PHC Business at whose Cost Koustuv Dalal Ph

PHC & Business: at whose Cost? Koustuv Dalal, Ph. D Director, Centre for Injury Prevention and Safety Pomotion, A WHO CCCSP Strategic Centre Örebro University, SWEDEN Koustuv. dalal@oru. se

Health as economic goods Demand for health consists of two simultaneous choices: (1) Consumption: health yields direct utility (satisfaction) i. e. you feel better when you are healthier (2) Investment: health increases the number of days available to participate in market and non-market activities – the novel bit of the model Total Time = 365 days = T H (Improving Health) + TB (Producing Home goods) + TL (Loss for illness) Leisure + TW (Work) koustuv. dalal@oru. se

Investing in health INPUTS Health Care Diet Exercise Environment Income Time P R O D U C T I O N OUTPUT P R O C E S S HEALTHY DAYS STOCK Physical Mental Limited activity koustuv. dalal@oru. se

Life Children 20 40 -45 Productive age Older Peoples years > 20 Society Economic Burden koustuv. dalal@oru. se Unhealthy Peoples Elderly

Major Healthcare Financing Models Model National Health Service Revenue Source Groups Covered Care Provision Finance General revenues Every one Public providers Central government Social Health Insurance Taxes from payroll Specific groups Own, public, or private facilities Communitybased Health Insurance Private, voluntary contributions Contributing members NGOs or private Non-profit plans facilities Voluntary Health Private Insurance voluntary contributions Contributing members Private and public facilities Out-of-Pocket Payments Individual payments to Public and private facilities Semiautonomous organizations For- profit and non-profit insurance organizations

Experience from SWEDEN after privatization of management (service paid by public money) • Shortage of physicians • High mobility of physicians • Over phone screening by nurses • Delay-dealing • Long waiting time => Most importantly over-use of over-the-counter drugs (paracetamol, pain-killers, vitamins etc)

Kazakhstan economy is in transition Population health is very important for steady economic growth. Business in healthcare has detrimental effects of population health (inequality) Do you think my Kazakh sisters and brothers are ready to accept such healthcare challenges?