GRID

"Flee fornication. Every sin that a man doeth is without the body; but he that committeth fornication sinneth against his own body." - 1 Corinthians 6:18 (King James Version)

In 1980, there was an increase of the occurrence of Kaposi's Sarcoma and fungal pneumonia among gay people in major cities in US, and since these diseases are common among immuno-compromise patients, they (doctors) named the disease as Gay Related Immune Deficiency (GRID). The name itself caused a major chaos among religion community, many preachers used this passage (1 Corinthians 6:18) condemning gay people and their lifestyle stating that this disease is the wrath from the Creator. But now we know better, for whatever reason that GRID a gay disease from God actually can  also infects straight people (how come?). Not until 1982 a proper name for this abomination was proposed; Acquired Immune Deficiency Syndrome (AIDS) and the probable cause of this disease had discovered, a retrovirus which now commonly known as Human Immunodeficiency Virus (HIV). This picture below is 10 facts on HIV/AIDS that we should all know from WHO website.

When discussing about HIV/AIDS, there's not much that i know about. One program i know that is implemented in Indonesia called Prevention of Mother-to-Child Transmission (PMTCT) which is very important in preventing HIV/AIDS pandemic situation. I remember when browsing about PMTCT in the net, there's even people asking regarding how-about a child can get HIV, since s/he is not having sex at all. This really shows that there's people that are still ignorance bout this and the awareness about knowledge about HIV/AIDS vertical transmission is still minimum. In fact, it's a common myth and believe that HIV women can't get pregnant, and they will die young. This myth is a total bullshit and I believe that not all of us know the fact that a HIV positive woman can get up to 98% of chance in having a completely health child. True story!! I'm not bullshitting you some more. Mother to child transmission risk can be reduced to 2% with 3 essential steps:

• Antiretroviral administration
• elective caesrean section
• non-breast feeding

As a conclusion, I encourage we all to support World AIDS Day campaign on December 1st of every year to increase the community awareness and showing that we care and want to help preventing and curing this disease, HIV and AIDS. In contrast to pink ribbon used in breast cancer awareness campaign, World AIDS Day uses red ribbons as a symbol that we are aware of HIV/AIDS health burden. Here is a short video ads regarding this campaign and this year 2010 themes of World AIDS Day : Universal Access and Human Rights

Shed me some light...

 

Since I haven’t enrolled in any lectures regarding this topic, I really don’t know what to write in this entry, hence the title: shed me some light. I would like to discuss about two organizations that are responsible in monitoring and making the enquiry about the health surveillance.

 One surveillance system is under the well-known health organization; WHO, to be specific, the department of communicable disease and surveillance response (CSR). This department; CSR have an integrated global and alert system for any public health emergency in case of new emergence diseases or even the current health problems in the world population. This system is called as Global Alert and Response or in short GAR have several core functions which basically functions as to increase readiness and preparedness in facing an epidemic or pandemic situation by strengthening the biorisk reduction and the global operational platform to support outbreak response. In order to achieve the missions of GAR, CSR also created a global network of institutions; Global Outbreak Alert andResponse Network (GOARN) which act as the outreach programme for GAR to cover the world’s population. The video above is a short clip from the WHO webpage explaining about the aims of GROAN network formation. GAR covers a wide range of diseases listed from Anthrax to Yellow fever but this list is growing as new emergence disease occurs around the world

Second organization that can involve in the health surveillance monitoring system is from ex-US World War II Malaria commission which is founded by Rockefeller Foundation. Nowadays, with the name of Centers for Disease Control and Prevention (CDC), it also has some sort of surveillance system. Under health and safety topics, there’s Emergency Preparedness and Response subtopic which covers several specific hazards and since this organization has a military root, it also focus on bioterrorism, chemical and radiation emergencies and any mass casualty caused by explosions or blasts. However, CDC also takes interest in recent outbreaks and incidents. CDC also provide some guideline for every human force that can be involved in any emergency situation including guidelines for health care facilities in preparation and planning in adapting guidance for health care professional in facing disasters, pandemic, bioterrorism and so on.

As a whole, from these two organizations which are responsible to perform the health surveillance, it’s also important that all health care professional take part in the network of recording and reporting system so that all health incidents can be monitored and in case any of future occurrence of the same incident, it can be prevented and if unsuccessful we can at least prepared and ready for it.

