International Healthcare Management Education

Daniel J. West, Jr., Ph.D., FACHE, FACMPE Professor and Chairman

Department of Health Administration & Human Resources Panuska College of Professional Studies

University of Scranton

Gary Filerman, Ph.D. Senior Vice President Atlas Research, LLC

Bernardo Ramirez, MD, MBA Assistant Professor

College of Health and Public Affairs Department of Health Professions

University of Central Florida

Jill Steinkogler, MHSA Senior Consultant

Atlas Research, LLC

CAHME

ACKNOWLEDGEMENTS This study was made possible through a grant from the ARAMARK Charitable Fund at the Vanguard Charitable Endowment Program. Additional contributions were received from the University of Scranton, Department of Health Administration and Human Resources and Atlas Research, LLC.

CONTENTS

ACKNOWLEDGEMENTS .................................................................................................................. 2 INTRODUCTION .............................................................................................................................. 5 OVERVIEW OF THE STUDY ............................................................................................................. 6 

Domestic Methodology ................................................................................................................ 8 International Methodology .......................................................................................................... 9 

The University Survey ............................................................................................................................. 9 

The Survey of Informed Leaders .......................................................................................................... 10 

SURVEY FINDINGS AND OBSERVATIONS..................................................................................... 11 Domestic ..................................................................................................................................... 11 

Overview ............................................................................................................................................. 11 

Limitations ............................................................................................................................................ 11 

CAHME Survey Results ......................................................................................................................... 12 

Observations ........................................................................................................................................ 12 

International ............................................................................................................................... 13 The 16 Country Programs: An Overview ............................................................................................. 13 

CONCLUSIONS ............................................................................................................................. 21 Domestic ..................................................................................................................................... 21 

SUGGESTIONS FOR FURTHER STUDY ........................................................................................... 24 APPENDIX A: INTERNATIONAL DATABASE .................................................................................... 26 APPENDIX B: COUNTRY PROFILES AND PROGRAM TEMPLATES .................................................. 27 

Australia .................................................................................................................................... 27 Australia: Programs ................................................................................................................... 31 Brazil ......................................................................................................................................... 41 Brazil: Programs ........................................................................................................................ 46 Chile ........................................................................................................................................... 50 Chile: Programs .......................................................................................................................... 54 China.......................................................................................................................................... 58 China: Programs ........................................................................................................................ 63 France ........................................................................................................................................ 67 France: Programs ....................................................................................................................... 71 India ........................................................................................................................................... 77 India: Programs .......................................................................................................................... 82 

Israel .......................................................................................................................................... 93 Israel: Programs ......................................................................................................................... 96 Mexico ....................................................................................................................................... 99 Mexico: Programs .................................................................................................................... 103 Philippines ................................................................................................................................ 111 Philippines: Programs ............................................................................................................... 115 Saudi Arabia ........................................................................................................................... 117 Saudi Arabia: Programs .......................................................................................................... 117 Singapore ................................................................................................................................ 122 Singapore: Programs ............................................................................................................... 126 South Africa ............................................................................................................................. 127 South Africa: Programs ............................................................................................................ 131 Spain ....................................................................................................................................... 135 Spain: Programs ...................................................................................................................... 138 Sweden .................................................................................................................................... 139 Sweden: Programs ................................................................................................................... 142 Turkey ...................................................................................................................................... 144 Turkey: Programs ..................................................................................................................... 148 United Kingdom ....................................................................................................................... 150 United Kingdom: Programs ...................................................................................................... 155 

APPENDIX C: CAHME SURVEY RESULTS ...................................................................................... 168 APPENDIX D: PRESENTATIONS AND CONFERENCES .................................................................. 198 APPENDIX E: SAMPLE LETTER TO INFLUENTIAL LEADERS ............................................................. 199 COUNTRY HEALTH SYSTEM ABSTRACT SOURCES ...................................................................... 200 

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INTRODUCTION

We live in a global village where the geopolitical landscape changes rapidly. In fact, change is the only constant in the globalization equation. This global transformation involves all sectors of the global economy and provides unique challenges and opportunities to rethink business strategy. The academic landscape is also changing. Ben Wildavsky in this book “The Great Brain Race” (2010) offers insight into the new university globalization movement suggesting that higher education is now a form of international trade.

According to Wildavsky:

Three of the most important higher education

trends of the last half century – mass access,

growing reliance on the merit principle, and significantly

greater use of technology- will all be accelerated

by globalization. And there is no reason to believe

that gains for one academic player will mean losses

for all the other. Indeed, academic free trade may

be more important than any other kind (p. 8)

A recent article in “The Chronicle of Higher Education” titled “University Mergers Sweep Across Europe” (January 7, 2011, p. 1) suggests that mergers and acquisitions among universities will continue as efforts are made to improve research quality, economic competitiveness and international reputation. Academic free trade will have national and international implications that reshape higher education worldwide. Joint programs of study, cross-disciplinary research and other venues for collaboration will emerge in response to global economic pressures.

The idea of a borderless world in higher education, as well as a movement towards consolidation, is augmented by the infusion of investments in investor owned universities in China, India, Mexico and Saudi Arabia, among other countries. The international mobility of students and faculty along with for-profit growth will only serve to enhance and reshape the global academic landscape. Opportunities for new growth and innovation will expand and attract new investments.

The accreditation of healthcare delivery programs in Europe during the 1990s responded to national efforts to improve quality of healthcare. This investment has been reviewed by WHO and reported by others (Shaw, C.D., Kutryba, B., Braithwaite, J., Bedlicki, M. & Warunek, A., 2010). It is clear that the trend for each country to develop its own standards is not new.

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Career ladders for professionals vary by regions, and the recognition of credentialing processes is not uniform and consistent across professional organizations. Given the diversity of countries and the variation in professional identity for health care management professionals, accreditation has a variety of purposes and orientations among regions of the global community.

Medical tourism provides another variable in the globalization of healthcare. This trade movement has a significant economic access and quality of care impact. The idea that clinical outcomes can be linked to quality management and hospital performance is not new, but is not accepted globally. The institutional framework and competencies of each profession suggests that although a common body of knowledge exists, there can be different expected levels of competencies, and that competencies can be country specific especially in the areas of law, ethics, financial management and public policy. Nationalistic concerns for quality may out weigh international criterion.

Given the aforementioned mega-trends, in addition to the Development Goals (DGs) for emerging economies an opportunity exists to develop an international platform to examine health management education competencies, certification, and accreditation. There is room for discussion, but the context and origin of standards raises issues in many countries. The high level of diversity among countries, varying levels of professional identity, a tendency towards national standards, and an orientation that currently values public health, all suggest that new models are needed within an international framework that embraces diversity rather than homogenous thinking.

The International Hospital Federation (IHF) may provide a framework to examine the relationship of hospitals, competency development, models of certification or credentials for healthcare managers, and the emergence of health management education as a viable professional preparation. The World Health Organization has been trying to improve competencies for managers especially in low and middle income countries, but their professional orientation is towards public health administration. Business schools have an increasing presence, but do not have significant recognition as a health care management training venue, especially at the CEO, CMO, COO, and CNO levels. This being said, a niche exists for health management education in countries where professional organizations and identity are established.

OVERVIEW OF THE STUDY

This survey research is an initiative of the Commission on Accreditation of Healthcare Management Education (CAHME), implemented by the University of Scranton and Atlas Research, LLC. It is supported primarily by the ARAMARK Charitable Fund with contributions from the University of Scranton and Atlas Research, LLC. The project team included:

Daniel J. West, Jr., Ph.D., FACHE Principal Investigator The University of Scranton Gary L. Filerman, Ph.D., MHA Senior Vice President Atlas Research, LLC

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Bernardo Ramirez, MD, MBA Assistant Professor & Consultant University of Central Florida Jill Steinkogler, MHSA Senior Consultant Atlas Research, LLC The study was limited in scope due to the constraints of the grant. However, the effort is considered to be Phase I of a multi-phase study. It is assumed that Information gained in the first phase will be used to structure future studies in Phase II and Phase III.

The grant award had a domestic initiative/methodology and an international initiative/methodology. Specifically the study was structured to:

1) Examine the supply and demand for professionally trained healthcare administrators in sixteen countries. A country profile template was created. Within each country program profiles were created that provide information on universities, degrees awarded, and other information.

2) Provide a summary of the health systems of the 16 countries.

3) Use an expert panel to provide opinions, advice, and access to information.

4) Assess the extent of international healthcare management education activities of CAHME accredited programs and their faculties and describe involvement in international health administration education.

5) Prepare recommendations on future areas of study with relevant research questions for Phase II and Phase III.

6) Suggest ideas for conferences, presentations, and other venues to disseminate the results of the project.

As part of the study five monthly progress reports were prepared and submitted to CAHME. Continuous input and contact was maintained with Mr. John Lloyd providing clarification and utilizing appropriate feedback. The expert panel was used extensively throughout the study by Dr. Gary Filerman and his staff at Atlas Research, LLC. The University of Scranton provided marketing and publicity associated with the study. Suggestions have continuously been sought from a variety of sources on presenting results of the study in journals and at professional meetings/conferences, both in the USA and to international audiences.

The project study team met for the initial planning session on June 21-22, 2010 at the University of Scranton, Scranton, Pennsylvania. A study strategy was discussed and agreed upon, along with descriptions of responsibilities, allocation of resources and time frames. Desirable outcomes were explored as well as study limitations. Throughout the study contacts were maintained via telephone conferences on a monthly basis as well as weekly telephone calls and e-mail. Reports were shared as they became available with other team members. As stated previously, Dr. West

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prepared and submitted monthly progress reports to Mr. John Lloyd at CAHME, who in turn shared information on the study with the CAHME Board of Directors and international advisory committee.

Domestic Methodology The study required a survey of CAHME accredited programs and their faculties and a description of their involvement in international health administration education. In the design of the survey instrument, specific information points of interest to CAHME were considered. Information and questions used on an earlier AUPHA survey prepared by Drs. Dominquez, West and Ramirez was reviewed. The survey responses on the Global Healthcare Management Faculty Survey were very small so the results could not be used with the CAHME study. Authorization was received by authors of the Global Healthcare Management Faculty Survey to use some questions on the new “CAHME International Health Management Education Survey.” A literature review was conducted to see if other international healthcare management questionnaires had been previously constructed and administered. Finally, faculty and colleagues with international health management education experience were asked to review the constructed survey and offer suggestions for improvement. The project team reviewed the survey construction, format and question design prior to IRB review. The CAHME International Survey was administered to a pilot group of faculty at other AUPHA programs to insure clarity, determine length of time to complete the study, and to receive suggestions in the ordering of questions in the various sections of the survey. This field test was useful to the final design and wording of questions.

The project team submitted an IRB/DRB Application Form B on October 12, 2010 at the University of Scranton. IRB approval was received on November 3, 2010.

The CAHME website and office was contacted to secure a listing of all CAHME accredited programs in the United States and Canada. A total of 72 programs were listed. Two accredited programs had two separate CAHME accreditations but the University was only surveyed once. A total of 70 surveys were administered.

The survey was titled “CAHME International Health Management Education Survey” and was composed of 39 items. The questions were grouped into five sections: demographic information, international involvement, international courses and curriculum, alumni, and ideas/opinions on global healthcare management education. A copy of the survey is illustrated in Appendix C. All program directors were asked to complete the online survey at:

http://www.surveymonkey.com/s/HPKJF53

The initial survey request was sent to all CAHME accredited programs on November 12, 2010. Mr. John S. Lloyd, President and CEO, CAHME sent a letter of support to all CAHME program directors on December 3, 2010 encouraging participation. A second notice and request was sent on December 9, 2010 to program directors who had not responded to the initial e-mail. A 3rd notice and request was sent on December 17, 2010 to program directors who had not responded. A 4th and final request was sent to 12 program directors on December 29, 2010. In

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addition to e-mail requests, telephone calls were made to program directors on two separate occasions to increase participation in the CAHME survey. Only one CAHME accredited program expressed an unwillingness to participate in the survey. The survey was closed on January 5, 2011. As of that date out of 72 programs surveyed, 66 responded and 6 did not respond. The overall CAHME participation rate was 91.67%

International Methodology The study team had the benefit of counsel from an advisory committee that reviewed the design and suggested sources of information about programs. The members of the committee were: • Gilles Dussault, Ph.D. Professor, National Institute of Hygiene and Medicine, Portugal

• Alex Preker, MD, Ph.D. Lead Health Economist, The World Bank

• Bernardo Ramirez, MD, MBA, Assistant Professor and Director, Global Health Initiatives, University of Central Florida

• Anne Rooney, RN, MS, MPH, Vice President, Consulting and Education Services, Joint Commission International

• Jorge Talavera, Ph.D. Rector, Universidad Esan and Executive Director, CLADEA, Peru

The University Survey

The intent of the international study was to identify university and other providers of programs that lead to a credential that is recognized by the health services delivery system/community as attesting to the successful completion of a course of study that is appropriate preparation for management practice.

We identified, researched, and contacted many potential sources of information about specific health care management education programs. Unlike the case of schools of medicine, public health and nursing, there is no international directory, registry or other guide to programs in health services administration. It was therefore necessary to contact many sources of information on components of the field. Each of them was sent an e-mail inquiry that included the project general information sheet. As the data base expanded, a summary paper for each country was developed that included sections listing key professional organizations, governmental agencies, employers and education providers and their contact information. The summary paper was forwarded to many of the contacts with the request they review it, adding missing details and correcting any information.

The identification effort included inquires to:

• The American College of Healthcare Executives, for international members • Joint Commission International, for the members of regional advisory committees • The World Health Organization Division of Human Resources and regional offices for

Europe, India and Southeast Asia • The Pan American Health Organization, Divisions of Health Services and Human Resources

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• The World Bank, various regional health sector leaders • The European Healthcare Management Association • The King’s Fund • The International Hospital Federation • The Global Business School Network • Association of University Programs in Health Administration for subscribers to the JHAE • World Association of Schools of Public Health • The Association of Schools of Public Health in the European Region • The World Federation of Public Health Associations • The African Association of Business Schools • AACSB International, for accredited business schools • European Foundation for Management Development: European Quality Improvement

System(EQUIS),European Programme Accreditation System (EPAS) for accredited business schools

• Consejo Latinamericano de Escuelas de Administracion

The education provider section of the summary paper was developed based upon the information provided by the above listed organizations, program files, personal contacts and journal articles. The result is that our inventory of the sixteen countries is the most comprehensive data base for them that has been developed since the publication of the AUPHA directories in the 1970’s and 1980’s.

A web search was conducted on each education provider. A profile of each was then developed. The profile and the project description were then sent to each program for which we found an email contact with a request that it be checked for accuracy and completeness and be returned. Appendix A, a separate document is an Excel spreadsheet providing in-depth information on each program. Appendix B provides an in-depth list of the country profiles and program templates filled out for each country. Over 200 contact emails were sent with a response rate of about 10%. Useful information about programs in China arrived too late for the profiles to be sent to the programs for confirmation before the end of the study.

*Note: due to current UK legislation, contact information for program staff (professors and department leadership) may no longer be provided online through university websites.

The Survey of Informed Leaders

The survey consisted of a letter with three questions and an open-ended request for opinions and observations (Appendix E). The primary target was 22 members of the JCI regional advisory committees who are located in the 16 study countries. We assumed that they are important and informed observers who would be interested in the study. The letters were sent by email, using the JCI address list, the first week of December and we had one response by the end of the month.

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Similar requests were directed to the leaders of several health administration practitioner organizations, national hospital associations and CEOs of hospital systems, with very poor response. Responses received after the close of the study will be forwarded to CAHME.

SURVEY FINDINGS AND OBSERVATIONS

Domestic

Overview

The CAHME International Health Management Education Survey consisted of 39 questions placed in five sections: demographic information, international involvement, international courses and curriculum, alumni, and ideas/opinions on global healthcare. SurveyMonkey was used to administer the questionnaire, organize responses and calculate results. This section of the report presents tabulated results for each question along with summarized responses for those questions that asked for further details, descriptions or explanations. For each question the responses are organized by “response percent,” “response count,” the number who “answered question,” and the number who “skipped the question”. A copy of the survey is illustrated in Appendix C. The survey was sent to 72 programs in the US and Canada and 66 Program Directors (PDs) responded giving a response rate of 91.67%.

Limitations

This study had several limitations that must be recognized and considered when drawing conclusions from the responses by 66 CAHME accredited programs. These limitations should also be considered when designing and implementing follow-up studies as contemplated by CAHME for Phase II and Phase III. Based on the responses, it is not possible to know why some Program Directors (PDs) elected not to respond to all questions. Several PDs skipped questions that asked for additional clarification and information. Some of the PD responses were very general lacking in specificity. For other questions, some PDs responded “yes” but did not include the additional response information to explain or clarify responses given. Very low responses were obtained on questions dealing with international involvement (questions # 22, #23, #24) that focus on faculty teaching assignments and courses. The same holds true for the section of the survey focusing on international courses and curriculum (questions #25, #26, #27 and #28). Another limitation is that PDs may not be knowledgeable about what faculty are doing internationally. It may have been more appropriate for someone other than the PD to complete the survey. There was a short period of time to respond to the questionnaire (November 12, 2010 to January 5, 2011) during which time most universities had holidays, final exams and closings for the holidays. The length of time to complete the entire study negated the ability to follow-up with PDs to request clarification and/or obtain additional information on specific questions. Finally, CAHME contact information was not always

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accurate or complete in terms of who was the PD, e-mail addresses and telephone numbers. This made follow-up difficult in terms of finding the correct PD to complete the survey.

CAHME Survey Results

The following observations summarize findings presented from the surveys per Appendix C. Tin addition to graphic presentation where appropriate, responses to open-ended questions are also included.

Observations Of the 66 CAHME accredited programs who responded to the survey (91% response rate), the responses offer some important information worthy of future consideration. • 89% of colleges or universities do not have a global center through which healthcare

management is delivered • Programs do provide some study abroad (30%), student exchanges (18%), faculty

exchanges (33%), online graduate courses (39%) and service learning abroad (27%) • 32% (N=20) of faculty have grants with an international focus; international projects 37%

(N=23); involvement in international research studies 51% (N=31) • Only 9 programs (14%) have a graduate program or school/college campus located in

another country and only 5 of the 9 programs consider this an abroad campus. Only 1 program teaches a healthcare management education course at this location

• 19 programs (31%) have international healthcare management partnerships, 43 programs do not (69%). Most of these programs are located in Western Europe, Central Europe and Asia and are university based partnerships

• 49 programs (82%) encourage and support faculty to present at international meetings/conferences; 78% (N=48) to publish in international journals; 63% (N=38) to lecture at foreign universities; 64% (N=38) to serve on international committees; and 64% (N=37) to take an international sabbatical

• Most faculty take sabbatical leaves in Western Europe followed by Asian countries. 43% of programs (N=23) have faculty members who have taken an international sabbatical leave

• 15 programs (26%) reported having faculty who serve on editorial boards of international journals but only 8% (N=5) provide financial support for an international journal

• 18% of programs have faculty who hold visiting faculty appointments (N=11); 13% of programs jointly sponsor international conferences (N=8); 13% of programs reported teaching courses at foreign universities (N=8); and 16% of programs (N=10) market themselves to specific countries or have a specific international strategy

• Of the program faculties who teach courses in other countries, 89% are full-time faculty followed by 57% who use adjunct faculty to teach courses. When faculty participate in international teaching assignments, 23% (N=6) receive release time, 19% (N=5)

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reassigned time, 50% (N=15) receive travel funds , and 36% (N=10) receive additional compensation

• Of the programs who teach courses internationally, 62% (N=16) teach face-to-face with no online courses, and 36% (N=10) use a blended model offering abroad selections of courses. Of the courses taught, 20% (N=5) address global healthcare management competencies

• 48 programs (83%) do not offer a track or concentration in global healthcare management and 10 programs offer some type of international courses. Only 4 programs (7%) offer a certificate in international healthcare management education

• Most foreign graduates of CAHME programs who work in international settings are in Asian countries (namely China, Indonesia, Taiwan, Philippines, Thailand, Japan, Singapore, and South Korea) followed by Middle East countries. 56 different countries were identified by CAHME programs where foreign graduates work

• 23 programs (40%) indicated that foreign graduates are active in their alumni association re. 60% (N=34) are not active. 23 programs (40%) reported that foreign graduates help recruit new graduate students, and 33% of programs “didn’t know.” When asked about the number of alumni (both domestic and foreign) who are working outside the US or Canada, 23 programs reported between 1 – 25 people and 12 programs reported “unknown”

• 44 programs (76%) do not feel international healthcare management education should be included in CAHME accreditation standards. 43 programs (74%) do not feel CAHME should have specific health management education course competencies. However, when programs were asked if CAHME should offer accreditation to programs outside of the US and Canada, 63% (N=35) of the PDs indicated “yes” but, provided no explanation.

• 44 programs (75%) had no suggestions for future research. Other programs felt the questionnaire could be modified: more details on partnerships, how will CAHME help programs outside of the US, identify courses that are best taught cross-culturally, defining global health management, what would CAHME actually do internationally, and documenting student outcomes.

