As with all technical areas there is a language used by people in that field which can be difficult for others to understand. In healthcare financing the terms come from a combination of health economics, health policy, social security and actuarial science. This is a growing document and it will be expanded during the course of the policy brief series as needed. The IMSA NHI glossary is organised into subject areas and related concepts are defined together.
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A measure of the proportion of a population that reaches appropriate health services.
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Access includes the ability of a sick person to gain entree to the system in order to establish a diagnosis and plan therapy. It then also includes the ability to move between differing levels of the system i.e. from primary care to specialist or even highly specialised care. Access is a function of many combined factors including funding policy, service capacity and structure, and management. It is the ability of the system to provide sufficient supply of services to meet the demand (suggested definition)
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- Financial accessibility measures the extent to which people are able to pay for care, usually measured through a community-based willingness and ability to pay survey.
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- Geographical Accessibility
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- Geographical accessibility measures the extent to which services are available and accessible to the population. It is, of course, linked to the distribution of infrastructure in a given region but also to the actual offering of these services at these facilities. Geographical accessibility will vary according to local means of transportation, as well as the local topography.
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- Cultural accessibility considers whether access to health services is impeded by cultural taboos. Three examples are provided: (i) can women use reproductive health services if all the physicians in the facility are male? (ii) will persons who belong to an ethnic minority use services that are staffed by the majority population? (iii) will persons use health services for processes that are considered natural, that is without the need for health intervention such as pregnancy?.
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- Universal access to Healthcare
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- Universal access to healthcare refers to all people having an equal opportunity to gain entry to a quality accredited health facility for diagnosis and therapy, regardless of their socio-economic class and ability to pay, ethnicity or physical disability. Accessibility includes not being obstructed by issues of transportation and affordability (suggested definition).
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- Universal coverage with the health care insurance function may be defined as physical and financial access to necessary health care of good quality for all persons in a society.
- Universal coverage includes access to an appropriate health care facility of good quality for all at an affordable cost regardless of socio- economic class, ethnicity or physical disability (alternative definition).
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- Coverage encompasses the extent to which a basket of defined services is available to people through cost sharing and cross-subsidisation.
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- Efficiency in health can be defined as “the extent to which objectives are achieved by minimising the use of resources.
- There are many specific uses of the word “efficiency” in health economics, including:
- Technical efficiency - producing the maximum possible sustained output from a given set of inputs
- Productive efficiency - health outcomes (outputs) cannot be produced at a lower cost without compromising on quality gains
- Social efficiency - no person can be made better off without making someone else worse off
- Macro-economic efficiency - containment of rising cost of care (includes financial sustainability).
- Micro-economic efficiency - efficiency in the production of care.
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- Equity in healthcare is about fairness and justice in the distribution of costs, benefits and opportunities in the health sector. Equity is therefore an ethical and subjective concept. Consequently, there are varied views on what equity in the health sector means. Nevertheless, the dominant perspective on equity is that “everyone should have equal opportunities to maximise their health status (irrespective of socio-economic, demographic and geographic characteristics of different individuals/groups within the population). Accordingly, the incidence of health care financing should be distributed according to ability to pay, and benefits should be distributed according to need. This view (referred to as the egalitarian perspective) has been the guiding principles for many health systems in recent years and is the basis for the definitions below.
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- Equity in health financing
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- Also termed “fair financing”. This is the case where wealthier groups contribute a greater proportion of their income to the overall financing of the healthcare than poorer groups. Equity in health care financing also advocates for the protection for the poor from catastrophic health care expenditure.
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- Equity in resource allocation
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- Resources for healthcare (clinics, human resources, hospitals, budgets) should be distributed in such a way that gives greater preference to those that have a greater need for healthcare (most vulnerable - poorer, those with greater disease burden etc.).
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- “Equal treatment for equal needs”. This implies that the health care system should deal with two individuals with the same health needs in the same way.
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- The “unequal but equitable treatment of unequals”. This implies that those with different needs for health care should be treated differently, according to the extent of need.
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- The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Quality is a perceptual, conditional and subjective attribute relating to a product or service. Quality in healthcare includes the delivery of safe care that is consistent with current medical knowledge and customer-specific values and expectations.
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- Responsiveness in healthcare
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- The WHO has defined several dimensions of responsiveness. These are: autonomy; information; confidentiality; dignity; prompt attention; quality of basic care; access to social support network; and choice of providers. Responsiveness reflects the individual’s actual experience with a health system. The fundamental goals of a health care system therefore can be expected to improve health outcomes and respond to the legitimate expectations of a population.
- There are certain prerequisites which are required for a system to achieve its goals. These include:
- Ensuring that there are adequate financial resources; trained staff; appropriate facilities, equipment; and pharmaceuticals.
- The appropriate allocation and utilisation of resources
- Regulatory framework ensuring stakeholder participation, and relationship management
- Infrastructure for continuous monitoring and evaluation and clinical governance.
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Sustainability of the health sector refers to the ability of the health system (based on its organization, financing mechanism, structure, etc) to adequately generate resources for the provision of good quality health care today and in the future. Implicit in this is the ability of the health system to change with the changing needs of the population that is served.
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Sustainable development is defined as development which bequeaths to future generations an opportunity set for human welfare equal to or greater than that enjoyed by the current generation.
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