Back to Basics

Merriam-Webster Open Dictionary

sur·veil·lance \sər-ˈvā-lən(t)s also -ˈvāl-yən(t)s or -ˈvā-ən(t)s\ 

noun 

Definition

: Close watch kept over someone or something (as by a detective); also : supervision

Examples

Government surveillance of suspected terrorists

The bank robbery was recorded by surveillance video cameras.

dis·ease \di-ˈzēz\ 

noun

Definition

1.      obsolete : trouble

2.      : a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms : sickness, malady

3.      : a harmful development (as in a social institution)

— dis·eased adjective

Examples

He suffers from a rare genetic disease.

A disease of the mind

Thousands die of heart disease each year.

Medical Definition

: an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors : sickness, illness—called also morbus; compare health  

—dis·eased adjective

com·mu·ni·ca·ble \kə-ˈmyü-ni-kə-bəl\

adj

Definition 

1. capable of being communicated : transmittable <communicable diseases>
2. : communicative <prove myself a gentleman, by being … virtuous and communicable — Izaac Walton>

— com·mu·ni·ca·bil·i·ty noun

— com·mu·ni·ca·ble·ness noun

— com·mu·ni·ca·bly adverb

Examples

1. <communicable diseases that are usually transmitted sexually>

Related

Synonyms: catching, contagious, pestilent, transmissible, transmittable

Antonyms: noncommunicable

Medical Definition

: capable of being transmitted from person to person, animal to animal, animal to human, or human to animal : transmissible

—com·mu·ni·ca·bil·i·ty noun, plural com·mu·ni·ca·bil·i·ties

non·com·mu·ni·ca·ble \-kə-ˈmyü-ni-kə-bəl\

adj

Definition

: Not capable of being communicated; specifically : not transmissible by direct contact <a noncommunicable disease>

communicable disease

noun

Definition

: An infectious disease transmissible (as from person to person) by direct contact with an affected individual or the individual's discharges or by indirect means (as by a vector)—compare contagious disease

out·break \ˈau̇t-ˌbrāk\

noun

Definition

1.      a : a sudden or violent increase in activity or currency <the outbreak of war> b : a sudden rise in the incidence of a disease <an outbreak of measles> c : a sudden increase in numbers of a harmful organism and especially an insect within a particular area <an outbreak of locusts>

2.      : insurrection, revolt

Examples

<There was an immediate outbreak of paper shuffling and a pretense of work when the supervisor passed through the room>

<The government quelled the outbreak with ruthless efficiency>

en·dem·ic \en-ˈdem-ik, in-\

adj

Definition

: Restricted or peculiar to a locality or region <endemic diseases> <an endemic species>—compare epidemic , sporadic

—en·dem·i·cal·ly adverb

noun

Definition

1.      : an endemic disease or an instance of its occurrence

2.      : an endemic organism

spo·rad·ic \spə-ˈrad-ik\

adj

Definition

1.      : occurring occasionally, singly, or in scattered instances <sporadic diseases>—compare endemic, epidemic

2.      : arising or occurring randomly with no known cause <sporadic Creutzfeldt-Jakob disease>

—spo·rad·i·cal·ly adverb

ep·i·dem·ic \ˌep-ə-ˈdem-ik\

adj

Definition

1.      : affecting or tending to affect an atypically large number of individuals within a population, community, or region at the same time <typhoid was epidemic>—compare endemic, sporadic

2.      : of, relating to, or constituting an epidemic <coronary disease…has hit epidemic proportions—Herbert Ratner>

—ep·i·dem·i·cal·ly adverb

noun

Definition

1.      : an outbreak of epidemic disease

2.      : a natural population (as of insects) suddenly and greatly enlarge

pan·dem·ic \pan-ˈdem-ik\

adj

Definition

: occurring over a wide geographic area and affecting an exceptionally high proportion of the population <pandemic malaria> <pandemic influenza>

noun

Definition

: A pandemic outbreak of a disease

Quality Control

The previous post [Payment Mechanism] explains about the income source of a GP, and based on Forbes Magazine, health care professionals are among the highest paid occupation in US according to the data released by US Department of Labour in Occupational Employment and Wage Estimates, May 2009. This statistic puts surgeon as the highest paid occupation with anesthesiologist in the second notch of the list. With this condition, how the health system can manage the quality of care given to the patient by their doctors?

For this, several country have take some action in manipulating the GP salary so that GP performance quality is maintain to its maximum. UK is a country which pay their GP by monthly salary, but there is a new system called quality incentive which will be paid to the contracted GP according to the pay-for-performance mechanisms. In a paper written by Peter C. Smith and Nick York entitle Quality Incentive: The Case of UK General Practitioners stated that traditionally  GP income come from a mix of remuneration methods, including fee-for-service, capitation, salary, and capital and information technology (IT) but starting in April 2004 quality incentive will contribute up to 13% of the UK GP's income. The new incentive scheme uses 146 indicators of quality across seven areas of practice from clinical quality, practice organization to patient experience. UK government trying to accomplish a better quality control with better health status result at the patient's end.