International

The 16 Country Programs: An Overview

Table 1 provides key health data for each of the 16 countries studied. Appendix B provides a detailed chart for each country with specific information regarding the economy, political status and brief description of the health care environment of the country. For those countries that do not have data on the specific number of hospitals, footnotes (a-e) provide data on the proportion of beds available through either public or private hospital facilities.

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Table 1. Country Overview

Country Population

GDP Per

Capita ($)

Health Care

Spending as a % of GDP

Public Hospitals

Number of Beds

Private Hospitals

Number of Beds

Australia 21,515,754 40,000 9.0 750 50,915 290 26,589

Brazil 201,103,330 10,200 8.4 2,600 140,000 4,800 330,000

Chile 16,746,491 14,700 6.2 207 - 179 -

China 1,330,141,295 6,600 5.8 14,000 - 5,736 -

France 64,768,389 32,800 11.2 1,000c - 3,000d

India 1,173,108,018 3,100 5.0 2,129 469,672 3,327 265,137

Israel a, b 7,233,701 28,400 8.7 46 % - 34 %

Mexico 112,468,855 13,500 5.9 1,107a - 3,082 33,931

Philippines 99,900,177 3,300 3.9 700 - 1180 85,000

Saudi Arabia

29,207,277 20,400 3.4 220 - 87 -

Singapore 4,701,069 50,300 3.1 13 - 16 -

South Africa

49,109,107 10,100 8.6 400 - 205 28,361

Spain 40,548,753 33,700 8.5 319 - 800 160,000

Swedene 9,075,055 36,800 9.1 - - - -

Turkey 77,804,122 11,200 5.7 850 260

United Kingdom

61,284,806 35,200 8.4 851 - 270 -

a Includes social security hospitals b 47 total hospitals provide 66% of all hospital beds

c Public hospitals provide 62% of all hospital beds

d 18% of private beds not for profit, 20% for profit e 21,000 total beds provided through public and private hospitals

Table 2 summarizes our findings of Master’ degree programs in the study countries. It includes those programs that are designated by the degree granting institution to be at the Master’s level. Master’s degrees vary in length within and among countries so it is necessary to track each one to determine to what extent it approximates the North American model. Table 2 summarizes Master’s data from the total report spread sheet. It does not include the

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programs that are designated as diplomas, which are included on the spread sheet, along with certificates, specializations, Bachelor’s degrees and doctoral degrees. The interpretation of diplomas presents a complicated challenge. In some countries some diplomas in health administration (or related title) are considered to be equivalent to a Master’s degree, while in some of the same countries diplomas are also awarded in recognition of two month courses. In some countries diplomas represent a postgraduate clinical specialization. There is an effort to standardize such titles in Europe, but it has not had any influence on other parts of the world. Appendix A provides a comprehensive spreadsheet that displays information specific to programs in each of the countries. This includes the name of the institution, and to the extent available, degrees offered, duration of each program, language in which courses are taught, the number of graduates per year, year each program started, and key contact information including name, title, address, phone number and email information.

Table 2. Master’s Programs

Country Universities: Active in the Field

Offer Master’s Degree

Offer Multiple Master’s Degrees

Australia 16 15 5

Brazil 6 5 1

Chile 3 4 -

China 6 3 1

France 8 5 3

India 20 10 1

Israel 4 2 -

Mexico 10 9 2

Philippines 4 2 -

Saudi Arabia 2 2 -

Singapore 5 4 -

South Africa 7 2 -

Spain 5 5

Sweden 2 1 -

Turkey 4 2 -

United Kingdom 54 41 8

The scope of the career addressed by the study. University-based programs (and in a few cases professional societies that confer the equivalent of a degree) that attract individuals who aspire to enter the field or incumbents seeking credentials and prepare them for management positions in health services delivery entities, with decision-making authority,

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whether government or non-governmental (e.g. ministries, military health systems, national health institutes,) provider or payer organizations (e.g. national insurance programs, social security systems, quasi-governmental companies, hospitals or hospital integrated health systems, physician’s groups, health centers, etc.) or community stakeholder or consumer groups.1,2

Based upon our observations of the 16 study countries, we conclude that it is helpful to visualize the status of the education system for health administration and the place of health administration careerists in the service delivery system in terms of the degree of alignment (congruence) between the two. The situation analyses of the countries can be arrayed from those that are highly aligned to the less aligned. In the highly aligned situation most, if not all, of the senior positions in the public and private health services delivery systems are either occupied by individuals with recognized credentials in the field, and/or the credential is a distinct advantage for appointment or promotion.

In the highly aligned situation the health systems administration education system is closely articulated with the recognized competency needs of the system and is producing a sufficient number of graduates to meet a substantial portion of the demand. There is a high degree of professional identity and credential holders are likely to remain in the field. The only country that comes close to this ideal model is Israel where the law requires that senior managers in the provider systems have recognized health administration credentials. The requirement provides the demand that drives the educational system to respond.

At the other end of the spectrum the degree of alignment is low, often reflecting low recognition of management degrees/credentials in other sectors. Overall recognition of the value of the credential is limited, usually to a few large government hospitals in capital cities and large private providers. The credential is rarely cited in position qualifications, there is little professional identity among administrators, there is not a career path associated with the credential and individuals with the credential often move to other kinds of higher paying organizations. There are few programs and usually there are a small number of students,

1 We use the term “health system” as it is used in the U.S./Canadian context, to include the many related or not

related governmental, not-for-profit and for-profit organizations with the primary mission of providing health services. The term includes supporting functions such as finance and regulation that are considered to be extensions of the health administration career space. It does not include the supply, device or pharmaceutical industries

2 We use the term “educational system” as it is used to describe Master’s degree providers in the context of the specific country. The educational system that addresses the health administration career varies among the study countries. For example, in India professional societies may control a degree that is recognized as professional. There are many variations of program content and length (variously defined in terms of hours, days or months, full-time or part-time), often within one country, that lead to a diploma. We have not assessed them for equivalency to the Master’s degree and have generally not included diplomas within the scope of the educational system for purposes of this study.

 

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reflecting the limited market. This describes several of the study countries. The Philippines is representative, where two programs produce relatively few graduates who may go to middle management jobs in the large private hospitals that are concentrated in the three major cities. However, many find employment in health related businesses such as pharmaceuticals, supplies, information management or insurance or do not enter the field. The exception is the national school of public health program that provides credentials to present or potential employees of the public health system.

In addition to Israel, higher degrees of alignment characterize Australia, the UK and France. In these countries management credentials enjoy wide recognition in other sectors, such as business, education and government, so the health system reflects the general management education culture. In Australia there is a high degree of recognition of the credential by employing authorities, both public and private. The professional environment in Australia is more similar to that of the US and Canada then in any other of the study countries. There is a similar infrastructure of professional organizations (including the Australasian College of Health Services Management), public and professional recognitions of educational attainments, professional journals and meetings. Accordingly, the degree of professional identity is high. The educational system is relatively robust, with many programs, some of them in leading universities. There is an active association of programs and program accreditation by the Australasian College. This pattern was influenced by the investments of the W.K. Kellogg Foundation, paralleling their efforts in the US and Canada.

In France and the UK the status of the health administration “profession” is strongly shaped by the civil service systems. Also, both countries have small but robust for-profit systems that are dominated by physicians without management credentials, but both are experiencing inroads by MBAs. This reflects recent developments in the general business sector.

The French health system is based upon universal health insurance that supports institutions owned by the public, not-for-profit and for-profit sectors. General management is a widely respected tradition that influences health services. France has a strong tradition of civil service generalist management training led by a few elite universities but including many others. The graduates enjoy a distinct status and often move among public and private organizations in different fields during their careers. As a result, many of the occupants of top positions in major public health facilities do not identify themselves as professionals in health care administration although some do. Private sector hospitals are generally headed by physicians who are supported by administrators. They have recently been hiring MBAs for senior management positions. The National School of Public program has fed into the civil service system for over 60 years, but it’s identity with the curative field, as opposed to pubic health administration, has been uneven, depending upon the leadership of the moment.

The profession has been robust in the UK for over forty years, but it is facing an uncertain future because the government has very recently announced a major down sizing of the NHS management workforce and the closing of several management structures. In the past the National Health Service has encouraged universities to provide credentials, even to point of

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enlisting and supporting them to participate in NHS national training schemes but this high degree of alignment has ended. Position descriptions generally specify health administration credentials, there is a high degree of career identification and a professional infrastructure that reinforces the identity (including the British Society of Medical Secretaries and Administrators and the Institute of Healthcare Management), with some union-like characteristics. Criteria for IHM membership mention but do not require a credential in the field. The proposed changes will considerably expand the relatively small private sector. The health administration education system is very large, with many programs in a variety of settings offering a variety of credentials, extensive health services and policy research, and continuing education. It has largely focused upon the NHS but can be expected to respond to the increasing private market. The UK has recently experienced rapid expansion of MBA programs that will likely respond to new opportunities in the health sector.

The relatively high health status that Spain has achieved in very recent years is attributed in part to an effective health care system in which management competence and quality improvement are well regarded. Most hospitals are non-profit or for-profit and have been early adapters of advanced information and other management systems. It appears that most hospitals, health centers and related entities are headed by physicians, many of whom are part-time. They are supported by administrators, for whom there is an extensive pattern of short courses under public and private sponsorship. The products of the two university programs occupy mid and upper level supporting positions in the large university hospitals, health insurance and in the private for-profit sector. The fact that there are only two programs targeted to the field in Spain’s large health education system suggests that the credential is not in demand.

Mexico presents interesting contrasts between relatively high alignment between education and urban health systems, where credentials enjoy some recognition, and low alignment with most of the rest of the country. National government and quasi-governmental systems, the petroleum and railroad company systems and growing for-profit chains are concentrated in the national and state capitals and secondary cities, with many very small facilities in rural areas. The world-class government teaching and research institutions, not-for-profit and proprietary hospitals of the capital employ many physicians and others with credentials from the nine programs. Nationally, non-physician CEOs are rare. There is a general pattern of hospitals having second level administrators, many of whom have Bachelor’s in business administration. Ministry and social security headquarters employ Master’s graduates in supporting roles to politically appointed physician CEOs. There have been full- and part-time programs in Mexico City since the late ‘50’s and recently some dispersion to other cities. Health services research is well established at the National School of Public Health and there are several journals for leaders in administration. The early developments were influenced by the Kellogg Foundation. The quasi-governmental Mexican Social Security Institute which owns over 200 hospitals has contracted with private universities for custom MBA programs for the CEOs and administrators of larger hospitals. Mexico is experiencing MBA growth with some interest in health related businesses.

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Chile is an interesting case of professional development, with a moderate degree of alignment between education and the market. Recognition of professional management education across sectors is recognized to be the highest in Latin America. Relative to the size of the health delivery system, the health administration educational system is quite strong. There is a long tradition of graduates of the University of Chile occupying important management positions in the pubic systems, although the CEO positions are often occupied by physicians without credentials in the field. There are now two universities offering four degrees, which reflects how well the credential is established. This is another case where the Kellogg Foundation played a key role in the early development of the field. Graduates of the present and past programs often occupy COO and other senior positions in larger public institutions. There are some professional activities that reinforce the identity of the field, including a professional organization and a history of publication. Chile too has seen a recent growth of MBA programs focused on the business sector and there has been some movement of graduates into the health field, particularly into the private hospitals in three or four cities.

Saudi Arabia’s large and advanced health system employs many individuals with credentials in the field. There are indications that a significant number of credentialed people leave the field for better paying opportunities in other sectors. The two programs are strongly influenced by the US model and have modest enrollment. Health services are provided by the separate systems of several ministries, the National Guard, industries such as ARAMCO (the national oil company), universities and others. The larger of these function as internal training markets. At least two large systems, the National Guard and ARAMCO, have supported Master’s level courses for their employees. Some of the courses have been held in the US and the UK while foreign faculty have been brought in for others. This has led to a large and growing private sector, which appears to be drawing managers from the general business market.

Sweden and Singapore present situations that are distinct from the other study countries. There are no formal education requirements for most positions in Sweden. CEOs come from diverse backgrounds; many are MBAs, H.R. specialists and some clinicians. Many are political appointees. Sweden has a strong tradition of education for general governmental social services management. The Karolinska Instituet, which has the only part-time health administration Master’s, will add a full-time two-year program this year. Health administration diplomas, mainly for clinicians, have been closed in response to the Bologna process. Some key positions have been occupied by graduates of the multi-national Nordic School of Public Health Master’s program (in Norway), which enjoys high regard but does not prepare significant numbers of people for the field.

Singapore is a single city dominated by two large “public” systems (government owned, but operated as if private not-for-profit) and a large private sector. It appears that credentials in the field are widely recognized and valued. There is an active chapter of the Australasian College of Health Service Management. The education sector has responded with four programs including one that is affiliated with Flinders University of Australia. Apparently the largest and most influential contributor of recognized credentials has been the Minnesota

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Independent Study Program which enjoyed a substantial enrollment over several years, but was recently closed.

Our sample included four countries, Brazil, India, South Africa and Turkey that are developing rapidly but unevenly. In the major metropolitan areas they have strong health administration education systems that are aligned with the delivery systems of the metro areas. They have vast small town and rural areas where the health and education centers can be characterized as being fifty or seventy five years behind the urban centers, that is, with very low alignment in health services administration and education. All are in stages of implementing universal health insurance that may be expected to drive rural service expansion and expansion of the profession, but that is long-term speculation.

Brazil is the most advanced and is demonstrating that insurance coverage stimulates service provision that creates opportunities for health administrators. It has a fifty year old tradition of hospital administration education based in the schools of public health, Catholic hospital systems and large government university hospitals. There are schools of public health, public administration and business administration that are considered to be world class and have been engaged in health administration and policy with support from Kellogg, Rockefeller and local foundations. The numbers of graduates has been small relative to even the urban market but they are influential leaders in administration and policy. There are professional associations of administrators and a tradition of periodical and text book publishing for the field. Rural health service and education development is a national priority that is driving the expansion of universities in general, business, and public health education. There is an effort to expand public health education to as many as 40 new regional centers backed up by distance learning programs. It is not clear if and when they may address health services administration but lack of qualified faculty will be a challenge. Credit mechanisms are being expanded to stimulate private sector federal health insurance supported hospital expansion in mid-range cities which will contribute to the demand for credentials.

It may appear that the 20 universities in India that are involved in education and/or teaching for the field are sufficient to constitute the beginnings of a “critical mass” to underpin the profession. However, most appear to be isolated from each other and to have very limited impact upon management practice. The experience in other countries suggests that a stimulus (a Kellogg-like strategy) could quickly organize the field, stimulate growth and improvement in programs and lead to the dissemination of managerial competencies into the health system. That would be in concert with the rapid expansion of management education and the growth of sophisticated business entities. India has a strong tradition of professionalism in the health professions and rudiments of a health administration infrastructure, including several professional organizations at the state level, are in place. The recent rapid growth of large and successful for-profit hospital chains has focused attention on the role of qualified executives and can be expected to strongly influence their status in the other sectors, but government services continue to carry the burden of the over-sized and overly bureaucratic civil service. Catholic health care, the largest non-governmental system (with something like

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20% of the beds), is considering founding a program, which would be very influential in setting the pattern.

Turkey and South Africa are very early in the development of the field but the fact that two or three of the most influential universities are involved bodes well for the future. The programs have small but well-qualified faculties that are networked internationally. Both countries have strong for-profit sectors with highly visible business leaders, which can be expected to influence the management pattern in the public sector.

China presents a unique situation. There are thousands of entities in the health system owned by many governmental units and a relatively few hospitals in the growing private sector. The programs, which are primarily health economics and health services research centers, are very small resources for healthcare management education relative to the potential demand. There does not appear to be much communication among them. There are organizations of physician CEOs in some metropolitan areas but we found no central source of information about them, their members or activities. It is possible that the recent health reform law that prescribes major changes in hospital management practice that will stimulate expansion of the education sector. Much will depend on the mandates of the government to be elected in March 2012.

CONCLUSIONS

Domestic

The International Health Management Education Survey was sent to 72 CAHME accredited programs with 66 PDs responding. This significant response rate of over 90% for accredited programs provides a foundation to understand the types of international program activities, faculty activities, involvement of alumni, international courses, curriculum and ideas of programs on globalization. This study represents the first attempt to compile international information on CAHME programs that will help define future strategy and direction for schools, colleges, and programs.

Approximately 30% of programs have international involvement of some type. University-based partnership models have been identified as a venue for different types of educational endeavors from courses, workshops/seminars, short courses, certification courses, and lectures. Faculty activities include international grants, international research, projects, publishing in international journals, and encouraging study abroad. There is a high probability these types of activities will increase. A limited number of faculty hold visiting faculty appointments at universities outside of the USA and Canada.

CAHME programs are involved in many countries but the focus seems to be on Asian, Middle Eastern and Western European countries. Joint degree programs of study are rare and very few PDs report having campuses located in other countries. There are a variety of different courses being taught in international settings, (mainly or mostly business administration and public health) but few courses in health management education or concentrations in health management

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education. A limited number of programs teach courses at foreign universities and only 10 PDs reported that they marketed programs to specific countries or had a specific international marketing strategy.

The number of programs having specific courses on global healthcare management is very small. Only four PDs reported offering a certificate in international healthcare management. However, several programs have foreign graduates who are alumni and help recruit new students. The number of alumni (both domestic and foreign) working outside the USA or Canada varies across programs.

Approximately 30% of PDs reported that their graduate programs provide study abroad, student exchanges, faculty exchanges, online graduate courses, and service learning opportunities abroad. Only one program reported having a university or college global center through which healthcare management education is delivered. A limited number of programs have faculty who take sabbatical leaves abroad and faculty who serve on editorial boards of international journals. Very few PDs reported subsidizing international journals financially, but provided in kind resources to these journals.

Another interesting finding relates to faculty participating in the AUPHA Global Healthcare Management Education Faculty Network (GHMEFN). Of the 60 programs responding, only 28% (N=17) reported yes to participation in GHMEFN, 45% (N=27) reported no involvement, and 27% (N=16) didn’t know if they participated. An opportunity exists to begin supporting international healthcare management education. It is relevant to raise the question on how many corporate sponsors have an international presence or agenda that would also support professional identity around global healthcare management education.

The final section of the survey asked four specific questions to obtain ideas and opinions on global healthcare management education: 76% (N = 44) of PDs reported they did not think international healthcare management educations (IHME) should be included in CAHME accreditation standards; 74% (N = 43) of PDs did not think CAHME should have specific IHME competencies; 63% (N = 35) of CAHME PDs felt CAHME should offer accreditation to programs outside the USA and Canada; and 75% (N = 44) did not have suggestions for IHME research in the future.

Opportunities will exist for CAHME programs to engage and embrace the global higher education trade movement. About 30% of programs have or currently are involved internationally. An opportunity exists for CAHME and AUPHA to advocate for increased globalization of healthcare management training. International

The survey, limited as it was to 16 countries, presents a positive assessment of the present status of formal education for the administration of health services and an encouraging perspective of the future. The objective is the improvement of the health of all peoples through the improved management of expensive and scarce health resources, and specifically the improved performance of systems. Professional education for health services administration is a means, not

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an end. All of the countries have a university-based or related health services education establishment but the national pictures vary greatly in professionalism, stature, resources and impact upon managerial practice. In the study countries professional healthcare administration has in the past half-century become recognized, at least at some levels, as a desired if not essential component of the health care workforce.

The prospect is that the field’s recognition, stature and support will increase at an increasing pace across the study countries. That is in response to the consensus among governments, planners, donors and all other global promoters of health services that the key to improving health status is not more money. It is to improve the performance of health services and the key to that improvement is competent management and strong leadership.

At the same time it is increasing clear that management education/training/development is of limited value in environments of dysfunctional systems and institutions. The point is particularly clear in the emerging economies, but to some extent to most of our sample when:

• National government health and education policy is unstable and inconsistent with changes of leadership

• There is a lack of coherent policy on decentralization of power from the national government to local governments, public healthcare institutions or to the private sector.

• Public hospital executives have little effective control of resources, systems or contracts. • There is little or no recognition of health administration credentials for appointment to senior

positions • Promotion of executives is based on political, family or clinical considerations rather than on

managerial competence and career development

The point is that although some of these factors exist in the US and Canada, the differences in the environment for which we educate are wide and deep. In most of the study countries it appears that professional education for health administration is not yet seen as a key to producing the necessary managerial competence and leadership. There is growing recognition that clinical competence is not the same as managerial competence, but also that there are many clinicians with little or no managerial training who are successful managers and leaders. That makes it difficult to change the culture, even in the context of improving system performance. It does appear that in most of the study countries that professional administrators are gaining status (often as COOs) over poorly trained or performing physicians who do not see themselves as administrators.

