Jack. Jack has a psychological disorder. Part of his disorder includes significant anxiety, so he finds it difficult to be in the outer world in general, let alone go to a clinic or a hospital. Oftentimes, people with psychological disorders believe they will look weak if they admit to having a disorder and seek help to address it. This is yet another barrier to effectively accessing healthcare services.
In Jack’s case, he can be counseled at home while he works on improving his ability to venture outdoors. And society in general can help people like Jack overcome feelings of shame or ridicule through education. Communities can band together to create everything from information sessions to public campaigns that explain to the public how psychological disorders are real diseases that need to be treated.
Barriers and Resources
Another big barrier to healthcare involves resources, such as financial resources. For people with high-deductible health plans or those living in countries where they need to pay for healthcare out of pocket, the issue of money is a very real one. These people may want to get treatment, and may be able to access a hospital or clinic, but they will not have the means by which to pay for healthcare services. The solutions to this problem are varied and depend upon the specific country in question. Solutions can range from providing tax credits to low income families (so they can afford insurance premiums) to creating a universal healthcare system. Barriers to Health Care Assignment
Other resource-based barriers to accessing healthcare include the inability of a clinic or hospital to gather enough supplies to deliver proper medical treatment. This is commonly the case in some developing nations; even if people can pay for their medical care, they simply may not have access to good healthcare. Solutions to this problem often involve non-governmental organizations (NGOs) providing medications and medical expertise in places where supplies and expertise are lacking. Governments also provide financial assistance to impoverished nations and their people through foreign aid programs. Community health centers and low-cost clinics, like those found in a local pharmacy, are another way by which people can avoid high medical costs, including copay or visitation fees.
Barriers to access of health services
Life for women and girls living in low-income urban settlements is characterized by exclusion, and this is reflected in poor access to basic health care and services. The thematic review and several case studies observed women’s poor access to appropriate, efficient and confidential health services. In some cases, it was a physical lack of access – health-care services were scarce, difficult to get to, or inappropriate. In Shillong, India, research revealed little SRH service provision in the low-income urban settlements. Similarly, in Kibera and Majengo, Nairobi, women and health-care workers reported a lack of HIV-related health services, stock-outs of essential drugs and faulty equipment, leading to time-consuming referrals. Barriers to Health Care Assignment
Even where health services are available and physically accessible, poverty in various forms can hinder women’s and girls’ access. Income poverty can make health care prohibitive. For example, in Shillong, India, despite the close proximity of urban health centers, some women reported that out-of-pocket expenses put them off seeking health care for themselves.
Time-poverty can also be a barrier to access. In Khayelitsha, South Africa, prior to the implementation of a community-based intervention to address the burden of NCDs, people would lose a day’s work due to waiting at the clinics all day. One of the successes of the intervention was that Community Health Workers (CHWs) provided services to the community, allowing people to access services in a more timely fashion.
Lack of patient confidentiality and absence of political will also affected access to services. Some women in Kibera and Majengo did not feel that health-care workers respected confidentiality, which prevented them from accessing HIV-related services. Additionally, it was found that ensuring access to and quality of health services was not a priority for some county-level policymakers, who felt it was not their role.
Innovative new products can and do transform industries every day, and the pace of change has accelerated due to massive technological breakthroughs such as the internet, smartphones and wireless technology. But when it comes to innovation, not all industries are created equal.
The healthcare sector is highly complex, and the medical care delivery ecosystem is under increasing pressures due to rising costs and patient expectations. These pressures and the inherent nature of the industry itself make innovation in healthcare more complicated than in the consumer products sector.Barriers to Health Care Assignment
To break through the complexity and move innovation in medicine forward, inventors and product research and manufacturing companies must first overcome the many barriers to healthcare product development. Here are 10 of the top barriers healthcare innovators regularly face.
1. Medical efficacy review
To be successful, a new healthcare innovation must improve upon the current standard of medical care without causing harm to the patient and ideally lower costs simultaneously. But gaining access to medical professionals with the appropriate specialized expertise to determine medical efficacy can pose a major obstacle to even the largest, most established companies, not to mention the individual inventor. The diverse sets of clinical expertise necessary to review projects are rarely found in-house and can be expensive to purchase from outsiders.
2. Product distribution
Unlike consumer products, healthcare products are distributed through a more complex supply chain that involves multiple parties, including medical device manufacturers and distributors, the NHS purchasing and supply agency, physicians and nurses who provide the product to the end user, and the patient, who generally has no input on product or pricing considerations. Determining how best to break into this elaborate network can be daunting, if not truly insurmountable for inventors.
3. Manufacturer access
Gaining access to quality manufacturers is a major hurdle for many healthcare inventors because of concerns that manufacturers have about “intellectual property contamination” issues. In this scenario, manufacturers avoid learning about an individual inventor’s idea since it may be too similar to an innovation their internal research and development team is already working on; manufacturers do not want to run the risk of having to later prove to the inventor (or to a judge) that the idea was not stolen.
4. Lack of access to NHS purchasing data
Even large, well-connected medical manufacturing companies may find it difficult to access purchasing and product needs data and input from NHS. And operating in the absence of this information makes accurately estimating product adoption rates and potential market size virtually impossible.
5. Regulatory oversight
While it’s necessary to enforce strict guidelines on healthcare product manufacture and distribution to prevent incompetent or unscrupulous suppliers from harming patients, the EU regulatory environment slows the innovation process considerably.Barriers to Health Care Assignment
6. Intellectual property complexity
Intellectual property rights have always been a confusing aspect of the inventing process for the majority of individual inventors. It can be virtually impossible to navigate without professional help.
7. Healthcare culture
By nature and for good reason, the healthcare industry is incredibly risk averse. As one doctor said: “The moment we step into medical school, we are trained to identify the most statistically proven method for treating a particular disease, and we are taught to not deviate from that path until a better method has been found and proven.” Compounding this issue is the fact that the majority of healthcare workers are increasingly time-pressed today, and so learning and adopting new systems, new methods of care or new devices often take a backseat to day-to-day patient care.
8. High-stress environment
Healthcare workers have high-stress jobs and often work long hours. They are dedicated to delivering great patient care, but the nature of the job can make it difficult for innovative thinking to flourish, since creativity naturally diminishes when an individual is in steady “fight or flight mode”.Barriers to Health Care Assignment
9. Complex value analysis model
In the healthcare sector, it is difficult for a product developer or individual inventor to generate data on how the product affects not only direct treatment but also the downstream healthcare supply chain, which means that determining the true value of a new innovation idea is difficult.
10. Misconceptions about what constitutes innovation
Within healthcare, those traditionally tasked with product development (ie engineers and technical experts) are generally not the same people who are actually living with or treating a particular healthcare challenge.
As this list demonstrates, there are numerous and significant barriers to healthcare innovation, but there are also common themes throughout: an industry that is evolving rapidly and a lack of centralized expertise that skews perspectives and limits resources. Consumer product inventors face many daunting challenges, but the institutional, industrial and knowledge barriers that confront innovators in the healthcare field are unique.
To truly optimize healthcare innovation, individual inventors and companies must find a way to overcome these barriers. A successful collaboration among all parties – manufacturers, providers, the NHS and patients – is critical.
Everyone who has a role in the healthcare delivery process and the influence necessary to bring about change must be invited to play a part, since only by combining each party’s respective strengths through collaboration can we overcome these hurdles and begin to deliver truly exceptional healthcare.Barriers to Health Care Assignment