Other than that, insurance company also can take action in maintaining the health care quality by putting a guideline to their contracted GP to perform clinical care accordingly and does not perform unnecessary procedure to the patient. This is called manage care and each insurance company has their own group of elite doctors in manage care which will assess the care given to that company's policyholder. Insurance company usually also give a list of essential drugs which can be prescribed to patient covered by that company. here it will help the patient from receiving unnecessary expensive drug where as cheaper yet same efficacy is available in the market.

Lastly, some hospital has their own committee that perform clinical audit to ensure that clinical care is done according to the latest evidence-based medicine and patient health care is handled correctly. This committee usually represented by the senior doctors in that practice. They are responsible to set the standard and collect the data from the current patient management in that practice, so that they can improve which area that need to be improved.

Payment Mechanism

All of us need and love money, it is essential and inevitable for living. That is why this blog is discussing about money yet again. First and foremost payment mechanism for a General Practitioner (GP) is monthly salary paid by the employers to the employees. Both public and private frequently used this same method to pay their employee and the only different is the total of renumeration earned by the GPs. Malaysia and Indonesia both pay their GP with salary, from the tax revenue, but the total income of GP in both country can widely vary. Indonesia GPs can earn unlimited allowance by working simultaneously in the private sectors, with limit of 3 different hospital allowed at a time. In contrary, Malaysia have limited allowances which mostly paid by the government to cover and compensate all the living expenditures and workload of a GP in Malaysia.  According to Suruhanjaya Perkhidmatan Awam (SPA) in Malaysia, the initial salary for a fresh graduated GP started from MYR 2458.39 and when sum up with all the allowances around give a total of MYR 4058.39 per month. This payment does not include the payment from the reimbursement for on call allowance and locum salary. From the news paper cut i read, on call allowance is at the rate of MYR150 per night and locum at the rate of MYR80 per hour.

Salary can be based on the GP contract with the employer, in this case; government because some countries use semi-negotiable salary to solve the "brain drain" of the GP to the big cities, private sector, and even overseas because of better renumeration and better living conditions. In Indonesia, semi-negotiable salary is used to attract more GP to work at the rural areas so they have an equal distribution of GP across the country. The payment is based on the degree of difficulty and rurality of the area. Some payment of salary is based on the capitation mechanism. The payment given to the GP is proportional to the amount of people under the responsibility of the GP, the more patients register under that GP, the more money that will be paid to that GP. This capitation payment can be used both government salary or payment reimbursement from health insurance for privileged GP.

Other payment mechanism to the GP is from the fee-for-service mechanism paid by the patient from out of pocket or from the insurance claims for medical services. Most people believe that this is the best way to maintain the quality of health care given by the GP because the amount of money they receive is totally depend on their patient satisfaction. It is just natural that a persons will try to give their best effort in delivering health care so that their patient pay their more. Happy patient means more money. There's another payment which is fundamentally derived from fee-for-service payment which is called as pay-for-performance (aka "P4P" or “value-based purchasing"). This payment mechanism gives incentive to the GP if there do well in treating their patient and preventive measures with a pre-established criteria and health indicators targets.

Moolah!!!

This is something that everyone crave for, including me.

Even health system craves for this.

We need this preferably in huge amount.

This is not a slang used by Malaysian to describe the sound of cows (moo lah).

We can rule the world with it, even cows.

Few years ago, a 2007 documentary film entitle Sicko by American filmmaker Micheal Moore was premiered which in investigate the health care system in US, focusing on its health insurance and the pharmaceutical industry. This movie really is an eye-opening documentary revealing about the truth condition of US health care, and basically the movie is trying to pursue a vision so that universal health care can be implemented in US. In US, moolah for health care comes from the health insurances. Most of health insurance in US is a commercial health insurance; a for-profit which requires the policyholder to pay premium to the insurance company. If you are not cover by any sort of health insurance, this is your only option. Since this is a for-profit health insurance, again, the only goal is to drain your moolah. Some even try to maintain the denial rate for medical claims because any claim is referred to as a medical loss.