Several developments are converging that focus attention on the competency gap and to support the expansion of opportunities for credentialed individuals and for their education. They include the rapid dissemination and adaptation of quality of care assessment and improvement. In some of the countries, aspects of information management for business and clinical functions are more advanced than in the US/Canada. Another is the rapid expansion of the private sector, including hospitals, insurance and supporting services and the impact of highly visible international

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accreditation. It is important to note the increasing competitive influence of “medical tourism,” much of which is internal, as a stimulant for improved managerial performance.

Developments in the education sector, including public health and business administration, as well as health administration education are also converging to set the stage for expanded recognition of credentials in the field. A global expansion of public health schools and programs started about ten years ago and clearly will continue in both developed and emerging countries. At the same time there is a recognition that traditional approaches to public health education have failed to deliver the management skills necessary to improve system performance. Medical schools are expanding community medicine and health systems related courses and specialties. Both are fueled by the world-wide growth of health economics and health services research.

The recent growth of the MBA is a far more potent development than we had anticipated, reaching into virtually all of the countries. Education for business is the most common feature of the expanding private for-profit universities in many emerging countries. The MBA programs started with the US model but many are moving toward more indigenous approaches to management and leadership as well as philosophies. It has been promoted by the World Bank as essential to foster entrepreneurship and as a fundamental strategy for business development. As the health care environment has become much more welcoming to private sector investment in all aspects of service delivery and financing, employment of MBAs has expanded, and as we have seen, some of the schools have followed. It is likely that the executive MBA model (present in Australia, United Kingdom, France and Sweden) will expand into the health sector in the coming decade. The expanded use of English as the universal language of commerce is also a contributing factor.

Other important recent developments include the growth of customized graduate level programs in several countries (e.g. IMSS Mexico, Apollo India, Saudi National Guard); distance education (e.g. Johns Hopkins, Virginia Commonwealth, University of Washington) and program teaming (e.g. Flinders and Parkway, INSEAD and Singapore) and very importantly, the fact that the global market for graduate degrees has expanded to many countries (GMAT scores are now sent in substantial numbers to France, UK, Spain, Australia, Singapore, India and Israel-all are in the top ten).

“It is not the decline of America but the rise of the rest”- Fareed Zakauia

SUGGESTIONS FOR FURTHER STUDY

This study provides the basis for complementary work that will produce a comprehensive picture of the global status of education for health administration in universities. To complete the picture it is suggested that: 1. There be a second phase of national studies consisting of A) follow-up on the university

contacts that were developed in the first phase to obtain more reviews of the program profiles and B) expand the study to other countries which may be significant participants in the field. They are: Japan, South Korea, Malaysia, Taiwan, Thailand, The Czech Republic, The

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2. The phase two study should put increased emphasis upon identifying professional organizations of health care executives. It is clear from this study that such organizations both reflect the status of the profession and may be significant players in promoting the field and activities such as program accreditation.

3. This study has revealed that there is some, and perhaps growing, influence on health administration education by accreditation programs in business, public health and perhaps medicine. It would be informative to identify these accreditations; their domains (interest in health services administration), sponsorship, processes and memberships.

4. Countries around the world are embracing standards to improve quality of care and access to care, although many of the standards appear to be predominantly nationalistic in orientation. It would be informative to survey international groups and organizations, external to the United States of America and Canada, on how useful and/or helpful external standards, metrics and competencies in health management education would be to improve management performance and improve quality outcomes.

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APPENDIX A: INTERNATIONAL DATABASE

The database can be found in the accompanying Excel spreadsheet. This file provides specific information (to the extent available) for each program in each country including the institution name, program offered, qualification obtained, program affiliations, language in which the program is taught, duration of the program, number of graduates, year the program was established and detailed contact information including website, address, phone number, key contact name and title, and email address when available. The second and third tabs provide contact information for public and private organizations and employers located in each of the 16 countries.

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APPENDIX B: COUNTRY PROFILES AND PROGRAM TEMPLATES

Australia POPULATION

% Urban 86%

% Rural 14%

Age Structure

0-14 years: 18.4% (male 2,033,106/female 1,929,863) 15-64 years: 67.8% (male 7,397,562/female 7,197,829) 65 years and over: 13.7% (male 1,350,248/female 1,607,146) (2010 est.)

Population 21,515,754 (July 2010 est.) HEALTH STATUS

Infant Mortality Rate

Total: 4.67 deaths/1,000 live births Male: 5 deaths/1,000 live births Female: 4.33 deaths/1,000 live births (2010 est.)

Life Expectancy at Birth

Total Population: 81.72 years Male: 79.33 years Female: 84.25 years (2010 est.)

CHARACTERISTICS

Religions Catholic 25.8%, Anglican 18.7%, Uniting Church 5.7%, Presbyterian and Reformed 3%, Eastern Orthodox 2.7%, other Christian 7.9%, Buddhist 2.1%, Muslim 1.7%, other 2.4%, unspecified 11.3%, none 18.7%

Languages English 78.5%, Chinese 2.5%, Italian 1.6%, Greek 1.3%, Arabic 1.2%, Vietnamese 1%, other 8.2%, unspecified 5.7%

Geographic Size

Total: 7,741,220 sq km Land: 7,682,300 sq km Water: 58,920 sq km

ECONOMY

Economy

The Australian economy grew for 17 consecutive years before the global financial crisis. The Australian financial system remained resilient throughout the financial crisis and Australian banks have rebounded. Australia was one of the first advanced economies to raise interest rates - three times since October 2009 - and the government removed the wholesale funding guarantee for financial institutions in March 2010. During 2010, the government focused on building Australia's economic productivity by managing the economic relationship with China, passing emissions trading legislation, and dealing with other climate-related issues. Australia is engaged in the Trans-Pacific Partnership talks and ongoing free trade agreement negotiations with China and Japan.

GDP Per Capita $40,000 (2009 est.)

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GOVERNMENT

Type Federal Parliamentary Democracy and a Commonwealth Realm

Components 6 states and 2 territories; Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia, Tasmania, Victoria, Western Australia

Form

Legal System: Based on English common law; accepts compulsory ICJ jurisdiction with reservations; accepts International Criminal Court jurisdiction with conditions. Executive Branch: Chief of State: Queen of Australia Elizabeth II Head of Government: Prime Minister Julia Eileen GILLARD (since 24 June 2010) Legislative Branch: Bicameral Federal Parliament consists of the Senate and the House of Representatives Judicial Branch: High Court (the chief justice and six other justices are appointed by the governor general acting on the advice of the government)

Government Departments Involved In Health Care

Australian Commission on Safety and Quality in Health Care Australian Medical Council Department of Health & Ageing Department of Human Services Medical Services and Advisory Committee (MSAC) Medicare

HEALTH CARE SPENDING

% of GDP 9.0% (est. 2006)

Government Australia’s health services are funded predominantly from taxation sources with federal, state, and territory governments, contributing close to 70% of all health spending

Private N/A

FACILITIES

Hospitals

Public There are approximately 750 public hospitals.

Private There are 290 private hospitals in Australia, representing 32% of all hospital beds in the country.

Facilities:

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Hospital Beds Public

Acute Public Psychiatric

Private Hospitals

Total

Hospitals 741 20 525 1,286

Available beds 50,915 (63.6%)

2,560 (3.2%)

26,589 (33.2%)

80,064

Available beds per 1,000 population 2.6 0.1 1.3 4.0

THE HEALTH CARE SYSTEM

Description Australia is an interesting health services system environment. The country is big and the population is small. The population is largely of European descent (89.3%), but that is changing as government promoted immigration expands the diversity. Australia provides universal health insurance through Medicare. Medicare provides free or subsidized access to most medical and some optometry services and prescription pharmaceuticals. It also provides free public hospital care, but patients may choose private care in public or private hospitals. The Australian government, together with state governments in most cases, also funds a wide range of other health services including care of the aged, population health, mental health, limited dental care, rural and indigenous health and services for veterans. The Commonwealth funds about 40% of the costs of services with the states making up the rest. There is also a Pharmaceutical Benefits Scheme that subsidizes a wide range of prescription medications supplied by community pharmacies. Payments are means tested. Medicare is funded mostly from general revenue and in part by a 1.5% income tax. Some low-income individuals are exempt or pay a reduced tax. Individuals and families with high incomes who do not have a certain level of private insurance pay a 1% Medicare tax surcharge. Private insurance contributes 7.6% of total health expenditure. Thirty percent of private premiums are paid by the government through a rebate that increases at age 65. In 2009, 44.6% of the population had private insurance. Private insurance covers some services that are not covered by Medicare such as optical, physiotherapy, podiatry and dental. Private insurance is community-rated and provide by both for and non-profit companies. The largest company, Medibank Private, is government-owned, but it operates as a private fund. The hospital sector includes a mix of public (run by the states and territories) and private hospitals. In 2006-07, there were 758 public hospitals and 543 private hospitals. Public hospitals provided 56,000 beds (67% of the national total) and 26,750 beds (32, 4%) were in private facilities. Private hospitals treat 40% of all patients and perform 64% of the elective surgery. Private facilities include investor owned and not-for-profit hospitals. Medicare provides free care for patients who elect to be treated as public patients. Public hospitals are jointly funded by the governments through five-year agreements. The states are fully responsible for public hospitals, sub-acute care

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and outpatient services. It is up to each jurisdiction to determine how the funding is allocated to each hospital. Each state and territory has it own method for funding individual hospitals, but they generally involve some form of activity-based funding for acute care. In January 2009 it was agreed that within five years a nationally consistent approach would be implemented. For the first time it will require uniform classification, costing and funding models. Public hospitals also receive income from patients who choose to be private patients. The patients that have private health insurance have a wider option of doctors and hospitals. Salaried specialists in pubic hospitals are able to treat some private patients, to which they usually contribute a portion of the fees. Medicare usually reimburses 85% to 100% of the fee schedule to ambulatory services and 75% of the schedule for in-patient services. Doctor’s fees are not regulated. Doctors can charge above the fee schedule, or they can treat patients for the cost of the subsidy and bill the federal government directly with no co-payment. In 2005 the Medicare payment for certain target populations (low-income, elderly, children and rural) were increased to 100%. There is an annual cap on the amount of co-payment that individuals and families pay. Most physicians are in private practice on a fee-for-service basis. GPs are gatekeepers, as Medicare will reimburse specialists only for referred consultations. Physicians in public hospitals are either salaried (though allowed to have separate private practices and additional fee-for-service income) or paid on a per-session basis for treating public patients. Generally, physicians working in private hospitals are in private practice and do not concurrently hold salaried positions in public hospitals. Abstracted from: Australian Private Hospitals Association. (2009). Provision of Services in Private Hospitals. Retrieved October 12, 2010, from Australian Private Hospitals Assocation: http://www.apha.org.au/media-centre/facts-and-figures/provision-of-services-in-private-hospital/

Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/ The Commonwealth Fund. (2009). The Australian Health Care System. New York: The Commonwealth Fund.

World Health Organization. (2009). Australia Health System. Geneva: World Health Organization.

World Health Organization. (2009). Australia: Health Profile. Retrieved August 20, 2010, from World Health Organization: http://www.who.int/gho/countries/aus.pdf

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Australia: Programs

Country Australia

Institution Curtin University of Technology School of Public Health Dept. of Health Policy and Management

Program(s) (1) Post Graduate Diploma in Health Administration

(PgradDipHlthAdmin) (2) Master of Health Services Management (MHSM) (3) Master of Health Administration (MHA)

Website http://courses.curtin.edu.au/course_overview/postgraduate/Master-HealthAdministration

Address GPO Box U1987, Perth Western Australia 6845

Telephone/Fax Tel: +61 8 9266 7331

Affiliations SHAPE, AUPHA

Country Australia

Institution Charles Sturt University School of Public Health

Program(s)

(1) Graduate Certificate in Health Services Management (GradCertHSM)

(2) Graduate Diploma of Health Services Management (GradDipHSM)

(3) Master of Health Services Management (MHSM)

Website http://www.csu.edu.au/faculty/health/pubhealth/

Address Faculty of Science, Locked Bag 588, Wagga Wagga, NSW 2678 Australia

Telephone/Fax Tel: 1800 334 733

Affiliations SHAPE

University Contact(s) Name and Title

Professor Grant O’Neill – Head of Business School

Email goneill@csu.edu.au

Language(s) English

Duration of Each Program

(1) 1 year, (2) 2 years, (3) 3 years

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University Contact(s) Name and Title

Janice Lewis, Program Leader

Telephone/Fax +61 8 9266 2075

Email j.a.lewis@curtin.edu.au

Language(s) English

Duration of Each Program

(1) 1 year, (2) 1.5 years, (3) 2 years

Country Australia

Institution Edith Cowan University Faculty of Exercise, Biomedical and Health Sciences Health Administration Program

Program(s) (1) Master of Health and Aged Services Management (2) Master of Public Health

Website http://www.chs.edu.au/

Address Edith Cowan University 270 Joondalup Drive Joondalup WA 6027

Telephone/Fax Tel: +61 8 6304 0000

Affiliations SHAPE

University Contact(s) Name and Title

Tony Watson, Executive Dean

Telephone/Fax +61 8 6304 5514

Email gmaddigan@ecu.edu.au (assistant)

Language(s) English

Duration of Each Program

(1) 2 years, (2) 2 years

Country Australia

Institution Flinders University, South Australia Department of Health Care Management

Program(s)

(1) Graduate Certificate in Health Administration (2) Graduate Diploma in Health Administration (3) Master of Health Administration (MHlthAdmin) offered in South

Australia and through Flinders University at Parkway College, Singapore

(4) *Master of Hospital Administration (MHA) coursework offered through Flinders University at Nankai University in Tianjin, China

(5) Master of Science (Health Administration) MSc(HlthAdmin)

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(6) Master of Business Administration (Health) (7) Master of Business Administration (Health) (Advanced) (8) Master of Public Health (Health Service Management)

Website http://www.flinders.edu.au

Address

Department of Health Care Management Health Sciences Building (Room 2.31) Flinders University GPO Box 2100 Adelaide SA 5001 Australia

Telephone/Fax Tel: +61-8-8201 7755 Fax: +61-8-8201 7766

Affiliations SHAPE, ACHSM

University Contact(s) Name and Title

Ms. Janny Maddern – Head, Department of Health Care Management Prof. Judith Dwyer - Head of Research, Department of Health Care Management Mrs. Pam Maslin – Administrative Officer, Department of Health Care Management

Telephone/Fax As above

Email Janny.Maddern@flinders.edu.au Judith.Dwyer@flinders.edu.au Pam.Maslin@flinders.edu.au

Language(s) English

Duration of Each Program

(1) 6 months (2) 1 year (3), (4), (6) and (8) 1.5 years (5) and (7) 2 years

Number of Graduates Per Year Over 100

Year Program(s) Started

(1), (2) and (3) 1995 in Adelaide, 2002 in Singapore (5) early 1990s, (4) 2003 (7) 2009, (6) 2010, (8) 2008

Country Australia

Institution Griffith University

Program(s) (1) Master of Health Services Management (2) Graduate Certificate in Health Services Management (3) Bachelor of Public Health

Website http://www.17.griffith.eduy.au/school/pbh/

Address Office of Graduate Studies Nathan Campus Griffith University

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170 Kessels Road Nathan QLD 4111

Telephone/Fax Tel: +61 (0)7 373 55323 Fax: +61 (0)7 373 53885

Affiliations SHAPE, ACHSM

University Contact(s) Name and Title

Professor Mark Avery Professor Don Steward

Email Mark.avery@griffith.edu.au Donald.steward@griffith.edu.au

Language(s) English

Duration of Each Program

(1) 1year , (2) 3 months, (3) 4 years

Country Australia

Institution James Cook University Faculty of Medicine, Dept. of Public Health and Tropical Medicine

Program(s) Master of Public Heath (MPH)

Website http://www.jcu.edu.au/fmhms/

Address Townsville Qls.4811

Telephone/Fax +61(0)77 225 725

Affiliations SHAPE

University Contact(s) Name and Title

Professor Peter Leggat

Email Peter.leggat@jcu.edu.au

Language(s) English

Duration of Each Program

1.5 years

Country Australia

Institution LaTrobe University School of Public Health

Program(s)

(1) Graduate Certificate in Health Services Management (HCHSM) (2) Post graduate Diploma in Health Services Management (HPHSM) (3) Master of Public Health and Master of Health Administration

(HZPHHA) (4) Master of Business Administration and Master of Health

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Administration (HZBAHA) (5) Master of Health Administration (HMHA)

Website http://www.latrobe.edu.au/publichealth/

Address University of Western Sydney Locked Bag 1797 Penrith South DC NSW 1797

Telephone/Fax N/A

Affiliations ACHSM

University Contact(s) Name and Title

Prof. Stephen Duckett, Dean, Faculty of Sciences (no response from him) Prof. Sandra Leggat

Email s.leggat@latrobe.edu.au

Language(s) English

Duration of Each Program

(1) 1 year, (2) 1 year, (3) 2.5 years, (4) 2.5 years, (5) 1.5 years

Country Australia

Institution Monash University

Program(s) Master of Health Services Management (MSc)

Website http://www.med.monash.edu.au/epidemiology/

Address

Department of Epidemiology & Preventive Medicine PO Box 64 Clayton Campus Victoria 3800 Australia

Telephone/Fax Tel: +61 (0)3 9905 1535 or 9905 4313 Fax: +61 (0)3 9905 4302

Affiliations SHAPE, ACHSM

University Contact(s) Name and Title

Dr. Virginia Plummer

Telephone/Fax Tel: +61 3 9904 4064

Email Virginia.Plummer@monash.edu

Language(s) English

Duration of Each Program

1.5 years, full-time

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Country Australia

Institution University of Melbourne School of Public Health

Program(s) Master of Public Health (MPH)

Website http://www.sph.unimelb.edu.au/future/coursework/public_health

Address Melbourne

Telephone/Fax Tel: +(61 3) 8344 4000

Affiliations Unknown

University Contact(s) Name and Title

Krishna Hort, Head of Health Systems Strengthening

Email khort@unimelb.edu.au

Language(s) English

Duration of Each Program

1.5 – 2 years

Country Australia

Institution University of New England

Program(s) (1) Graduate Certificate in Health Management (GradCertHM) (2) Master of International Health Management (MIHM) (3) Master of Health Management with Honours (MHM (Hons)) (4) Doctor Health Services Management (DHSM)

Website http://www.une.edu.au/study/health-management/

Address University of New England Armidale NSW 2351 Australia

Telephone/Fax Tel: +61 2 6773-3660 Fax: +61 2 6773-3666

Affiliations SHAPE, ACHSM

University Contact(s) Name and Title

Dr. David Briggs – Course Coordinator Prof. Steven Campbell – Head. School of Health

Email dbriggs@une.edu.au scampb44@une.edu.au

Language(s) English

Duration of Each Program

(1) 1 year, (2) 2 years (3) 2 Years (4) 3 Years

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Number of Graduates Per Year These are variable figures from year to year

Year Program(s) Started

Since 1993 with ACHSM (formerly ACHSE accreditation)

Country Australia

Institution University of New South Wales School of Public Health & Community Medicine

Program(s)

(1) Master of Health Management (MHM) (2) Graduate Diploma in Health Management (GradDipHM) (3) Graduate Certificate in Health Management (GradCertHM) (4) Master of Public Health/Master of Health Management

(MPH/MHM) (5) Master International Public Health/Master of Health Management (6) Master of Health Administration (MHA)

Website http://www.sphcm.med.unsw.edu.au/ http://www.sphcm.med.unsw.edu.au/sphcmweb.nsf/page/Contacts

Address

School of Public Health and Community Medicine Faculty of Medicine UNSW Sydney 2052 Australia

Telephone/Fax Tel: +61 (2) 9385 2507

Affiliations SHAPE, ACHSM Business School – EQUIS

University Contact(s) Name and Title

Dr. David Greenfield, Prof. Jeffrey Braithwaite Professor Raina MacIntyre – Head of Public Health & Community Medicine School

Telephone/Fax Professor MacIntyre Tel: +61 (2) 9385 3811

Email j.Braithwaite@unsw.edu.au hos-sphcm@unsw.edu.au

Language(s) English

Duration of Each Program

(1) 1 year, (2) 9 months, (3) 6 months, (4) 1.5 years, (5) 1.5 years, (6) 1 year

Country Australia

Institution University of Queensland Faculty of Health Sciences

Program(s) (1) Bachelor of Health Services Management

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(2) Graduate Certificate in Health Services Management

Website http://www.uq.edu.au/study/plan.html?acad_plan=HLTSMX5431

Address Brisbane St Lucia, QLD 4072

Telephone/Fax Tel: + 61 07 3346 4950

Affiliations SHAPE

University Contact(s) Name and Title

Professor Nicholas Fisk, Executive Dean

Telephone/Fax +61 (7) 3346 5300

Email execpa@health.uq.edu.au

Language(s) English

Duration of Each Program

(1) 3 years, (2) 6 months

Country Australia

Institution University of South Australia Division of Health Sciences

Program(s) (1) Graduate Certificate in Health Science (Health Service

Management (2) Graduate Diploma in Health Science (Health Service Management) (3) Master of Health Science (Health Service Management)

Website http://www.unisa.edu.au/hsc/

Address

University of South Australia Division of Health Sciences City East Campus GPO Box 2471 Adelaide SA 5001 Australia

Telephone/Fax Tel: +61 8 8302 2253

Affiliations SHAPE, ACHSM, EQUIS (Div of Business)

University Contact(s) Name and Title

Professor Robyn McDermott

Telephone/Fax Tel: +61 8 830 22922

Email Robyn.mcdermott@unisa.edu.au

Language(s) English

Duration of Each Program

(1) 6 months, (2) 1 year, (3) 1.5 years

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Country Australia

Institution University of Tasmania

Program(s) (1) Graduate Certificate in Health (Specialization) (2) Graduate Diploma of Health (Specialization) (3) Master of Health (Specialization)

Website http://www.utas.edu.au/

Address Tasmania

Telephone/Fax Tel: +61 (03) 6324 4025

Affiliations ACHSM

University Contact(s) Name and Title

Professor Judith Walker - Deputy Dean Faculty of Health Science

Telephone/Fax Tel: +61 3 6430 4561

Email Judith.walker@utas.edu.au

Language(s) English

Duration of Each Program

(1) 1 year, (2) 2 years, (3) 3 years

Country Australia

Institution University of Technology Sydney (UTS) Centre for Health Services Management

Program(s)

(1) Graduate Certificate in Health Services Management (GradCertHSM)

(2) Graduate Diploma in Health Services Management (GradDipHSM)

(3) Master of Health Services Management (MHSM)

Website http://www.nmh.uts.edu.au/chsm/

Address University of Technology, Sydney P.O. Box 123 Broadway, NSW 2007 Australia

Telephone/Fax Tel: +61 2 9514 2000

Affiliations SHAPE

University Contact(s) Name and Title

Professor Jane Hall

Email Jane.Hall@uts.edu.au

Language(s) English

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Duration of Each Program

(1) 6 months, (2) 1 year, (3) 1.5 years

Country Australia

Institution University of Western Sydney School of Biomedical and Health Sciences

Program(s) Master of Public Health (MPH)

Website http://www.uws.edu.au/about/acadorg/schools/biomedicalsciences

Address University of Western Sydney Locked Bag 1797 Penrith NSW 2751

Telephone/Fax Tel: + 61 2 9852 5499 Fax: + 61 2 9685 9314

Affiliations SHAPE, ACHSM

University Contact(s) Name and Title

Prof. Gregory Kolt

Telephone/Fax Tel: + 61 2 9852 3747

Email G.Kolt@uws.edu.au

Language(s) English

Duration of Each Program

1 year

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Brazil

POPULATION

% Urban 86%

% Rural No data available

Age Structure 0-14 years: 26.5% (male 27,170,378/female 26,134,844) 15-64 years: 66.9% (male 66,667,099/female 67,932,910) 65 years and over: 6.6% (male 5,578,397/female 7,619,702) (2010 est.)

