International Health Care Management
Part 3b
Steffen Fleßa
Institute of Health Care Management
University of Greifswald
Supply of Health Services: Structure
1 International Public Health 2 Demand for Health Services 3 Supply of Health Services
3.1 Factors of Production
3.2 Spatial Structure of Supply 3.3 Levels of Care
3.4 Provider Portfolio 4 Health Reforms
2
3.3 Levels of Care
Health Care Pyramid
Village Health Workers, Traditional Midwives Dispensaries
Health Care Centers District Hospitals Regional Hospitals
Tertiary Hospitals
3.3 Levels of Care
Health Care Pyramid
Village Health Workers, Traditional Midwives Dispensaries
Health Care Centers District Hospitals Regional Hospitals
Tertiary Hospitals
4
3.3 Levels of Care
Health Care Pyramid
Village Health Workers, Traditional Midwives Dispensaries
Health Care Centers District Hospitals Regional Hospitals
Tertiary Hospitals
3.3 Levels of Care
Health Care Pyramid
Village Health Workers, Traditional Midwives Dispensaries
Health Care Centers District Hospitals Regional Hospitals
Tertiary Hospitals
6
Quality in Structure and Level of Care
Kenya Service Provision Assessment Survey (2004)
Quality in Structure
(Cost per outpatient visit in a private hospital, Kenya 2005)
52 5
57 8
78 4
83 5
86 4
98 2
1,01 6
1,02 4
1,17 0
1,37 6
1,38 4
1,60 7
1,75 0
1,94 1
2,17
1 2,17
3
2,58 7
2,60 0
3,23 0
3,42 7
4,01 1
4,21 8
1,43 2
- 50 0 1,00 0
1,50 0 2,00 0 2,50 0 3,00 0 3,50 0 4,00 0 4,50 0
Hospital Code
Cost per Out-patient Visit [Ksh]
Hospital Code 8
Quality in Structure
(
Cost per outpatient visit in a private hospital, Kenya 2005)52 5
57 8
78 4
83 5
86 4
98 2
1,01 6
1,02 4
1,17 0
1,37 6
1,38 4
1,60 7
1,75 0
1,94 1
2,17
1 2,17
3
2,58 7
2,60 0
3,23 0
3,42 7
4,01 1
4,21 8
1,43 2
- 50 0 1,00 0
1,50 0 2,00 0 2,50 0 3,00 0 3,50 0 4,00 0 4,50 0
There are private hospitals of low quality for the poorer!
There are also private hospitals of high quality for the rich!
Cost per Ambulance Visit [Ksh]
Cost per Admission 2007
(Kenya Costing Model)
Publ. Distr.
Hospital Publ. Prov.
Hospital
NGO. Distr.
Hospital
Priv. Distr.
Hospital
10
Cost per admission [Ksh]
Traditional Medicine
• Spiritual Background of Medicine
– disabilities and taboos
– Child mortality and fontanel
– Evil eye, protecting small children
– Cycle and reincarnation, „living dead“
• Forms of Traditional Healers
– Traditional midwives – Herbalists
– Traditional surgeons
Traditional Medicine
• Spiritual Background of Medicine
– disabilities and taboos
– Child mortality and fontanel
– Evil eye, protecting small children
– Cycle and reincarnation, „living dead“
• Forms of Traditional Healers
– Traditional midwives – Herbalists
– Traditional surgeons – Spiritual healers
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