Other type of health insurance is the non for-profit health insurance/social health insurance. This is what currently implemented in Indonesia. This type of health insurance is sometimes called as single-payer health insurance because the moolah paid to this insurance comes from the tax revenue. Social insurance can be public or private company; public company run by government paid by the government and private company paid by government but run by a non for-profit organization. However, most countries encourage their social insurance to have commercial insurance as well for those whom not covered by the social insurance. In this case, the premium will be paid by the policyholders themselves.

Moreover, most of the best health care systems ranked by WHO in their issue of The World Health Report 2000, Health System : Improving Performance use taxation as the source of moolah in health care. Allocation of taxation revenue moolah in the health care is widely used in Europe such as UK and France and Asia including Malaysia. UK and France a developed country, they are drowning by taxed paid by their citizen, therefore it is easier to allocate more money in health care and even educational fee. In Malaysia, health care system is operating in a two-tier health care; public and private sector. Moolah from tax revenue is only allocated to the public sector hospitals and private sector will earn their moolah from fee-for-service (out of pocket) and commercial insurance payments for health care services.

Moolah   =  Money

"Medicine is a business"

I read somewhere in the net where a German physician stating that, in his own words; "Medizin ist ein Geschäft". In plain English, it means that medicine is where a lot of money is and can be made or simply put medicine is a business. Part of me also believe that medicine is some sort of business where medicine can be seen in this business homologous:

Medicine Vs Business

Health system/governance <-> Company

Providers/care giver <-> Worker/human resources

Health care services/drug <-> Products/sales

Financing <-> Money

From this point of view, we actually can medicine can really works as a money with money oriented goal. If all health system in this world operate in such business-oriented mechanism, it will definitely will eliminate all of the true objectives[Tour d'horizon] of health system.  All that matters in business, is money, money and money. All health care services will be based on fee-for-service trade, which will generate even more money. Even in some conspiracy theory think that US are actually withholding cure for cancer to earn money from the pharmaceutical sales of chemotherapy which is used comprehensively in the treatment of most of cancers. Business-oriented health care system jeopardizes all the community health needs and reduces services delivery quality.

Hence, a well-structured and organized health care system need to be governed so that the latter situations will never happened. For this, we need great leadership can lead and governed health care system to reach its aims. It does not matter if a country decides to use either centralized or decentralized health system governance. Both of them have their own pros and cons.

"Decentralization does not mean a lack of accountability in resource management, nor that central government should opt out of planning and monitoring. It should be designed to increase accountability and should give central government and ministries a new role, focusing on overall regulation and monitoring." - Page 91 of The World Health Report 2000, Health System : Improving Performance

Secondly, provider and care givers is also an important input toward definitive health system. Human resources trainings will produces high quality medical and non medical staffs which will define the quality and effectiveness of care services given to the patients. These highly trained and skilled care provider also need to be distributed equally to all regions in order to the delivery of care reaching out to the community. All these can be easily achieved by leadership and well-governance health system.

Lastly, money. Apparently money is not that evil after all, money can be our friend instead of foe if we treat it cautiously.  We need money to run all the policies and technologies needed to achieve our goal. Financial status of a health system greatly determine the smooth running of all that have been mentioned here.

Tour d'horizon

Greeting fellow life forms,

First of all, I used to believe that blogging is a complete hokum but here I am, "blogging". The existence of this blog itself is actually surprises me. I used to read a blog written by a psychology student discussing about psycho-sexuality development and I learned a lot from that blog. It's a very systematic blog, and most of the posts are summarizing the content of a psychology textbook. So I hope this blog can be beneficial and educational too. In this blog, all posts are dedicated for block 4.2; i.e. this blog will discuss about what I learned from the learning materials about Health System and Disaster.

As the title says, goodness and fairness are the double-fold objectives of an effective and efficient health system apart from the improving health status of the community. Health status of the community can be measured by looking into the health indicators in the community that are established by World Health Organization (WHO). For the complete global health status indicators, it can be read in WHO's World Health Statistics (WHS) which is publish every year in WHO website by Global Health Observatory (GHO). These indicators include infant and child mortality (the probability of dying between birth and 1 and 5 years of age, respectively), adult mortality (the probability of dying between 15 and 60 years of age) and overall life expectancy at birth.

"Indicators derived from mortality rates provide a good picture of overall population health" - WHS 2009

The other objectives of good health itself goodness which means health system need to manage and optimize the quality of the health care delivery itself and fairness which expect the health care services to be served equally well to everyone, without discrimination. All these goals, can be achieved by having excellence policy in all key component of a well heath system (The World Health Report 2000, Health System : Improving Performance):

• Leadership and governance
• Health financing
• Human resources for health/providers
• Service delivery/consumer