Population 201,103,330; (2010 est.) HEALTH STATUS

Infant Mortality Rate

Total: 21.86 deaths/1,000 live births Male: 25.39 deaths/1,000 live births Female: 18.15 deaths/1,000 live births (2010 est.)

Life Expectancy at Birth

Total population: 72.26 years Male: 68.7 years Female: 76 years (2010 est.)

CHARACTERISTICS

Religions Roman Catholic (nominal) 73.6%, Protestant 15.4%, Spiritualist 1.3%, Bantu/voodoo 0.3%, other 1.8%, unspecified 0.2%, none 7.4% (2000 census)

Languages Portuguese (official and most widely spoken language); other less common languages include Spanish (border areas and schools), German, Italian, Japanese, English, and a large number of minor Amerindian languages

Geographic Size

Total: 8,514,877 sq km Land: 8,459,417 sq km Water: 55,460 sq km

ECONOMY

Economy $2.025 trillion (2009 est.) (GDP Purchasing Power Parity)

GDP Per Capita $10,200 (2009 est.) GOVERNMENT

Type Federal republic

Components 26 states

Form Based on Roman codes; has not accepted compulsory ICJ jurisdiction

Government Departments Involved In Health Care

Ministry of Health - Family Health Program

HEALTH CARE SPENDING

% of GDP 8.4%

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Government Data not provided

Private Data not provided FACILITIES

Hospitals 7,400 (470,000 beds)

Public 2,600 (140,000 beds)

Private 4,800 hospitals (330,000 beds)

THE HEALTH CARE SYSTEM

Description

Brazil is one of the most complex and interesting health systems. It is also one of the most significant for the rest of the world because of the innovations and experiments that are taking place there. A recent editorial in The Lancet suggested that the UK had much to learn from the recent primary care experience of Brazil. There are several lenses through which to view the country; the hospital centered delivery system and the primary care system; the metropolitan center system and the rural system, and the public and private systems. The vast health professions education infrastructure is similarly divided. Health status progress in the past 15 years has been arguably the most remarkable in the world and perhaps among the most of any country in history. To cite some examples, infant mortality has dropped from 48 to 17 per 1000. In the past five years diabetes hospital admissions have decreased by 25% and the proportion of underweight children under five has fallen by over 67%. It is also important to note that poverty rates fell from 41.9% in 1990 to 21.4% in 2009, leaving 40 million poor. During the last two decades Brazil has experienced a demographic transition, with its growth rate decreasing. This, together with an epidemiological transition has led to a shift in the burden of disease from infectious to non-communicable diseases. The result will be an increase in the demand for services and pressure on financial resources. The evidence suggests that the key to this progress is the Family Health Program. It provides comprehensive primary care services in 95% of municipalities, covering 55% of the population-more than 85 million people. The FHP is based on multidisciplinary teams working in health units that serve geographically defined areas that include from 3500 to 5000 people. Budgetary and logistic responsibility for the units has been devolved to the municipal level, which permits managerial flexibility and autonomy. The money comes primarily from the federal level with some regional contributions. It is considered to be the impressive example of a rapidly scaled up, cost effective, comprehensive primary care system. The system faces significant problems, including the recruitment and retention of appropriate doctors, large variations in the quality of care, poor integration with secondary and tertiary care and slow adoption in large urban centers where the middle classes are more accustomed to private healthcare. The maintenance of

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adequate financing has also been problematic. Brazil has been described as a having a “hospital-centric” health care system, with about 7,400 facilities containing about one-half million beds. The health sector is shaped by the decentralized and publicly funded Unified Health System (SUS), which was originally designed as a social security system, and by a large privately financed system consisting mainly of private insurers and prepayment plans. SUS services are universal and free. Brazilians are entitled to all of the care that they need. In practice, fewer than 60% (mainly a low-income population) use SUS-financed services as their regular source of care. Many middle- and high-income people covered by private insurance do use the SUS occasionally, particularly for high-complexity services and those not covered by private insurance. The SUS services are characterized by: decentralization of service organization and delivery to municipal governments and, to a lesser extent, state governments; public financing of services by public and private providers; use of federal grant transfers to co finance care at sub national levels; and formalized social participation mechanisms. The Ministry of Health (MS) is mainly responsible for system coordination and policy formulation, with states and municipalities having a role in adapting federally mandated policies. This also applies to regulation. Private organizations such as hospitals and professional and health plan associations have traditionally played a self-regulation role, but the government seldom recognizes the self-regulating role of the private sector. Financing is split between several government bodies. The Ministry of Finance collects federal taxes and social insurance, and the MS allocates and distributes federal funds. The MS also collects reimbursement from private health insurance and prepayment plans for patients treated in SUS facilities. State and Municipal governments collect taxes and allocate funds to local health care providers. As a general rule, primary and secondary care is the responsibility of the municipalities, and the state assumes tertiary, secondary and referral responsibilities. The Ministries of Education and Health operate a few referral and university hospitals. Although most municipalities perform basic care functions, large urban municipalities generally offer a broad range of medium-and high-complexity care. There are many complicating factors, including politics, that have constrained the effectiveness of the SUS, but it has been successful in several respects. It has implemented a national health system, rationalized the roles of the different government levels, improved coordination between them, and decentralized provision to the municipal level. It has extended coverage to the whole population (although 25% of the population chooses not to use the SUS as their main source of care) and has reduced inequities in access. Finally, it has moved from a vertically structured, disease-focused approach to an integrated model and ensured participation of civil society in health care planning and evaluation. In 2002 there was an estimated 7,400 hospitals with about 471,000 beds. The private sector provides 65% of the hospitals and nearly 70% of the beds. More than 60% have less than 50 beds. Hospitals consume more than two-thirds of total health spending. The mean rate of occupancy for SUS hospitals is only 45%.

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Brazilian hospitals are markedly inefficient in personnel management, with the average hospital using 50% more personnel than the average OECD hospital. Nearly 30% of admissions are for conditions that could be treated in ambulatory centers. There are substantial regional variations in distribution of hospital and technology, with concentration in a few metropolitan areas. SUS payments for hospital care are not based on the cost of services. There are many distortions, among them paying far over cost for high-complexity services. SUS payments do not include the cost of capital. Public hospitals receive irregular and unsystematic specific budget allocations managed centrally. Some private hospitals under SUS contracts receive bailout payments, but most must find funds from other sources and revenue from private patients. Many of the nonprofits, most of them small, are underutilized, highly indebted and verging on bankruptcy. The gap between costs and SUS payments has led to many closures, and more than 30 have been taken over by municipalities. The financial instability of private hospitals undermines the stability of the SUS. There are three main subsectors: • Public hospitals owned and managed by federal, state or municipal health

authorities (71%). Nearly all are publicly financed and managed. The federal government is responsible for 147 hospitals including many large teaching facilities. The municipal hospitals have a mean size of 36 beds. They are severely underutilized with occupancy rates under 30%.

• Private hospitals under contract to the SUS. About 70% of private hospitals receive public funding and also receive funding from private sources. These include most nonprofit and about half of the for-profit hospitals. The for-profits have a mean size of 53 beds. The nonprofits are required to allocate 60% of their beds to SUS patients.

• For-profit and some nonprofit hospitals not financed by the SUS constitute 20% of all facilities and 30% of all private hospitals.

It is important to note that most hospitals are thin on management and administrative processes. A 2002 study of 1500 non-profits found that less than 5% have cost accounting systems, with obvious implications for introducing effective payment or billing mechanisms. Between one-third and one-half of hospital managers work part time and more than half are volunteers. This informality spills over to other positions. Even many large hospitals do not have positions for such areas as human resources, general services and materials management. Abstracted from: Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/ Harris, M., & Haines, A. (2010). Brazil's Family Health Programme. British Medical Journal , 341; 1171-1172.

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La Forgia, G. M., & Couttolenc, B. F. (2008). Hospital Performance in Brazil. Washington: The World Bank.

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Brazil: Programs Country Brazil

Institution

University of Sao Paulo and Hospital da Clinicas PROAHSA (Advanced Program In Health Administration Education) in collaboration with the Getulio Vargas Foundation (School of Business) Centro de Estudos em Planejamento e Gestão da Saúde da FGV-EAESP GVSaúde

Program(s)

1) Medical Residency in Hospital Administration and Health Systems (PROAHSA) 2) Doctorate in Business Administration with concentration in Health Management and Planning 3) Master in Business Administration with Concentration in Health Administration (GVSaúde) 4) Specialization in Hospital Administration and Health Systems (CEAHS) 5) Diploma Health Policy and Management (DIP) 6) Management for Physicians (on line course) (GVmed)

Website

1) http://www.hcnet.usp.br/proahsa/index.htm 2) http://gvsaude.fgv.br/node/33 3) http://cmcd.fgv.br/pt-br/sobre-cursos 4) http://www.fgv.br/especializacao/ceahs/index.asp 5)http://eaesp.fgvsp.br/pt/ensinoeconhecimento/cursos/post-graduate-diploma/health-policy-management 6)http://www5.fgv.br/fgvonline/internaInternaCursoMBA.aspx?prod_cd=GVMED_01

Address (1) Hospital de Clinicas USP: R. Dr. Ovídio Pires de Campos, 471. CEP: 05403-010 Sao Paulo, Brazil (2, 3, 4, 5 & 6) Getulio Vargas Foundation: Av 9 de Julho 2029 - 11º andar – Gvsaúde, Bela Vista, 01313-902 - Sao Paulo, SP - Brasil

Telephone/Fax (1) Tel.: (011) 3069-6208 / 3069-6994 Fax: 3069 7025 (2, 3, 4, 5 & 6) Tel: (55-11) 3799-7717 / Fax: (55-11) 3799-7717

Affiliations None

University Contact(s) Name and Title

2, 4, 5 & 6) Dra. Ana Maria Malik 3) Prof. José Ernesto Lima Gonçalves

Telephone/Fax 1) Tel.: (55-1) 3069-6208 / 3069-6994 Fax: 3069 7025 2, 3, 4, 5 & 6) (55-11) 3799-7777

Email 1) proahsa@hcnet.usp.br 2,3,4,5 & 6) Ana.Malik@fgv.br

Language(s) Portuguese

Duration of Each Program

1) 2 Years 2) Master plus 24 credits 3) 2 Years 4) 540 Hrs. 10 Months 5) between 9 and 12 credits (2 semesters w/2 courses each) 6) 9 months (200 Hrs on line and 20 Hrs face to face)

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Year Program(s) Started

The program started 35 years ago. It was reviewed in 2006.

Country Brazil

Institution Sergio Arouca National School of Public Health-Escola Nacional de Saude Publica Sergio Arouca (ENSP)

Program(s) Specialization in Operations Management: Materials and equipment management

Website http://www.sigals.fiocruz.br/pub/unidade.do?CodM=7&codU=471

Address Rua Leopoldo Bulhões, 1480 – Térreo 21041-210 - Manguinhos - Rio de Janeiro – RJ

Telephone/Fax Tel.: (21) 2598-2558 Fax: (21) 2598-2557

Affiliations Unknown

University Contact(s) Name and Title

Antônio Ivo de Carvalho, Director

Telephone/Fax Tel.: (55-21) 2598-2558 Fax: (55-21) 2598-2557

Email secapresencial@ensp.fiocruz.br

Language(s) Portuguese

Duration of Each Program

436 Hrs. (1 Year)

Country Brazil

Institution Centro Sao Camilo de Desenvolvimento em Administracao de Saude

Program(s) (1) Undergraduate program in Health Administration (2) Graduate program in Health Administration

Website

(1) http://www.saocamilo-sp.br/novo/graduacao/administracao-hospitalar.php (2) http://www.saocamilo-sp.br/novo/posgraduacao/administracao-hospitalar.php

Address V. Nazaré, 1.501 - Ipiranga – Brasil

Telephone/Fax Phone: (55-11) 2588-4000

Affiliations Unknown

University Contact(s) Name and Title

(1) Coordinador: Prof. Dr. Luis Hernan Contreras Pinochet (2) Coordinator: Adriano Antonio Marques de Almeida

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Telephone/Fax Phone: (55-11) 2588-4000

Email Not available

Language(s) Portuguese

Duration of Each Program

(1) 8 Semesters (2) 504 Hrs. 11 Months

Country Brazil

Institution Fundação Dom Cabral (FDC)

Program(s) (They can customize programs but do not offer a regular health administration program) Reference from Andre Medici that met at GBSN 2010

Website http://www.fdc.rorg.br/en/Pages/default.aspx

Address Av. Dr. Cardoso de Melo, 1184, 15º andar Vila Olímpia - 04548-004 São Paulo/SP - Brasil

Telephone/Fax (55-31) 3589-7300

Affiliations Partnership with Kellogg School of Management (USA) and INSEAD (France)

University Contact(s) Name and Title

Emerson de Almeida, President Heitor Leopoldo Nugueira Coutinho, Director Customized Programs

Email heitor@fdc.org.br

Language(s) Portuguese

Year Program(s) Started

Founded in 1976

Country Brazil

Institution Universidade Sao Francisco

Program(s) (1) Specialty in Health Management (2) Specialty in Hospital Administration Note: Dr. Carlos F. Franco Jr., MBA coordinator looked for US HA program partner. Invited GF to visit. Franco@USF.com.br

Website http://www.saofrancisco.edu.br/braganca/especializacao/FreeComponent496content12876.shtml

Address Av. São Francisco de Assis, 218, Jd. São José CEP 12916-900

Telephone/Fax Tel: (55-11)2454-8000

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Affiliations Unknown

University Contact(s) Name and Title

(1) Coordinator: Prof. Beatriz Helena Verri (2) Coordinator: Prof. Carlos Ferrara

Telephone/Fax Tel.: (55-11) 2454-8170 / 2454-8172

Email centraldeatendimentobp@saofrancisco.edu.br

Language(s) Portuguese

Year Program(s) Started

The University is 34 years old.

Country Brazil

Institution Universidad Federal de Sao Paulo

Program(s) Programa de Pós-graduação em Informática em Saúde

Website http://www.unifesp.br/dis/pg/

Address Rua Botucatu, Sao Paulo, 862 CEP 04023-062

Telephone/Fax Tel.: (11) 5576-4521 / 5574-5234

Affiliations Unknown

University Contact(s) Name and Title

Profa. Heimar de Fatima Marin, Coordenador

Telephone/Fax Tel.: (11) 5576-4521 / 5574-5234

Email contato-pg@dis.epm.br

Language(s) Portuguese

Duration of Each Program

10 Months

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Chile

POPULATION

% Urban 88% (2008)

% Rural No data available

Age Structure 0-14 years: 22.7% (male 1,946,217/female 1,858,277) 15-64 years: 67.9% (male 5,690,402/female 5,688,174) 65 years and over: 9.3% (male 653,772/female 909,649) (2010 est.)

Population 16,746,491 (July 2010 est.)

HEALTH STATUS

Infant Mortality Rate

Total: 7.52 deaths/1,000 live births Male: 8.29 deaths/1,000 live births Female: 6.71 deaths/1,000 live births (2010 est.)

Life Expectancy at Birth

Total Population: 77.53 years Male: 74.26 years Female: 80.96 years (2010 est.)

CHARACTERISTICS

Religions Roman Catholic 70%, Evangelical 15.1%, Jehovah's Witness 1.1%, other Christian 1%, other 4.6%, none 8.3% (2002 census)

Languages Spanish (official), Mapudungun, German, English

Geographic Size

Total: 756,102 sq km Land: 743,812 sq km Water: 12,290 sq km

ECONOMY

Economy

$243.7 billion (2009 est.) (GDP Purchasing Power Parity) Chile has a market-oriented economy characterized by a high level of foreign trade and a reputation for strong financial institutions and sound policy that have given it the strongest sovereign bond rating in South America. Exports account for more than one-fourth of GDP, with commodities making up some three-quarters of total exports. In the years since then, growth has averaged 4% per year. Chile deepened its longstanding commitment to trade liberalization with the signing of a free trade agreement with the US, which took effect on 1 January 2004. Chile claims to have more bilateral or regional trade agreements than any other country. It has 57 such agreements (not all of them full free trade agreements), including with the European Union, Mercosur, China, India, South Korea, and Mexico. Over the past five years, foreign direct investment inflows have quadrupled to some $17 billion in 2008, but FDI dropped to about $7 billion in 2009 in the face of diminished investment throughout the world. The economy was starting to show signs of a rebound in the fourth quarter of 2009, although GDP still fell more than 1% for the year. In December 2009, the OECD invited Chile to become a full member, after a two-year period of compliance with organization mandates. The magnitude 8.8 earthquake that

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struck Chile in February 2010 was one of the top ten strongest earthquakes on record. It caused considerable damage near the epicenter, located about 70 miles from Concepcion - and about 200 miles southwest of Santiago.

GDP Per Capita $14,700 (2009 est.) GOVERNMENT

Type Federal republic

Components 15 regions

Form

Legal System: Based on Code of 1857 derived from Spanish law and subsequent codes influenced by French and Austrian law Executive Branch: Chief of State: President Sebastian PINERA Echenique (since 11 March 2010) Legislative Branch: Bicameral National Congress or Congreso Nacional consists of the Senate or Senado and the Chamber of Deputies or Camara de Diputados Judicial Branch: Supreme Court or Corte Suprema (judges are appointed by the president and ratified by the Senate from lists of candidates provided by the court itself; the president of the Supreme Court is elected every three years by the 20-member court); Constitutional Tribunal (eight-members - two each from the Senate, Chamber of Deputies, Supreme Court, and National Security Council - review the constitutionality of laws approved by Congress)

Government Departments Involved In Health Care

Ministry of Health Superintendence of Health

HEALTH CARE SPENDING

% of GDP 6.2%

Government FONASA covers 67% of the population

Private Comprised of the 13 ISAPRES (Institutes of Public Health and Preventive Medicine) FACILITIES

Hospitals

Public 207 facilities

Private 179 facilities

THE HEALTH CARE SYSTEM

Description Chile is in many respects an industrialized country. The components of health

C A H M E | 52

services are equal in quality to those of Europe and the US. There is a well developed public health infrastructure and the health status indicators are high. Life expectancy, for example, is equal to that in the US. Health care is guaranteed to all citizens. The health insurance system is recognized as innovative and responsive and it is closely watched by policy analysts and program designers from other countries. There are essentially two parallel health systems that together cover over 90% of the population. Both operate under the authority and policy direction of the Ministry of Health. The MOH directly oversees the public system, FONASA and regulates the private system of 13 insurance companies (ISAPREs). The majority of the population (67%) is covered by FONASA, and about 15% are enrolled in ISAPREs. Employees are required to participate in either the public or the private system. The public system consists of the National Health Services System that is organized into 28 hospital and clinic service regions and the fund, FONASA. The government owns two-thirds of inpatient capacity with 200 hospitals and 1000 ambulatory centers. The National Services System covers a large segment of the population, including retirees and those below a certain income level. It also provides broad public health programs. The private system is mainly comprised of the 13 ISAPRES (Institutes of Public Health and Preventive Medicine). There are also small private insurers that are not part of the ISAPRES structure since they are not funded by mandatory contributions. It is interesting to note that the inspection of quality standards and financial oversight of the system are preformed by an independent government agency called the Superintendence of Health. In 2003 there were a total of 386 hospitals, 207 public and 179 private for and non-profit, including two that are JCI accredited. The national biometric identification system is also noteworthy. The fingerprint system is used by all public and private providers to immediately verify eligibility and benefits. The technology can also generate electronic vouchers to cover specific examinations, procedures, treatments and consultations. Both the public and private systems are financed in large part through mandatory contributions. The minimum required contribution is 7% of taxable income up to an inflation indexed maximum. Under the national public health care system, everyone has access to the same basic benefits, regardless of the level of their contributions. Those who choose an ISAPRE can choose to pay more for additional coverage. Those who cannot pay for coverage can access medical, dental, nursing and midwifery services at municipal primary care centers or National Health Service System hospitals. Persons who contribute to FONASA can receive treatment in the public health care system or they can choose a private provider and make a co-payment that is based upon income level. The ISAPRES are distinguished by the amount of co-payments and the level of coverage beyond the basic benefit package that is offered by FONASA. The ISAPREs generally work through a network of private

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providers with are either independent or under contract. Although the indicators of health status and patient satisfaction with both the public and private systems are high, gross inequalities between the public and private systems have been recognized, leading to system reform. A recent World Bank and WHO study found that more than 650,000 people were on waiting lists for public health care and a 70% difference in patient-to-physician ratio between the public and private sectors. A major reform aimed at reducing the gaps was launched in 2005 and is being phased in. The reform guarantees a basic uniform for listed conditions that applies equally to both plans. The list has been expanded each year to now total 80 conditions and procedures. The reform also enhances the decentralization of management authority in the public hospitals. The directors of the larger, more complex hospitals are to comply with national policy directives on procedures for cost measurement, quality of care, patient satisfaction and allocate most of their budgets to personnel. They can now direct execution of programs, design future plans and organize the institution internally. They are required to establish a patient’s advisory council with community and employee representation. Abstracted from: Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/ Hagen, K. (2009). How Health Care Covverage is Provided in Chile. Retrieved November 1, 2010, from Assocated Content: http://www.associatedcontent.com/article/2242119/ Mendez, C. A., & Torres, M. C. (2010). Hospital Management Autonomy in Chile: Challenges for Human Resources in Health. Rev. Saude Publica , 44 (2).

Merco Press. (2010, May 11). Dramatic Gap between Chile's Public and Private Health Care Sectors. Merco Press , pp. 3-5.

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Chile: Programs Country Chile

Institution University of Chile (Universidad de Chile) School of Public Health

Program(s) Diploma for Executive Development in Top Hospital Leadership

Website http://www4.saludpublica.uchile.cl/esp/;jsessionid=1BCBE58482020E38467ABD3519F08391 and http://www4.saludpublica.uchile.cl/esp/index.jsp

Address

Facultad de Medicina Escuela de Salud Publica Coordinación de Extension y Comunicaciones Av. Independencia 939, comuna de Independencia, Santiago, Chile.

Telephone/Fax Phone: (56-2)978-6146 or 978-6536

Affiliations Unknown

University Contact(s) Name and Title

Dr. Juan Margozzini Roca Director Program Specialists in Public Health Daniela Araneda Repossi

Telephone/Fax Phone: (56-2) 978 652

Email jmargozzini@med.uchile.cl and brebolle@med.uchile.cl

Language(s) Spanish

Duration of Each Program

10 Months (200 Hrs.) 3 Modules including 5 Courses and 1 workshop (in 2011 they will convert this diploma into a Master in Hospital Administration in collaboration with Johns Hopkins University).

Country Chile

Institution

University of Chile (Universidad de Chile) School of Economy and Business IAS Institute of Health Administration (Instituto de Administración en Salud)

Program(s) (1) Diploma in Management of Health Organizations DEGIS (Diploma en Gestión de Instituciones de Salud) (2) MBA with a concentration in Health Services

Website (1)http://www.ias.uchile.cl/ (2)http://www.postgradouchile.cl/mba/mba-para-profesionales-de-la-salud/

Address Diagonal Paraguay 257 Piso 19, Oficina 1901 Santiago de Chile

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Chile

Telephone/Fax (56-2)978-3558

Affiliations Unknown

University Contact(s) Name and Title

Dr. Vito Sciaraffia M. Director IAS

Telephone/Fax (1) (56-2)978-3340 and 978-3337 (2) (56-2)222-8159, 222-9323 and FAX: 222-9750

Email (1) decanato@fen.uchile.cl (2) nriveros@fen.uchile.cl

Language(s) Spanish

Duration of Each Program

(1) 10 months (176 Hrs.) The program is offered in 3 other locations besides Santiago. La Serena, Osorno and Concepcion. (2) The MBA is two year and the concentration in Health Services includes 4 introductory courses (58 Hrs.) and 3 quarters (4 courses with 96 Hrs.+ 4 courses with 96 Hrs.+ 3 courses with 102 Hrs.)

Number of Graduates Per Year N/A

Year Program(s) Started

27 years old. Since 2007 they offer again the MBA with a concentration of 3 quarters in Health Services.

Country Chile

Institution University Andres Bello ISF-Institute Health and Future (Instituto Salud y Futuro)

Program(s) (1) MBA with a specialization in Health (2) Diploma in Management of Health Organizations (3) Diploma in Quality Management for Health Services (4) Diploma in Quality Management in Health Sciences

Website

http://www.institutosaludyfuturo.cl/salud/site/edic/base/port/programa_portada.php (1)http://www.institutosaludyfuturo.cl/salud/site/edic/base/port/programa_mba.php (2)http://www.institutosaludyfuturo.cl/salud/site/edic/base/port/programa_diplomado1.php (3)http://www.institutosaludyfuturo.cl/salud/site/artic/20091125/pags/20091125094640.php (4)http://www.postgradounab.cl/diplomado_gestion_calidad_ciencias_salud_2.html

Address Santiago de Chile: Av. Republica 237, Viña del Mar: 7 Norte # 1348

Telephone/Fax (56-2)661-8000

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Affiliations European University of Madrid; Johns Hopkins University and UNICOC (Institucion Universitaria Colegios de Colombia)

University Contact(s) Name and Title

Sr. Hector Sanchez Rodriguez (Director ISF) (1) Claudia Contreras (4) Ximena Burboa (Viña del Mar) (4)Paula Flores (Rancagua)

Telephone/Fax (56-32) 284-5072 (Viña del Mar) (56-72)221-1872 (Rancagua)

Email (1) claudiacontreras@unab.cl (4) xburboa@unab.cl (Viña del Mar) (4)pflores@unab.cl (Rancagua)

Language(s) Spanish

Duration of Each Program

(1) 2 years with 120 hrs. in the European University of Madrid (Spain) (2 & 3) 1 Semester (4) 2 semesters

Number of Graduates Per Year N/A

Year Program(s) Started

2005 an alliance with the European University of Madrid, School of Business (IEDE)

Country Chile

Institution University of Development (Universidad del Desarrollo) Facultad de Medicina

Program(s) (1) Master in Health Management (2) Diploma in Health Management

Website http://www.gestionsalududd.cl/

Address Barros Arana 1735 Concepcion, Chile

Telephone/Fax (56-2)327-9523 (Santiago) (56-41)226-8672 and 226-8584 (Concepcion)

Affiliations Comision Nacional de Acreditacion-Chile 2006-1011 Basbon College Clinica Alemana (Santiago Chile)

University Contact(s) Name and Title

Dr. Carlos Vukasovic Ranele (Director Postgraduate Program) Dra. Liliana Jadue Hund (Is the Director but now has been appointed Deputy Minister of Health of Chile) Pilar Sepulveda V/ Jannette Arriagada (Coordinators)

Email gestionsalud@udd.cl

Language(s) Spanish

Duration of Each (1) 1.5 years (2) 1 semester

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Program

Number of Graduates Per Year 2010: 90 graduates (not clear because includes other programs too)

Year Program(s) Started

2006

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China

POPULATION

% Urban Data not available

% Rural Data not available

Age Structure 0-14 years: 17.9% (male 128,363,812/female 109,917,641) 15-64 years: 73.4% (male 501,987,034/female 474,871,442) 65 years and over: 8.6% (male 55,287,997/female 59,713,369) (2010 est.)

Population 1,330,141,295 (July 2010 est.) HEALTH STATUS

Infant Mortality Rate

Total: 16.51 deaths/1,000 live births Male: 15.84 deaths/1,000 live births Female: 17.27 deaths/1,000 live births (2010 est.)

Life Expectancy at Birth

Total population: 74.51 years Male: 72.54 years Female: 76.77 years (2010 est.)

CHARACTERISTICS

Religions Daoist (Taoist), Buddhist, Christian 3%-4%, Muslim 1%-2%

Languages Standard Chinese or Mandarin (Putonghua, based on the Beijing dialect), Yue (Cantonese), Wu (Shanghainese), Minbei (Fuzhou), Minnan (Hokkien-Taiwanese), Xiang, Gan, Hakka dialects, minority languages

Geographic Size

Total: 9,596,961 sq km Land: 9,569,901 sq km Water: 27,060 sq km

ECONOMY

Economy

The Chinese government faces numerous economic development challenges, including over the next coming years. Economic development has been more rapid in coastal provinces than in the interior, and approximately 200 million rural laborers and their dependents have relocated to urban areas to find work. One demographic consequence of the "one child" policy is that China is now one of the most rapidly aging countries in the world. In 2009, the global economic downturn reduced foreign demand for Chinese exports for the first time in many years. The government vowed to continue reforming the economy and emphasized the need to increase domestic consumption in order to make China less dependent on foreign exports for GDP growth in the future.

GDP Per Capita $6,600 (2009 est.) GOVERNMENT

Type Communist State

Components 23 provinces, 5 autonomous regions, and 4 municipalities

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Form

Legal System: Based on civil law system; derived from Soviet and continental civil code legal principles; legislature retains power to interpret statutes; constitution ambiguous on judicial review of legislation; has not accepted compulsory ICJ jurisdiction Executive Branch: Chief of State: President Hu Jintao (since 15 March 2003); Head of Government: Premier WEN Jiabao (since 16 March 2003); Executive Vice Premier LI Keqiang (17 March 2008), Vice Premier Hui Liangyu (since 17 March 2003), Vice Premier ZHANG Deijiang (since 17 March 2008), and Vice Premier Wang Qishan (since 17 March 2008) Legislative Branch: Unicameral National People's Congress or Quanguo Renmin Daibiao Dahui Judicial Branch: Supreme People's Court (judges appointed by the National People's Congress); Local People's Courts (comprise higher, intermediate, and basic courts)

Government Departments Involved In Health Care

Ministry of Health

HEALTH CARE SPENDING

% of GDP 5.8% (est. 2001)

FACILITIES

Hospitals

Public As of 2005, there were 1141 for-profit hospitals. From 2010 to 2013, approximately 2000 community hospitals will be constructed

Private Data not provided

Health Centers Data not provided

THE HEALTH CARE SYSTEM

Description

China’s health system is described as being “in transition” or being in “disarray.” Descriptions of what it is usually began with what it is not-a centrally controlled and organized structure that is built upon a vast rural primary care system that assures most people to at least rudimentary care. That system was dismantled with the shift to capitalism in about 1980. The new emphasis was on decentralization. The years between then and now have left the country with great disparities in access between regions, cities, and urban and rural areas. It is estimated that less then one-third of the population can feel secure that it has a place to go for care. There are hundreds of local experiments in financing and organizing services. The primary care system has largely disappeared, so people go to hospitals for everything, which the hospitals, most of which are government owned, welcome

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because they must raise 90% of their income through “revenue generating activities”. Most of the 10% government support is based upon staff and bed size, which encourages large staffs and construction. The government helps doctors and hospitals generate revenue by setting the prices of high-tech diagnostic services above the cost and allowing a 15% profit margin on drugs, all of which drives up the costs to the population. Also, 75% of common cold patients and 79% of hospital patients are prescribed antibiotics with serious implications beyond the costs. Drugs represent 42.7% of expenditures per inpatient episode and 50.5% per outpatient visit. Hospital doctors are paid very poorly. However, yearly bonuses based on the revenue he or she brings in can be substantial. Many hospital doctors enhance their incomes by prescribing expensive drugs and expensive services. The few qualified health professionals are concentrated in the cities. The few doctors that remain in villages operate independently, without stable compensation and no service delivery infrastructure. Most doctors depend upon peddling black market drugs and costly treatments to patients, whether they need them or not. This bleak situation has been recognized by the government as being out of sync with the economic development of the country and a cause of social unrest. In 2006, there were nearly 10,000 incidents of violent protest against the care, or lack of it, provided by state hospitals. The central government has now placed a high priority on improving access and quality of care. Between 2006 and 2007, the central government health budget was increased 87%. In 2009, a major health care reform plan was approved. Introducing the plan, the official opinion of the CPC Central Committee stated that, “health care undertakings are developing unevenly between urban and rural areas and among different regions; resource allocation is unreasonable; the work of public health as well as rural and community health care is comparatively weak; the medical insurance system is incomplete; pharmaceutical production and circulation order is not well regulated; the hospital managerial system and operational mechanism are imperfect; government investment in health is insufficient; medical costs are soaring; individual burden is too heavy, and therefore the people’s reaction is very strong.” From 2010 to 2013 all levels of government are investing a total of US$124 billion to build or renovate local hospitals, health centers, and clinics. About 2000 new county-level hospitals will be constructed. The management and operation of public hospitals will be reformed in a pilot program in several cities. Public hospitals will be moved toward independent corporate status. Subsidies to insurance programs will be raised to extend coverage to more than 90% of the population. The drug system will be reformed to focus on essential drugs and to separate drug sales from hospital operations. There will be an effort to “regulate the qualifications for hospital management personnel, and gradually form a professional and specialized managerial team for health care institutions. Private insurance will be encouraged.” In 2006, the government launched a community health center development

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program that is intended to restore public health and primary care. The centers integrate Western and Chinese medicine through a program of prevention, health education, birth control, outpatient evaluation and management of common illnesses, case management of chronic illness and rehabilitation. The funding is coming from local governments. This plan of course confronts the health workforce shortage. In 2005, just 17% of China’s medical workers were university graduates. In rural areas only 2% were. There a number of efforts to provide health insurance, most of which provide minimal coverage. There is a voluntary contributory rural county medical cooperative program subsidized by the government, launched in 2005, that covers 25 to 30% of hospital costs for about 86% of the rural population. It is intended to reduce out-of-pocket costs, but the provider incentives continue to drive up the cost. About 120 million are enrolled in a program for urban workers (but not their dependents). Some cities and provinces provide additional subsidies, and companies and individuals can buy private insurance policies with limited coverage. All of these efforts have little real impact in the absence of more effective cost control. The government has also responded by encouraging private sector investment. It is official policy that for-profit hospitals will supplement the non-profit hospital system. In 2005 there were 1141 for-profit hospitals. It has been estimated that there are about 500 hospitals that have Western style management. Reflecting the policy, The Ministry of Health and Joint Commission International have an active MOU that included the recent translation of the international standards and their distribution throughout the country. There are eight JSI accredited hospitals, of which foreign companies own four. International investment in hospitals is expanding. Abstracted from: Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/ Government of China. (2009-2011). Implementation Plan for the Recent Priorities of the Health Care System Reform. Retrieved January 2, 2011, from China.org.cn: http://www.china.org.cn/government/scio-press-conferences/2009-04/09/content_17575401.htm

Government of China. (2009). Opinions of the CPC Centeral Committee and the State Council on Deepening the Health Care System Reform. Government of China.

Houggaard, J. L., Osterdal, L. P., & Yu, Y. (January 2008). The chinese Health Care System: Structure, Problems and Challenges Discussion Paper No. 08-1. Copenhagen: University of Copenhagen.

Sun, Q., Santoro, M. A., Meng, Q., Liu, C., & Eggleston, K. (July/August 2008).

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Pharmaceutical Policy in China. Health Affairs , 27 (2); 1042-1050.

Yip, W., & Hsiao, W. C. (March/April 2008). The chinese Health System at a Glance. Health Affairs , 27 (2); 460-468.

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China: Programs

Country China

Institution Nankai University (Flinders University)

Program(s) Masters of Health Administration

Website http://www.flinders.edu.au

Address Department of Health Care Management Health Sciences Building (Room 2.31) Flinders University Tanjin, China

Telephone/Fax Tel: +61 8 8201 7758

Affiliations SHAPE, ACHSM

University Contact(s) Name and Title

Janny Maddern – Head, Department of Health Care Management

Email janny.maddern@flinders.edu.au

Language(s) English

Duration of Each Program 1.5 years

Number of Graduates Per Year 100

Year Program(s) Started 2003

Country China

Institution Peking University Guanghua School of Management

Program(s) Health Management

Website http://english.pku.edu.cn/Academices_ Research/Humanities_Social_Sciences/

Address Office of External Relations Guanghua School of Management Peking University, Beijing 100871 The People’s Republic of China

Telephone/Fax Tel: 86-10-62765137/Fax: 86-10-62751471

Affiliations Unknown

University Contact(s) Name and Title

Ms. Fu Cang – Health Economics and Management

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Email smilefc00@gsm.pku.edu.cn

Language(s) English

Country China

Institution Fudan University School of Medical Sciences

Program(s) Training Center for Health Management

Website http://www.fudan.edu.cn

Address Not available

Telephone/Fax Tel: +8621 54237283

Affiliations Unknown

University Contact(s) Name and Title

Professor Wen Chen, PhD, MPH – Deputy Dean Xingyuan Gu – Professor

Email wenchen@fudan.edu.cn sltang@fudan.edu.cn

Language(s) Chinese

Country China

Institution Shandong Medical University School o Public Health

Program(s) Health Administration (Bachelors)

Website http://www.sph.sdu.edu.cn/english/intro.htm

Address Department of Health Care Management Health Sciences Building (Room 2.31) Flinders University Tanjin, China

Telephone/Fax Tel: 86 531 8382131

Affiliations SHAPE, ACHSM

University Contact(s) Name and Title

Dr. Qingyue Meng

Email qmeng@bjmu.sdu.cn

Language(s) Chinese

Duration of Each Program 5 years

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Number of Graduates Per Year 120

Year Program(s) Started 2000

Country China

Institution University of Macau

Program(s) (1) Health Policy and Management (Masters) (2) Health Policy and Management (PhD)

Website http://www.umac.mo

Address Av. Padre Tomás Pereira Taipa, Macau, China

Telephone/Fax Tel: +8621 63846590 776157

Affiliations Unknown

University Contact(s) Name and Title

Ying Bian, PhD, MPH - Associate Professor, Health Policy and Management

Email bianying@umac.mo

Language(s) Chinese

Duration of Each Program (1) 2 years, (2) 5 years

Number of Graduates Per Year N/A

Year Program(s) Started (1) 2002, (2) 2004

Country China

Institution University of Shangai Jaio Tong

Program(s) (1) Health Administration (Bachelors) (2) Health Administration (Masters) (3) Health Administration (PhD)

Website http://www.shsmu.edu.cn

Address N/A 

Telephone/Fax Tel: +8621 63846590 776157

Affiliations Unknown

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University Contact(s) Name and Title

Professor Jin Ma

Email majin@shsmu.edu.cn

Language(s) Chinese

Country China

Institution Xiamen University Center for Health Economics and Policy

Program(s) Health Administration courses

Website http://wise.xmu.edu.cn/english

Address Wang Yanan Institute for Studies in Economics (WISE) A307, Economics Building, Xiamen University Xiamen, 361005 China

Telephone/Fax Tel: 0086-592-2187878

Affiliations Unknown

University Contact(s) Name and Title

Dr. Ya Fang – Professor

Email fangya@xmu.edu.cn

Language(s) Chinese

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France 

POPULATION

% Urban Data not available

% Rural Data not available

Age Structure 0-14 years: 18.6% (male 6,160,071/female 5,866,997) 15-64 years: 64.9% (male 21,041,384/female 21,008,320) 65 years and over: 16.5% (male 4,470,839/female 6,220,778) (2010 est

Population 64,768,389 HEALTH STATUS

Infant Mortality Rate

Total: 3.31 deaths/1,000 live births Male: 3.63 deaths/1,000 live births Female: 2.98 deaths/1,000 live births

Life Expectancy at Birth

Total population: 81.09 years Male: 77.91 years Female: 84.44 years

CHARACTERISTICS

Religions

Roman Catholic 83%-88%, Protestant 2%, Jewish 1%, Muslim 5%-10%, unaffiliated 4% Overseas departments: Roman Catholic, Protestant, Hindu, Muslim, Buddhist, pagan

Languages French 100%, rapidly declining regional dialects and languages (Provencal, Breton, Alsatian, Corsican, Catalan, Basque, Flemish)

Geographic Size

Total: 643,427 sq km; 551,500 sq km (Metropolitan France) Land: 640,053 sq km; 549,970 sq km (Metropolitan France) Water: 3,374 sq km; 1,530 sq km (Metropolitan France)

ECONOMY

Economy

France is in the midst of transitioning from a modern economy to one that relies more on market mechanisms. It maintains a strong presence among sectors, particularly power, public transport, and defense industries. France's leaders are committed to retaining a capitalistic economy that maintains social equity through legislation, tax policies, and social spending that reduce income disparities. France has weathered the global economic crisis better than most other big EU economies as they are more resilient to consumer and government spending, and less exposure to the downturn in global demand.

GDP Per Capita $32,800 GOVERNMENT

Type Republic

Components

26 regions

France is divided into 22 metropolitan regions (including the "territorial collectivity" of Corse or Corsica) and 4 overseas regions (including French Guiana, Guadeloupe, Martinique, and Reunion) and is subdivided into 96 metropolitan

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departments and 4 overseas departments (which are the same as the overseas regions)

Form

Legal System: Civil law system with indigenous concepts; review of administrative but not legislative acts; has not accepted compulsory ICJ jurisdiction Executive Branch: Chief of State: President Nicolas Sarkozy (since 16 May 2007) Head of Government: Prime Minister Francois Fillon (since 17 May 2007) Cabinet: Council of Ministers appointed by the president at the suggestion of the prime minister Legislative Branch: Bicameral Parliament or Parlement consists of the Senate or Senat (343 seats; 321 for metropolitan France and overseas departments Judicial Branch: Supreme Court of Appeals or Cour de Cassation, Constitutional Council or Conseil Constitutionnel, Council of State or Conseil d'Etat

Government Departments Involved In Health Care

Ministry of Health

HEALTH CARE SPENDING

% of GDP 11.2% (est. 2005) FACILITIES

Hospitals

Public Around 62% of hospital beds are provided by public hospitals

Private 18 % of hospital beds provided by private non-profit organizations and around 20% by for-profit companies

Health Centers N/A

Others N/A

THE HEALTH CARE SYSTEM

Description

The well-known 2000 WHO report comparing world health systems found that France “provided the best overall health care.” The statement is repeated often and continues to be a widely held belief. France excels in prenatal and early childhood care. France has a universal national health insurance system with many features that shape cost, quality and access. The entire population of France pays for compulsory health insurance. Solidarity is fundamental of the system. The more ill a person becomes, the less they pay. This means that for people with serious or chronic illnesses, the insurance system

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reimburses them 100% of expenses and waives co-pays. The public scheme covers hospital care, ambulatory care and prescriptions. Co-insurance applies to all; 20% plus E16 daily for the first 31 days of hospital care, 30% for doctor visits and dental care. All citizens have a smart card containing the details of their insurance benefits. The non-profit insurers annually negotiate with the state regarding the overall funding of health care. Ninety-five percent of the public are covered by three main schemes, one for commerce and industry workers and their families, another for agriculture and the third for self-employed non-agricultural workers. Co-pays are required according to the rated effectiveness of the drug; from 0% for highly effective drugs to 35% for those of limited value. Cost sharing can be reimbursed by private insurance, carried by over 92% of the population, within prescribed limits. Private insurance is mainly provided by non-profit mutual funds. In recent years for-profit companies have started to offer coverage for other services. A government agency, The National Agency for Accreditation and Health Care Evaluation, is responsible for issuing practice recommendations and practice guidelines. Doctors are required to follow practice guidelines according to agreements between professional societies and the health insurance funds. Physicians are legally required to maintain professional knowledge through CME. Every five years physicians requited to undergo an external practice audit. Around 62% of hospital beds are provided by public hospitals, 18% by private non-profit organizations and around 20% by for-profit companies. The public hospitals have been financed primarily (91%) by endowment funding paid by the insurance funds, but a DRG system is being implemented for all hospitals. Through the Medical Care Program of Information, it is possible to calculate identical activities and services, the relative productivity of each establishment and adjust the endowments. Theoretically, the national rate is adjusted for macroeconomic factors (inflation, growth, the public deficit), politics (the “social peace of the establishments”) and rarely, technical considerations. The MOH appoints the heads of all hospital services. The MOH plans the number and sizes of hospitals, the allocation of major technologies (e.g. MRI and CT scans) and the supply of specialty wards. The private non-profits (originally denominational but now mainly foundations) are financed through endowments like the public hospitals but have the right to autonomy like the private clinics. There is cooperation between the public and private sector that allows citizens to avoid waiting lists for surgeries. The private sector provides over 50% of surgeries and over 60% of cancer care. It is generally agreed that quality of care is equal across all sectors. The mandatory accreditation system covers all hospitals and clinics. There is also a mandatory appraisal system for ambulatory care. Hospital-based physicians are audited in the accreditation process. The national “2012 Hospital Plan”

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committed 10 billion Euros to expand collaboration among facilities, upgrade security systems and improve the computerization of the hospital system to reduce duplication of tests, over-prescribing and facilitate the introduction of DRGs. Most general physicians are in private practice but draw much of their incomes from the publicly funded insurance funds. They are paid a reference fee but may charge more depending upon their level of experience. It is interesting to note that all doctors are required to share medical records. Hospital physicians (about 36%) and other providers are salaried, with advancement based on seniority. Within limits they are permitted to see private patients in the public hospitals. There is a nation-wide system of ranking hospital practitioners. Abstracted from: Brunner, S. (2009, June 28). The French Health Care System. Medical News Today .

Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/ Durand-Zaleski, I. (2009). The French Health Care System. Eurohealth , 14(1); 3-4.

Embassy of France. (2010). French Health Care System. Embassy of France.

Wikipedia. (2010). Health in France. Wikipedia. Retrieved October 22, 2010, from Wikipedia: http://www.wikipedia.org

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France: Programs

Country France

Institution École de Management Strasbourg (Strasbourg School of Management)

Program(s)

(1) M2 Management des organisations de santé (Management of Health Organizations)

(2) Executive MBA – Management Hospitalier et des structures de santé (EMBA in the Management of Hospitals and Health Structures)

Website http://www.em-strasbourg.eu/formations/master-mos-205.html

Address Ecole de Management Strasbourg - 61 avenue de la Forêt Noire - 67085 STRASBOURG

Telephone/Fax Tel : +33 (0)3 68 85 80 00 - fax : +33 (0)3 68 85 85 93

Affiliations Unknown

University Contact(s) Name and Title

Babak Mehnmanpazir, Ph.D. – Associate Professor, Maître de Conférences, Associate Dean For Programme Grande École

Email Babak.mehmanpazir@em-strasbourg.eu

Language(s) French

Duration of Each Program

(1) 6 months, (2) 9 months

Country France

Institution École des Hautes Études en Santé Publique EHESP School of Public Health

Program(s) (1) Hospital Administration Manager (2) Hospital Director

Website http://www.ehesp.fr/

Address Avenue du Professeur Léon-Bernard - CS 74312 - 35043 Rennes cedex

Telephone/Fax Tel : +33 (0)2 99 02 22 00/Fax : +33 (0)2 99 02 26 25

Affiliations EHMA

University Contact(s) Name and Title

M. Patrick Mordelet – Directeur Martine Bellanger – Director, MPH Program Bertrand Parent – Director, Executive Health MBA Program Stefane Kabene Christine Grenon

Email Martine.bellanger@ehesp.fr

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Bertrand.parent@ehesp.fr christine.grenon@ehesp.fr

Language(s) French, English

Duration of Each Program

(1) 6 months, (2) 27 months

Country France

Institution ESSEC Business School

Program(s) Healthcare Management

Website http://www.essec.edu/faculty/gerard-de-pouvourville

Address

ESSEC Business School Av. Bernard Hirsch B.P. 50105 95021 Cergy Pontoise Cedex France

Telephone/Fax +33 (0)1 34 43 39 90

Affiliations Unknown

University Contact(s) Name and Title

Gérard de Pouvourville, Ph.D. – Professor, Healthcare Management Department, Chair Health Economics Gregory Katz, Ph.D. – Associate Professor

Email pouvourville@essec.fr katz@essec.fr

Language(s) French, English

Country France

Institution

Institut de Formation et de Recherche des Organisations Sanitaires et Sociales (IFROSS) (Institute for Training and Research of Health and Welfare Organizations) Housed in Jean-Moulin University Lyon 3 Law Center

Program(s)

(1) Licence Professionnelle: Management des Services Sanitaires, Sociaux et Médico-Sociaux Licensed Professional : Management of Health Care and Social Welfare Services

(2) Master Spécialité : Management des Pôles Hospitaliers et des Fonctions de support Specialty Masters : Management of Hospital Areas and Functions of Support

C A H M E | 73

Website http://www.ifross.com/

Address Université Jean Moulin Lyon 3 IFROSS 18 rue Chevreul 69007 LYON

Telephone/Fax Tél : 04 78 78 75 81

Affiliations EHMA

University Contact(s) Name and Title

Christophe Pascal Florence Dumas

Email christophe.pascal@univ-lyon3.fr florence.dumas@univ-lyon3.fr

Language(s) French

Duration of Each Program

(1) 2 years (2) License or equivalent – 2 years, Master niveau 1 – 2 year

Country France

Institution INSEAD

Program(s) Healthcare Management Initiative

Website http://www.insead.edu

Address INSEAD Social Innovation Centre Boulevard de Constance 77305 Fontainebleau Cedex France

Telephone/Fax Tel: + 33 (0) 1 60 72 41 89

Affiliations EHMA, GBSN, EQUIS

University Contact(s) Name and Title

Professor Stephen Chick – Academic Director ANA-Cristina De Sa – Centre Coordinator Professor H. Landis Gabel

Email Stephen.chick@insead.edu Landis.gabel@insead.edu

Language(s) French, English

Country France

Institution Institut Supérieur de Communication et de Management Médical (ISCMM) (Superior Institute of Communication and Medical Management)

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Program(s) Executive Specialized Master in Healthcare Management

Website www.iscmm.fr

Address 191 rue de Vaugirard 75015 PARIS

Telephone/Fax Tél. 01 53 94 52 94

Affiliations Unknown

University Contact(s) Name and Title

General inquiries

Email iscmm@iscmm.fr

Language(s) French

Duration of Each Program

2 years

Country France

Institution Pierre & Marie Curie University

Program(s) Spécialité : économie et management des systèmes de santé (M2) (Specialty : Economy and Management of Health Systems)

Website http://www.upmc.fr/

Address Université Paris Dauphine Place du Mal de Lattre de Tassigny 75775 Paris cedex 16 - bureau A526

Telephone/Fax 01.44.05.43.50

Affiliations Unknown

University Contact(s) Name and Title

Reinsch Léa – Administrator

Email Lea.reinsch@dauphine.fr

Language(s) French

Country France

Institution Sciences Po

Program(s) Executive master Gestion et politiques de santé (Executive Master – Management and Health Policy)

Website http://sciences-po.fr

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Address Sciences Po 28 rue des Saints-Pères 75007 Paris

Telephone/Fax Tel: + 33 (0)1 45 49 63 09

Affiliations EHMA, GBSN, EQUIS

University Contact(s) Name and Title

Didier Tabuteau – Director Isabelle Gourio - Admissions

Email isabelle.gourio@sciences-po.fr Didier.tabuteau@sciences-po.fr

Language(s) French, English

Country France

Institution Université Montpellier 1

Program(s)

1) Master : Droit, Economie, Gestion (Master : Law, Economics, and Management) 2) Mention : Droit et Gestion de la Santé (Mention : Law and Management of Health) 3) Specialité: Administration Et Management Des Etablissements

Publics De Santé (Specialty : Administration and Management of Public Health Institutions)

Website http://offre-formation.univ-montp1.fr

Address Université Montpellier 1 Service Communication 5 bd Henri IV - CS 19044 34967 Montpellier Cedex 2

Telephone/Fax +33(0)4.67.41.74.00

Affiliations Unknown

University Contact(s) Name and Title

General inquiries

Email sri@univ-montp1.fr

Language(s) French

Duration of Each Program

1 year

C A H M E | 76

Country France

Institution Université Paris Descarte

Program(s)

Licence Professionnelle: Management des organisations: Gestion des établissements du secteur de la santé

(Professional License: Management of organizations: Management of Health Sector Institutions)

Website http://formations.univ-paris5.fr/ws?_cmd=getFormation&_oid=P5-PROG6398&_redirect=voir_fiche_program&_onglet=1&_lang=fr-FR

Address 143, avenue de Versailles 75016 PARIS France

Telephone/Fax +33 (0) 1 42 86 46 74 / 75 / 76

Affiliations Unknown

University Contact(s) Name and Title

Administrator

Email secretariat-lp-mgt-iut@parisdescartes.fr

Language(s) French

C A H M E | 77

India 

POPULATION

% Urban 29% of total population (2008)

% Rural No data available

Age Structure

0-14 years: 30.1% (male 187,397,168/female 165,403,830) 15-64 years: 64.6% (male 391,430,598/female 366,256,167) 65 years and over: 5.3% (male 29,806,029/female 32,814,226) (2010 est.)

Population 1,173,108,018 (July 2010 est.) HEALTH STATUS

Infant Mortality Rate

Total: 49.13 deaths/1,000 live births Male: 47.7 deaths/1,000 live births Female: 50.73 deaths/1,000 live births (2010 est.)

Life Expectancy at Birth

Total population: 66.46 years Male: 65.46 years Female: 67.57 years (2010 est.)

CHARACTERISTICS

Religions Hindu 80.5%, Muslim 13.4%, Christian 2.3%, Sikh 1.9%, other 1.8%, unspecified 0.1% (2001 census)

Languages Hindi 41%, Bengali 8.1%, Telugu 7.2%, Marathi 7%, Tamil 5.9%, Urdu 5%, Gujarati 4.5%, Kannada 3.7%, Malayalam 3.2%, Oriya 3.2%, Punjabi 2.8%, Assamese 1.3%, Maithili 1.2%, other 5.9%

Geographic Size

Total: 3,287,263 sq km Land: 2,973,193 sq km Water: 314,070 sq km

ECONOMY

Economy $3.56 trillion (2009 est.) (GDP purchasing power parity)

GDP Per Capita $3,100 (2009 est.) GOVERNMENT

Type Federal Republic

Components 28 states and 7 union territories

Form

Legal System: Based on English common law; judicial review of legislative acts; accepts compulsory ICJ jurisdiction with reservations; separate personal law codes apply to Christians, Hindus, and Muslims

Government Departments Involved In Health Care

General Insurance Company (GIC) Ministry of Health

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HEALTH CARE SPENDING

% of GDP 5% (est. 2006)

Government Government expenditure on health amounts to 2.9% of total government expenditures. 17.3% is spent from government funds.

Private 82.7% from private and out-of-pocket sources. Of the total private expenditure on health, 93.8% is out of pocket, the rest is funded by social health insurance for employees and dependents.

FACILITIES

Hospitals

Public There are approximately 469,672 beds available in public hospitals located in both rural and urban areas.

Private

Recent information on hospitals and beds in the private sector is not available. As of 1993, 66% of total hospitals and 35% of total bed capacity came from the private sector. Today this is estimated to be approximately 3,327 hospitals and 265,137 beds.

Facilities:

Institutional Type Number of Hospitals

Allopathic Medicine/Public Health (government/public)

Rural primary health centers 23,109 Rural subcenters 142,655 Community health centers 3,080 Other rural hospitals 884 CHCs in urban locations 433 Other urban hospitals 2,256 Institutional Type Number of Beds

Allopathic Medicine/Public Health (government/public)

Total publicly funded rural hospital 111,872 Total publicly funded urban hospital 292,813 Total government-funded open to public 469,672

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Institutional Type Number of Hospitals

Indian Systems of Medicine and Homeopathy

Hospitals (including 450 medical colleges) 1,110 Institutional Type Number of Beds

Indian Systems of Medicine and Homeopathy

Medical college hospitals 24,880

THE HEALTH CARE SYSTEM

Description

There are two medical India(s): the country that provides high-quality medical care to middle-class Indians and medical tourists and the India in which the majority of the population lives - a country whose residents have limited or no access to quality care. Only 25% of the population have access to Western medicine, which is practiced mainly in the urban areas, where two-thirds of Indian hospitals and health centers are located. In terms of revenue and employment healthcare is one of the India’s largest and fastest growing sectors. The healthcare industry is projected to grow 23% per annum to touch US$ 77 billion by 2012 from the current estimated size of US $35 billion. The private sector accounts for over 80% of total healthcare spending. The principal responsibility for public health funding lies with the state governments which provided about 80% of public funding. The federal government contributes about 15% through targeted programs. In 2002 there were 15,400 hospitals and the number has increased substantially since then. About two-thirds are public and provide only basic care. With a few notable exceptions public facilities are inefficient, poorly managed and staffed and have poorly maintained equipment. In 2007 WHO estimated that India would need 450,000 additional beds by 2010. The government was expected to contribute only 15-20% of the total, leaving an enormous gap to the private sector. Ernst & Young estimates a need for 1.75 million more beds by 2025. It is estimated that the country needs 75,000 community health centers but has less than half of that number. At least 11 states do no have laboratories for testing drugs and more than half of existing laboratories are not properly equipped or staffed. The shortage of trained medical personnel is another major challenge. It is complicated by both the pattern of exporting talent and the difficulty of attracting qualified people to work in rural areas. There are over 250 Western medical colleges that graduate over 250,000 doctors annually and about 400 schools of the Indian system of medicine and homeopathy.

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Private firms provide about 60% of all outpatient care and as much as 40% of the hospital beds. There are 13 JCI accredited hospitals and several more are In the applications stage. The government is moving to encourage a domestic accreditation program. In response to real and anticipated growth in private insurance and medical tourism there has been an enormous growth in “super specialty” hospitals, many of which are partnerships of Indian and foreign companies. For example, Wockhardt Hospitals Group partnered with Harvard Medical International to create a chain that is attracting medical tourists from the UK and US. Furthermore, Sahara Group is planning a 200-bed tertiary care hospital, a 1,500-bed specialty hospital and 30-bed multi-specialty hospitals in 217 townships. Telemedicine is a fast-growing trend based upon the urban-rural disparity and the growth of the information and technology sectors. Several major hospitals have adopted telemedicine services and public-private partnerships. There are about 120 telemedicine centers throughout the country with at least 60 more in development by the Asian Heart Institute and 100 by the Indian Space Research Organization. ISRO has linked 25 major hospitals and will link 650 district hospitals by 2011. The lack of health insurance is a major challenge. It is estimated that 20 million people a year fall below the poverty line because of inability to pay healthcare costs. Only about 11% of the population has any form of coverage. The main provider is the government-run General Insurance Company (GIC). In 2004-05, only 1% of the population was covered by private health insurance. It is important to keep in mind that 1% is millions of people. There are several new government insurance programs that will increase the number of covered lives significantly in the coming five years. There has been a recent liberalization to allow the growth of the private insurance market. In response, a large number of international insurance companies are moving into India and are forming joint ventures. The number of private policies sold is increasing, though only reaching a small percentage of the market. It is not expected go grow very fast because all are indemnity policies. Medical tourism is one of the major drivers of growth in the health sector. English-speaking medical staff, state-of-the-art private hospitals and diagnostic facilities and relatively low cost address the high costs in much of the industrialized world. The private hospitals excel in cardiology, joint replacement, orthopedic surgery, gastroenterology, transplants and urology. In 2004, there was an estimated 180,000 medical tourists. With an annual growth rate of 25-30%, the number will reach one million very soon. The Indian government actively supports medical tourism. A vast medical city is under construction on the outskirts of Delhi. It will include a 900-bed hospital for 17 super specialties, a medical and para-medical school and a major telemedicine center.

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Abstracted from: Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/ PricewaterhouseCoopers. (2007). Healthcare in India: Emerging Market Report. Chicago: PricewaterhouseCoopers.

C A H M E | 82

India: Programs

Country India

Institution Administrative Staff College of India (ASCI)

Program(s) Post Graduate Diploma in Hospital Management

Website http://www.asci.org.in/healthcare_writeup.asp

Address Center for Healthcare Management, College Park Campus, Road No.3, Banjara Hills Hyderabad – 500034

Telephone/Fax +91 40 66720708

University Contact(s) Name and Title

Dr. Anirban Sengupta – Professor and Director, Centre for Healthcare Management

Email asengupta@asci.org.in

Language(s) English

Country India

Institution Apollo Institute of Health Administration (AIHA)

Program(s) Master in Hospital Management

Website www.apolloiha.ac.in

Address Apollo Health Street Road No 2, Film Nagar, Hyderabad, Andhra Pradesh 500033, India 040 2354 3269

Telephone/Fax +91 (40) 23607777 23543269

University Contact(s) Name and Title

General Inquiries

Email info@apolloiha.ac.in

Language(s) English

Duration of Each Program

2 years

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Country India

Institution Armed Forces Medical College

Program(s) Post graduate MD Course in hospital administration offered

Website http://afmc.nic.in/hospital_administration.html

Address Armed Forces Medical College, Wanowrie, Pune - 411040

Telephone/Fax Contact no: +91 020 - 26306003

University Contact(s) Name and Title

Brig Sanjiv Chopra, VSM

Email Email contacts not provided on website

Language(s) English

Country India

Institution Devi Ahilya Vishwavidyalaya Institute of Management Studies

Program(s) MBA Hospital Administration

Website http://www.dauniv.ac.in/MBA_Admission_Notice.php

Address Registrar DAVV R.N.T. Marg Indore (M.P.), India Pin-452 001

Telephone/Fax +91 731-2527532

Affiliations Unknown

University Contact(s) Name and Title

Dr. P.K. Gupta - 2478800

Email registrar.davv@dauniv.ac.in General Inquiries

Language(s) English

Duration of Each Program

2 years

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Country India

Institution Dr. N.G.P. Arts & Science College

Program(s) (1) M.Sc Hospital Administration (2) M.Phil Hospital Administration

Website http://www.drngpasc.ac.in

Address Dr.N.G.P. - Kalapatti Road, Coimbatore - 641 048. Tamil Nadu. INDIA

Telephone/Fax +91 0422-2628944

University Contact(s) Name and Title

General Inquiries

Email drngparts@kmch.ac.in

Language(s) English

Duration of Each Program

(1) 2 years, (2) 1 year

Number of Graduates Per Year (1) 36, (2) 4

Country India

Institution Dr. Reddy’s Foundation for Health Education MoU with Osmania University (As of 4/29/2010)

Program(s) Postgraduate Diploma in Healthcare Management (PGDHM)

Website http://www.drfhe.com/education-initiative.html

Address 6-3-864/5, RPAS Chambers, Opp.Green Park Hotel, Ameerpet, Hyderabad-500016 India.

Telephone/Fax Telephone No: +91 040-66511584/88

University Contact(s) Name and Title

General Inquiries

Email drfhe@drreddys.com namratak@drreddys.com

Language(s) English

Duration of Each Program

5 months

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Year Program(s) Started

2003

Country India

Institution Indian Institute for Health Management Research

Program(s) (1) Post Graduate Diploma in Hospital and Health Management

(PGDHM) (2) Post Graduate Degree in Rural Management (PGDRM)

Website http://www.iihmr.org/

Address 1, Prabhu Dayal Marg, Sanganer Airport, Jaipur - 302 011

Telephone/Fax 91-141-3924700

University Contact(s) Name and Title

S.D. Gupta, MD, PhD – Director Ashok Agrawal, PhD Dr. K.S. Srinivasa Rao – Director, Bangalor

Email sdgupta@iihmr.org iihmr@iihmr.org Graduate Program ksrao@iihmr.org

Language(s) English

Country India

Institution

Indian Institute of Management Centre for Management of Health Services (CMHS)

*Developing health related teaching and research base at IIM Ahmedabad jointly with Nuffield Institute for Health, Leeds University

Program(s) Specific degree program not listed on website

Website http://www.iimahd.ernet.in/

Address Center for Management of Health Services Indian Institute of Management Vastrapur, Ahmedabad – 380 015 India

Telephone/Fax +91 -79-66323456 / 26308357

Affiliations IIMB, EQUIS

University Contact(s) Name and Title

Professor B. Dolakai – President B.H. Jajoo – Dean Professor K.V. Ramani – Center for Management of Health Services

C A H M E | 86

Email director@iimahd.ernet.in jajoo@iimahd.ernet.in ramani@iimahd.ernet.in

Language(s) English

Country India

Institution Indian Society of Health Administrators

Program(s)

(1) Post Graduate Programme in Hospital Administration leading to MHA

(2) Post Graduate Programme in Health Management leading to MHA

(3) Post Graduate Programme in Public Health leading to MHA (4) Evening Post Graduate Programme for senior managers leading to

MBA

Website http://www.ishaindia.com/html/trainee.htm

Address 3009, II-A Main, 17th Cross, Banashankari Iind Stage, K R Road, Bangalore – 560 070

Telephone/Fax +91 080-26771313 / 26772223

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email ashoksah@blr.vsnl.net.in

Language(s) English

Country India

Institution Indira Gandhi National Open University

Program(s) Postgraduate Diploma in Hospital and Health Management (PGDHHM)

Website http://www.ignou.ac.in

Address Indira Gandhi National Open University Maidan Garhi, Newdelhi-110068 India

Telephone/Fax Tel: +91 29533078 / Fax: +91 29534935

Affiliations Unknown

University Contact(s) Dr. Bimla Kapoor – Director, School of Health Sciences

C A H M E | 87

Name and Title

Email bkapoor@ignou.ac.in

Language(s) English

Duration of Each Program

1 year

Country India

Institution K.E.M. Hospital Healthcare Management Institute

Program(s) Postgraduate Diploma in Healthcare Management (PGDHM)

Website http://kemhospitalhmi.com/

Address

K.E.M. Hospital Banoo Coyaji Building, 6th floor, Opp Diabetes unit, Healthcare Management Institute, Rasta Peth, Pune – 411 011.

Telephone/Fax Tel: +91 020-66203435

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email kemhospitalmgtcourse1@gmail.com

Language(s) English

Duration of Each Program

1 year

Country India

Institution National Institute of Health and Family Welfare

Program(s) (1) Diploma in Health Administration (2) Post Graduate Diploma in Public Health Management (PGDPHM) (3) Certificate Course in Hospital Management Through Distance

Learning

Website http://nihfw.org/

Address National Institute of Health and Family Welfare Munirka, New Delhi-110067

Telephone/Fax +91 11-2616 5959

C A H M E | 88

Affiliations Unknown

University Contact(s) Name and Title

D. J.K. Daas - Dean

Email nihfw@mantraonline.org dean@nihfw.org

Language(s) English

Duration of Each Program

(1) 2 years, (2) 1 year (3) 1 year

Number of Graduates Per Year (1) 6, (2) 30

Country India

Institution National Institute of Preventive and Social Medicine

Program(s) MPH in Hospital Management

Website http://www.nipsom.org/

Address National Institute of Preventive and Social Medicine (NIPSOM) Mohakhali, Dhaka -1212, Bangladesh

Telephone/Fax Tel: +91 880-2-8821236

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email nipsom@dhaka.net Director@nipsom.org

Language(s) English

Duration of Each Program

1 year

Country India

Institution Nizam’s Medical College

Program(s) Master in Hospital Management (MHM)

Website http://nims.ap.nic.in

Address Punjagutta, Hyderabad - 500 082, Andhra Pradesh, India

Telephone/Fax +91 40-23489000

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Affiliations Unknown

University Contact(s) Name and Title Dr. P. V. Ramesh, IAS – Director

Email pvrameshun@gmail.com

Language(s) English

Duration of Each Program 2 years

Number of Graduates Per Year 20

Country India

Institution Sri Ramachandra Medical College & Research Institute

Program(s) MBA (Hospital & Health Systems Management – Fulltime)

Website http://www.sriramachandra.edu.in

Address Thiru. V. Swaminathan Additional Registrar (Law) Sri Ramachandra University Porur, Chennai - 600 116

Telephone/Fax +91 2476 5625

Affiliations Unknown

University Contact(s) Name and Title

Registrar

Email registrarsru@gmail.com

Language(s) English

Duration of Each Program

2 years

Number of Graduates Per Year 30

Country India

Institution St. Johns National Academy of Health Sciences St. John's Institute of Health Management and Paramedical Studies

Program(s) Post Graduate Certificate Course in Health Care Administration

C A H M E | 90

Website http://www.stjohns.in/news/Health%20Care%20Administration.pdf

Address

St. John's National Academy of Health Sciences Sarjapur Road Bangalore Karnataka State India 560 034

Telephone/Fax +91 080 22065105/264

Affiliations Unknown

University Contact(s) Name and Title

F.Thomas Kalam – Director

Email tkalam@gmail.com

Language(s) English

Duration of Each Program

11 months

Number of Graduates Per Year 20

Country India

Institution Symbiosis Institute of Healthcare

Program(s) MBA – Hospital & Healthcare Management

Website http://www.sihspune.org/mba.html

Address P-26, C.I.T Road, Scheme-VIM, Kolkata 700054, West Bengal, India.

Telephone/Fax Tel. +91 95525 99863

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email admission_hhm@sihspune.org

Language(s) English

Duration of Each Program

2 years

Number of Graduates Per Year 80

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Country India

Institution Tamil Nadu Open University

Program(s) MBA in Hospital Administration

Website http://www.tnou.ac.in/index/MBA_files/pdf/MBA(HA)2008.pdf

Address Tamil Nadu Open University Directorate Of Technical Education Campus, Guindy, Chennai 600 025.

Telephone/Fax Ph: +91 044-22300704

Affiliations Unknown

University Contact(s) Name and Title

Dr. S.N. Geetha, MBA, M.Phil, Ph.D. – Professor and Head, School of Management Studies

Email Yes_en@yahoo.co.uk

Language(s) English

Duration of Each Program

2 years

Country India

Institution TATA Institute of Social Sciences (TISS)

Program(s) (1) Master of Health Administration (2) Master of Hospital Administration

Website http://www.tiss.edu/Admissions/masters-programmes.php#1

Address P.O. Box 8313, Deonar, Mumbai 400 088.

Telephone/Fax Tel: +91-22-25525000

Affiliations Unknown

University Contact(s) Name and Title

Professor S. Parasuraman, MSc, CPS, DPD, PhD – Director

Email sparasuraman@tiss.edu

Language(s) English

Duration of Each Program

(1) Minimum – 2 years, Maximum – 5 years (2) Minimum – 2 years, Maximum – 5 years

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Country India

Institution Tripura Institute of Paramedical Sciences

Program(s) Bachelor in Hospital Management (BHM)

Website http://www.bipstrust.org/tips/courses_bhm.html

Address P-26, C.I.T Road, Scheme-VIM, Kolkata 700054, West Bengal, India.

Telephone/Fax +91 09830939433

Affiliations Tripura university (A Central University)

University Contact(s) Name and Title

Soumen Mukherjee

Email sormenmuk@gmail.com

Language(s) English

Duration of Each Program

3 years

Number of Graduates Per Year 60

Year Program(s) Started

2009

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Israel 

POPULATION

% Urban Data not available

% Rural Data not available

Age Structure 0-14 years: 27.9% (male 1,031,629/female 984,230) 15-64 years: 62.3% (male 2,283,034/female 2,221,301) 65 years and over: 9.9% (male 311,218/female 402,289) (2010 est.)

Population 7,233,701

HEALTH STATUS

Infant Mortality Rate

Total: 4.22 deaths/1,000 live births Male: 4.39 deaths/1,000 live births Female: 4.05 deaths/1,000 live births (2010 est.)

Life Expectancy at Birth

Total population: 80.73 years Male: 78.62 years Female: 82.95 years (2010 est.)

CHARACTERISTICS

Religions Jewish 76.4%, Muslim 16%, Arab Christians 1.7%, other Christian 0.4%, Druze 1.6%, unspecified 3.9% (2004)

Languages Hebrew (official), Arabic used officially for Arab minority, English most commonly used foreign language

Geographic Size

Total: 22,072 sq km Land: 21,642 sq km Water: 430 sq km

ECONOMY

Economy

Israel has a technologically advanced market economy. Israel's GDP grew about 5% per year from 2004-07. The global financial crisis of 2008-09 caused a brief recession in Israel, but the country entered the crisis with guarded fiscal policy and a series of liberalizing reforms. Due to a resilient banking sector, the economy has shown signs of an early recovery. Following GDP growth of 4% in 2008, Israel's GDP grew by 0.5% in 2009 and was expected to expand in 2010.

GDP Per Capita $28,400 (2009 est.) GOVERNMENT

Type Parliamentary Democracy

Components Six districts (mehozot, singular - mehoz); Central, Haifa, Jerusalem, Northern, Southern, Tel Aviv

Form

Legal system: Mixture of English common law, British Mandate regulations, and in personal matters, Jewish, Christian, and Muslim legal systems; has not accepted compulsory ICJ jurisdiction. Executive branch:

C A H M E | 94

Chief of State; President Shimon Peres (since July 15, 2007) Head of Government: Prime Minister Binyamin Netanyahu (since March 31, 2009) Legislative branch: Unicameral Knesset (120 seats; political parties are elected by popular vote and assigned seats for members ob a proportional basis; members serve four-year terms) Judicial branch: Supreme court (justices appointed by Judicial Selection Committee – made up of all three branches of the government)

Government Departments Involved In Health Care

Ministry of Health

HEALTH CARE SPENDING

% of GDP 8.7%

Government Data not provided

Private Data not provided FACILITIES

Hospitals

Public Data not provided

Private Data not provided

THE HEALTH CARE SYSTEM

Description

The 1995 National Health Insurance Law (NHI) mandates all residents to register with a sick fund. The NHI is a population-wide social insurance, administered by four major competing sick funds. It led to a legally defined universal standard basket of services. The major funding sources are social insurance contributions, tax subsidy and modest amounts of copayments. While the mandatory insurance offers a wide range of entitlements, supplemental insurance plays a marginal (but growing) role. It offers coverage for the costs of private physicians, treatment in private clinics, and complementary medicine. Israelis can choose the fund they want to register with. The largest fund, Clalit, covers just over 50% of the population. The sick funds are legally independent entities, but the Ministry of Health is responsible overall. It sets the rules, defines benefits, is involved in the planning and allocation of budgets, sets hospital benefits and imposes limits on public spending as well as on the number of physicians. While the MOH has strengthened it oversight of the sick funds since the enactment of the NHI, it has the reputation of being a somewhat ineffective regulator. Part of this reputation results from the fact that the MOH owns eleven hospitals with two-thirds of the general hospital beds. There are seven private hospitals and seven run by Chalit.

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The insured can seek supplementary insurance offered both by sick funds and by private health insurance (about 34% of the population chose the latter, but this share has not increased in recent years). In 1998, the government set up a Public Committee to assess the addition of new services by way of a technology assessment. The committee decides which services will be included based upon ethical, economic and social criteria. Health services include hospitals owned by the government and sick funds, clinics owned by sick funds, and private for-profit hospitals, laboratories and institutional care. While Israelis can, and do, exercise choice of hospital, referrals generally specify a particular provider. Hospitals receive capped budgets, though the funds typically reimburse 50% of budget overruns. National professional associations of hospital physicians, nurses and other providers negotiate salaries on behalf of their members. In Jerusalem, physicians are permitted private work in hospitals under strict regulation. Many physicians in public hospitals have after-hours private practice and perform procedures at private hospitals. The collective bargaining and active participation of the main organized stakeholders gives providers of care strong veto position. Through control over hospital reimbursement rates, the MOH has been able to stabilize health expenditure. The Ministry has been less effective at regulating quality of care. Lacking resources and confronting less-than complete cooperation from physicians’ associations, it has not been able to create a framework for ongoing quality assurance in provision and insurance. All sick funds and hospitals have developed electronic patient records (EPRs), which aim to improve the appropriateness, coordination, and continuity of care. However, the EPRs differ with each constituent of the system. There is no standard data model and, often, more than one type of model per hospital. While the sick funds shy away from alienating members by restricting free choice of provider, there is some channeling of patients to preferred providers in the spirit of selective contracting. One incentive for this behavior is the “capping” of hospital budgets. Each sick fund pays every general hospital a combination of DRG, fee-for-service, and per diem payment. Based upon estimates of expected use, each sick fund pays full price up to a budget cap, with a 50% discount above the cap. The sick funds thus have an incentive to channel patients to hospitals that have exceeded the cap. Abstracted from: Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/ Chinitz, D., & Meislin, R. (2009). Israel: Partial Health Care Reform as Laboratory for Ongoing Change. In K. G. Okma, & L. Crivelli, Six Countries, Six Reform Models: The Healthcare Reform Experience of Israel, The Netherlands, New Zealand, Singapore, Switzerland and Taiwan (pp. 25-41). London: World Scientific.

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Israel: Programs

Country Israel

Institution Ben-Gurion University of the Negev Faculty of Health Sciences

Program(s) Master of Health Systems Management (MHSM)

Website http://cmsprod.bgu.ac.il/eng/fohs

Address Ben-Gurion University of the Negev P.O.B. 653 Beer-Sheva 84105 Israel

Telephone/Fax +97286477408972

Affiliations Unknown

University Contact(s) Name and Title

Shifra Shvarts, Ph.D. – Chair, Department of Health Systems Management Dr. Joseph Pliskin – Head, Division of Public and Social Health Sciences Dov Chernichovsky

Email shvarts@bgu.as.il jpliskin@bgu.ac.il dov@bgu.ac.il

Language(s) English, Hebrew

Country Israel

Institution Braun School of Public Health and Community Medical Centre

Program(s) International MPH

Website http://publichealth.huji.ac.il/eng/programs.asp

Address P.O. Box 12272 Jerusalem 91120 Israel

Telephone/Fax (972-2) 677-8074

Affiliations Unknown

University Contact(s) Name and Title

Michal Gutman – Administrator, International MPH Program

Email michalg@hadassah.org.il

Language(s) English

Duration of Each Program

2 years

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Country Israel

Institution Galillee College Israel Study Centre on Kibbutz Mizra

Program(s) Health Systems Management

Website http://www.galilcol.ac.il/page.asp?id=21

Address P.O. Box 208, Nahalal, 10600, Israel

Telephone/Fax (972-4) 642 8888

Affiliations Unknown

University Contact(s) Name and Title

Mrs. Z. Kaufman Dr. Gabriel Plotkin – Academic Director, Dept. of Health Management

Email zkaufman@galilcol.ac.il quin@zahav.net.il

Language(s) English, French, Spanish

Duration of Each Program

3 weeks

Country Israel

Institution Hebrew University School of Public Health Department of Health Policy and Management Health Administration

Program(s) Health Administration Program

Website http://publichealth.huji.ac.il/eng/programs.asp?cat=100&in=0

Address P.O. Box 12272 Jerusalem 91120 Israel

Telephone/Fax 972-2 677-7115

Affiliations Unknown

University Contact(s) Name and Title

David Chinitz

Email Chinitz@cc.huji.il

Language(s) Hebrew, English

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Country Israel

Institution Tel Aviv University Sackler Faculty of Medicine

Program(s) Master of Health Systems Administration (MHA)

Website http://recanti.tau.ac.il/

Address

Tel Aviv University School for Overseas Students Carter Building Ramat Aviv 69978 ISRAEL

Telephone/Fax (212) 742-9030, (800) 665-9828

Affiliations Unknown

University Contact(s) Name and Title

Dr. Aharonson Barak – Lecturer, Faculty of Management

Email aharonson@stern.nyu.edu

Language(s) English

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Mexico 

POPULATION

% Urban 77% of total population (2008)

% Rural No data available

Age Structure 0-14 years: 28.7% (male 16,469,087/female 15,786,614) 15-64 years: 64.9% (male 35,290,051/female 37,723,834) 65 years and over: 6.4% (male 3,238,802/female 3,960,467) (2010 est.)

Population 112,468,855 (July 2010 est.) HEALTH STATUS

Infant Mortality Rate

Total: 17.84 deaths/1,000 live births Male: 19.71 deaths/1,000 live births Female: 15.88 deaths/1,000 live births (2010 est.)

Life Expectancy at Birth

Total population: 76.26 years Male: 73.45 years Female: 79.22 years (2010 est.)

CHARACTERISTICS

Religions Roman Catholic 76.5%, Protestant 6.3% (Pentecostal 1.4%, Jehovah's Witnesses 1.1%, other 3.8%), other 0.3%, unspecified 13.8%, none 3.1% (2000 census)

Languages

Spanish only 92.7%, Spanish and indigenous languages 5.7%, indigenous only 0.8%, unspecified 0.8%; Note - indigenous languages include various Mayan, Nahuatl, and other regional languages (2005)

Geographic Size

Total: 1,964,375 sq km Land: 1,943,945 sq km Water: 20,430 sq km

ECONOMY

Economy $1.482 trillion (2009 est.) (GDP purchasing power parity)

GDP Per Capita $13,500 (2009 est.) GOVERNMENT

Type Federal Republic

Components 31 states

Form Mixture of US constitutional theory and civil law system; judicial review of legislative acts; accepts compulsory ICJ jurisdiction with reservations

Government Departments Involved In Health Care

Mexican Institute of Social Security (IMSS)

HEALTH CARE SPENDING

% of GDP 5.9%

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Government Approximately 25% of Mexicans insured through the public insurance.

Private Serves about three million of those who pay private insurers for access to high quality services.

FACILITIES

Hospitals

Public 1,107 hospitals and 19,103 public health facilities (78,643 beds)

Private 3,082 (33,931 beds)

Health Centers N/A

Others IMSS – (215 general hospitals, 41 specialty hospitals and 1,077 primary care clinics)

THE HEALTH CARE SYSTEM

Description

The Mexican health care system has been described as a “patchwork of evolving and sometimes confusing services in a country still suffering from diseases of the developing world, such as tuberculosis and malaria. Meanwhile, first world maladies have also been emerging—the World Health Organization lists diabetes as the leading cause of death in Mexico, followed by heart and liver disease.” Mexicans have everything from a small, private system to huge universal health insurance programs that mix private, public and employer funding. According to PAHO, it is an unequal system since the various providers receive different levels of payment and provide different levels of care at various levels of quality. However, it is a system in the process of a fundamental transition that is aimed at correcting the most serious imbalances. The private sector serves about three million (2-3% of the population) wealth and middle class Mexicans. They pay private insurers for access to high quality services. It has been estimated that up to 25% of Mexicans who are insured through the public insurance systems also pay out of pocket for private care. The private provider sector is “booming.” It includes 3,082 facilities of which only 75 have 50 or more beds. Most are small: 153 have 25-49 beds, and 2,854 have 24 or less. In the past five years several domestic and international chains have entered the market, often by acquiring small hospitals. The large hospitals include several highly regarded not-for-profit institutions. Beds in the private sector total 33,931. About 50 million salaried Mexicans, approximately 40% of the population, and their families belong to the Mexican Institute of Social Security (IMSS). Members, employers and the government contribute, with the employee paying according to their wage level. IMSS runs 215 general hospitals, 41 specialty hospitals and 1,077 primary care clinics throughout the country. There is significant variation in the quality of facilities between the large cities and small towns. Seventeen million public employees (7 % of the population) and their families are enrolled in the Institute of Security and Social Services for Civil Servants (ISSSTE) which operates a separate system of 95 hospitals and over 1000 clinics. There are also separate insurance schemes for the military and PEMEX, the national

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petroleum company, which operates 724 hospitals and clinics. Up until 1994, this system of parallel insurance systems segmented between insured, formal, salaried employees and their families with the right to social security-with many benefits in addition to health care- and the self-employed, unemployed, non-salaried and informal-sector workers. This population was the responsibility of the Ministry of Health. The benefits were not defined, and services were funded from a combination of federal funds, state contributions and fees. Access and quality varied markedly across the country and were (or are) particularly weak in the large rural area of the country. There are a total of 1,107 public hospitals and 19,103 public clinics, with a total of 78,643 beds. Most of the public hospitals are managed centrally by the institutions to which they belong. Budgets are usually allocated on a historical basis. Oversight is norm-based, and managers generally have little decision-making authority. Public hospitals can sell services to IMSS, private insurers and other public institutions. The managers of public facilities are subject to state and federal human resource management legislation. IMSS and the states are bound by agreements with national unions of all employees that further limit institutional workforce management. Fourteen large specialty hospitals are exceptions. They include national institutes, university hospitals and large federal hospitals, located in Mexico City. These facilities have traditionally operated autonomously, possessing legal personality and governing boards. They are required to adhere to laws governing permanent personnel. The uninsured, roughly 45 million, are in the process of gaining basic coverage through Seguro Popular (PHI), the most ambitious health services development since the beginning of IMSS in 1943. The program was launched in 2004 and is being phased in. Families pay an income-based premium. About 20% of the poorest do not pay. When fully implemented, PHI will cover primary care, outpatient consultation, and hospitalization for the basic specialties. The number of covered interventions and medications is gradually being expanded to include 255 interventions targeting more that 90% of the service demand causes. Most of the services are provided by the service networks of the states, which have their own hospitals and clinics, and they retain their own salaried health staffs. The package of guaranteed services is a quality assurance tool, since every facility is accredited on the basis of having the resources to provide the listed interventions. Before 2003, the year the reform passed, the financial structure of the health system was marked by serious imbalances. In 2003, Mexico spent only 6.1% of GDP on health care. This was below the Latin American average and too low to address the epidemiological transition to chronic disease. Second, out-of-pocket spending accounted for more than half of total health spending. Although the uninsured are almost half of the population, they received only a third of the federal funding for health. Further, there was a five-to-one difference in spending per capita across states, and the differences in state contributions were even more dramatic. This situation creates tremendous inequalities, which are the target of the PHI. By the end of 2007, 20 million people were covered by PHI.

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Abstracted from: Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/ Frenk, J., Gomez-Dantes, O., & Knaul, F. M. (2009). The Democratization of Health in Mexico: Financial Innovations for Universal Coverage. Bulletin of the World Health Organization , pp. 87: 542-548.

Knaul, F., & Frenk, J. (2005). Health Insurance in Mexico: Achieving Universal Coverage Through Structural Reform. Health Affairs , 24; 1467-76.

Massachusetts Mexico Office. (2009). Mexican Health Care System. Retrieved November 2010, from Massachusetts Mexico Office: http://www.moiti.state.ma.us/export_marketfocus_mexico.asp

Ruelas, E. (2008, March 25). A Comprehensive Country-Wide Strategy Towards Quality and Safety in a Health Care System. (M. Lecture, Performer) Georgetown University, Washington, DC.

Whyte, S. (2000, May 4). How Mexico's Health System Works. CBC News Glovbal Header .

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Mexico: Programs Country Mexico

Institution

Anahuac University [Universidad Anáhuac] (1) IDEA/CADEN (Institute of Entrepreneurship Development/ Center for Top Leadership in Economy and Business/)[Instituto de Desarrollo Empresarial Anáhuac/Centro de Alta Dirección en Economía y Negocios] (2) School of Health Sciences [Facultad de Ciencias de la Salud]

Program(s) (1) Master in Economy and Business with Emphasis in Health Care Organizations (IDEA/CADEN) (2) Master in Direction of Health Institutions (School of Health Sciences)

Website

(1) http://www.anahuac.mx/idea/capacitacion.diplomados.10.html (CADEN-IDEA) (2)http://www.anahuac.mx/medicina/archivos/Maestria%20en%20Direccion%20de%20Instituciones%20de%20Salud%202.pdf (School of Health Sciences)

Address Av. Universidad Anáhuac #46, Col. Lomas Anáhuac. Huixquilucan, Edo. de México, C.P. 52786

Affiliations In collaboration with Hospital ABC The programs are authorized by the Secretary of Public Education of Mexico.

University Contact(s) Name and Title

(1) Laura Iturbide Galindo, General Director (2) Dr. Adrián Peña Sánchez, Academic Coordinator

Telephone/Fax

(1) Tel: (52-55) 5328-8069 Fax: (52-55) 5627-0210 Ext. 8602 (2) Tel. 01 800 508 9800 and (52-55) 5627-0210 Ext 7100 and 7190

Email (1) liturbid@anahuac.mx (2) adrain.pena@anahuac.mx

Language(s) Spanish

Duration of Each Program

(1) Master’s Program in six trimesters and has 18 courses (2) Master’s Program in 4 semesters and has 14 courses

Number of Graduates Per Year

(1) Diploma that is not offered now graduated 100 in 4 years including 20 from the Mexican Institute of Social Security (IMSS)

(2) Current Master’s Program admits about 20 students a year. On Year 1 they graduated 7 individuals.

Year Program(s) Started

(1) They offered a Diploma Program for 4 years. The current program started in 2008 (2) The Program will start in August of 2011

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Country Mexico

Institution

National Autonomous University of Mexico [UNAM-Universidad Nacional Autónoma de México] School of Accounting and Administration [Facultad de Contaduría y Administración]

Program(s) Master in Health Systems Administration (MASS-Maestria en Administracion de Sistemas de Salud)

Website http://posgrado.fca.unam.mx/ma_administracion.php http://posgrado.fca.unam.mx/docs/maestrias/MASS.pdf

Address Circuito Exterior s/n de Ciudad Universitaria Delegación Coyoacán C.P. 04510 Cubículo 2 del edificio de Posgrado de la FCA Mexico D.F., Mexico

Telephone/Fax (52-55) 5622-8478

Affiliations Unknown

University Contact(s) Name and Title

Dr. Jorge Ruiz de Esparza, Director Dr. Gabino Garcia Tapia, Program Coordinator

Telephone/Fax (52-55) 5622-8455

Email gabino@correo.unam.mx

Language(s) Spanish

Duration of Each Program

4 semesters

Number of Graduates Per Year 15-20

Year Program(s) Started

1977

Country Mexico

Institution National Institute of Public Health [Instituto Nacional de Salud Publica]

Program(s)

(1) Doctorate in Public Health Sciences with Concentration in Health Systems (2) Master in Health Sciences with concentration in Health Systems (3) Master in Management and Direction of Health (4) Diploma in Leadership and Management Health Competencies

Website

http://insp.mx/centros/sistemas-de-salud/bienvenida.html http://www.insp.mx/informacion-academica/oferta-academica/maestria-en-salud-publica/areas/administracion-en-salud-sedes-cuernavaca-y-tlalpan.html

Address Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C. P. 62100, Cuernavaca, Mor. México.

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Telephone/Fax Tel. (777) 101-2900

Affiliations Unknown

University Contact(s) Name and Title

(1) Dr. Gustavo Nigenda López, Coordinator Doctoral Program (2 & 3) Dr. Juan Francisco Molina Rodriguez, Coordinator of the Area of Health Leadership (4) Dr. Mario Salvador Sanchez Dominguez, Coordinator Diploma

Telephone/Fax Tel. (777) 101-2900

Email (1) gnigenda@insp.mx (2 & 3) jmolina@insp.mx (4) mario.sanchez@insp.mx

Language(s) Spanish

Duration of Each Program

(1) 3 years (2 & 3) 4 semesters and has 19 courses. (4) 160 Hrs./16weeks

Number of Graduates Per Year

(2&3) There are approximately 12-20 graduates every year (4) from 2005-2007 16 courses were given with 614 graduates

Year Program(s) Started

The School of Public Health of Mexico was established in 1922. Since 1987 is part of the new INSP. The doctoral program started in 1991.

Country Mexico

Institution La Salle University [Universidad La Salle A.C.]

Program(s) Master in Administration of Health Organizations School of Medicine (Facultad Mexicana de Medicina)

Website http://www.ulsa.edu.mx/educativa/maestrias/salud/

Address Facultad Mexicana de Medicina Universidad La Salle Fuentes #17 (esq. Av. San Fernando), Colonia Tlalpan, Delegación Tlalpan C.P. 14000, México D. F.

Telephone/Fax Tel: (5255) 52-78-95-00

Affiliations Unknown

University Contact(s) Name and Title

Sra. Fabiola Rivera Zamudio

Telephone/Fax Tel: (5255) 52-78-95-00 Ext. 2117

Email rzof@ulsa.mx

Language(s) Spanish

Duration of Each Program

8 to 9 semesters (4 months long) and 18 courses.

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Number of Graduates Per Year N/A

Year Program(s) Started

The University is 200 years old and the program has operated for several years.

Country Mexico

Institution Inter-American Center for Social Security Studies (CIESS) [Centro Interamericano de Estudios de Seguridad Social]

Program(s) (1) Diploma in Health Management (2) Master in Social Security Administration (3) Specialization in Long Term Care Management

Website

(1) http://www.ciss.org.mx/ciess/index.php?id=diploma_hm (2) http://www.ciss.org.mx/ciess/index.php?id=master_administrationss (3) http://www.ciss.org.mx/ciess/index.php?id=2do_curso_especializacion

Address Calle San Ramón S/N Col. San Jerónimo Lídice C.P. 10 100. Delegación M. Contreras México, D.F

Telephone/Fax Tel:(5255) 5377-4734 Fax: (5255) 5377-4707

Affiliations (1 & 2) courses offered in collaboration with the UNAM

University Contact(s) Name and Title

Dra. Raquel Abrantes Pêgo Coordinación Académica CIESS

Telephone/Fax Tel: (5255) 5377-4734

Email (2) maestria.administracion@ciss.org.mx (3) especializacion.adultomayor@ciss.org.mx

Language(s) Spanish

Duration of Each Program

(1) Mixed mode (distance 4 months and face-to-face 10 days. The course has 4 modules. (2) 4 semesters with 16 courses. Executive program with on line activities and face-to-face activities 1 week at the beginning and 1 week at the end of each semester. (3) 380 Hrs. 36 weeks of work on line and 1 week face-to-face seminar in CIESS Mexico.

Number of Graduates Per Year Participants to these courses come from all of Latin America.

Year Program(s) Started

(1) Offered in 1010. Courses have been offered since 1970 (2) Course offered for a second time in 2010

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Country Mexico

Institution Monterrey Technologic Institute [Instituto Tecnológico y de Estudios Superiores de Monterrey]

Program(s) (1) Bachelor in Health Systems Management (2) Diploma in Health Services Management

Website

(1)http://www.itesm.edu/wps/wcm/connect/itesm/tecnologico+de+monterrey/carreras+profesionales/areas+de+estudio/negocios+y+administracion/las (2)http://extension.ccm.itesm.mx/educacioncontinua/industria_farmaceutica_y_salud/gestion_de_unidades_de_servicio_de_salud._2010-05-28.html

Address (1) Ave. Eugenio Garza Sada 2501 Sur, Col. Tecnológico C.P. 64849, Monterrey, N.L., México (2) Calle del Puente 222, Col. Ejidos de Huipulco, 14380, Tlalpan, Mexico, D.F.

Telephone/Fax (1) (52- 81) 8158 2269 & 01 800 (2) Tel: (52-55) 5483-2020 Fax: (52-55) 5673-2500

Affiliations Unknown

University Contact(s) Name and Title

Ana María Álvarez Salazar Director of Academic Programs

Telephone/Fax (52-55) 5483 2379

Email ana.alvarez@itesm.mx

Language(s) Spanish

Duration of Each Program

10 semesters

Number of Graduates Per Year N/A

Year Program(s) Started

2007

Country Mexico

Institution University of Monterrey [Universidad de Monterrey] School of Business

Program(s) Master in Hospital and Health Services Administration

Website http://www.udem.edu.mx/posgrados/maestria_en_administracion_de_hospitales_y_servicios_de_salud/tema/plan_de_estudios/4287/4289/1

Address Edificio 6, oficina 6117 Av. Morones Prieto 4500 Pte. San Pedro Garza García, N. L. México

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C. P. 66238

Telephone/Fax 52 (81) 8215-1000

Affiliations Unknown

University Contact(s) Name and Title

Guadalupe Martinez de Leon, Director of the Academic Program

Telephone/Fax 52 (81) 8215-1000 Ext 1567

Email gmartinez30@udem.edu.mx

Language(s) Spanish

Duration of Each Program

6 semesters (4 months each) and 22 courses

Country Mexico

Institution Benemerit Autonomous University of Puebla [Benemérita Universidad Autónoma de Puebla]

Program(s) Master in Health Services Administration

Website http://www.viep.buap.mx/posgrado/cpb/m17.htm www.buap.mx/aspirantes/maestrias/medicina/administracion/

Address Facultad de Medicina Secretaría de Investigación y Estudios de Posgrado Calle 13 sur 2903, Col. Volcanes, Puebla, Pue. C.P. 72400

Telephone/Fax Tel: 52 (222) 229 55 00 ext. 6301 y 6303

Affiliations Unknown

University Contact(s) Name and Title

M.A.S.S. Edith López Ramírez Program Coordinator

Telephone/Fax 52 (222) 229 5500 ext. 6301 y 6303 Fax: 52 (222) 243 1444

Email mass.med@mail.buap.mx

Language(s) Spanish

Duration of Each Program

Two years and 23 courses.

Number of Graduates Per Year N/A

Year Program(s) Started

1993

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Country Mexico

Institution Olmeca University [Universidad Olmeca]

Program(s) Master in Leadership and Hospital Management

Website http://www.olmeca.edu.mx/index.php?option=com_content&view=article&id=112&Itemid=79

Address Constitución Esquina Lerdo #1001 Comalcalco, CP 09230, Tabasco, Mexico

Telephone/Fax Tel: (52-933) 1 87 97 00

Affiliations Secretary of Education of the State of Tabasco

University Contact(s) Name and Title

Mtra. Veronica Solis Ramirez Coordinator Master Program

Telephone/Fax Tel: (52-933)1 87 97 00. EXT. 230 Linea Directa (52-933)1 87 97 16

Email vsolis@olmeca.edu.mx posgradosuo@olmeca.amedu.mx

Language(s) Spanish

Duration of Each Program

Four semesters and 28 courses.

Number of Graduates Per Year N/A

Year Program(s) Started

2004

Country Mexico

Institution Veracruz University [Universidad Veracruzana]

Program(s) Master in Health Services Administration

Website http://www.uv.mx/posgrado/programas/Informesmsaludpr.html

Address Boulevard Lázaro Cárdenas No. 801, Col. Morelos Poza Rica, Veracruz, México.

Telephone/Fax Tel: (52-782) 824-57-00

Affiliations Unknown

University Contact(s) Name and Title

Mtra. Sofia Gámez VelázquezProgram Coordinator

Telephone/Fax Tel: (52-782) 824-57-00

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Email sgamez@uv.mx

Language(s) Spanish

Duration of Each Program

5 semesters and 25 courses. (1 of the 5 semesters and 6 courses are preparatory)

Number of Graduates Per Year Approximately 20

Year Program(s) Started

N/A but has operated for several years

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Philippines

POPULATION

% Urban 65% of total population

% Rural 35% of total population

Age Structure 0-14 years: 34.9% (male 17,809,044/female 17,104,237) 15-64 years: 60.9% (male 30,384,504/female 30,410,691) 65 years and over: 4.2% (male 1,808,966/female 2,382,735)

Population 99,900,177 (July 2010 est.) HEALTH STATUS

Infant Mortality Rate

Total: 19.94 deaths/1,000 live births Male: 22.49 deaths/1,000 live births Female: 17.26 deaths/1,000 live births

Life Expectancy at Birth

Total population: 71.38 years Male: 68.45 years Female: 74.45 years

CHARACTERISTICS

Religions Roman Catholic 80.9%, Muslim 5%, Evangelical 2.8%, Iglesia ni Kristo 2.3%, Aglipayan 2%, other Christian 4.5%, other 1.8%, unspecified 0.6%, none 0.1%

Languages

Filipino (official; based on Tagalog) and English (official); eight major dialects - Tagalog, Cebuano, Ilocano, Hiligaynon or Ilonggo, Bicol, Waray, Pampango, and Pangasinan

Geographic Size

Total: 300,000 sq km Land: 298,170 sq km Water: 1,830 sq km

ECONOMY

Economy The economy faces several long-term challenges. The Philippines must maintain the reform momentum in order to improve trade, alleviate poverty, and improve employment opportunities and infrastructure.

GDP Per Capita $3,300 GOVERNMENT

Type Republic

Components 80 provinces and 120 chartered cities

Form

Executive Branch: Chief of State: President Benigno Aquino (since 30 June 2010); Vice President Jejomar Binay (since 30 June 2010) Legislative Branch: Bicameral Congress or Kongreso consists of the Senate or Senado and the House of Representatives or Kapulungan Ng Nga Kinatawan

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Judicial Branch: Supreme Court (15 justices are appointed by the president)

Government Departments Involved In Health Care

PhilHealth

HEALTH CARE SPENDING

% of GDP 3.9%

Government N/A

Private N/A FACILITIES

Hospitals

Public 700

Private Between 595 and 1180 reported (85,000 beds based on 1180 figure)

Health Centers N/A

Others N/A

THE HEALTH CARE SYSTEM

Description

The Philippines consists of more than seven thousand islands and has the world’s twelfth largest population. Of the 90 million people, 27 million survive on a dollar a day, the World Bank poverty threshold. A former chief of the Philippine Department of Health described the health situation as “a fragmented system with a dysfunctional health workforce, which results in great disparity between healthcare for the rich and poor.” The Health Care Financing Strategy for 2008-2017 characterizes health care as “underfunded, offering limited protection against the cost of illness and having an inefficient use of health resources.” Public sector spending on health care is very low, less than 3% of GDP. Outside of the for-profit hospitals and insurance plans, health management information is rudimentary. The continuing exodus of doctors and nurses has a devastating impact. Drug prices are among the highest in the world. The Philippine Health Insurance Corporation (PHIC), or PhilHealth, the publicly sponsored national health insurance company, does not yet provide universal coverage. All citizens are required to enroll eventually. The number of uninsured fell to 24% in 2009. The coverage figure is misleading because many of those with insurance, limited as it is, do not use it because they do not understand how it works. Benefits are capped and limited mainly to inpatient care, so copayments can be high. Studies show that out-of-pocket expenses account for nearly 60% of health spending, private providers or HMOs for 20% and PhilHealth for 12-15%. Ninety percent of the top users of PhilHealth are private tertiary facilities. It is also important to note that despite the increasing availability of national health insurance the number of hospital beds has not increased. Another important reality is the limited protection of PhilHealth is also closely related to the fee-for-

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service payment system. As physicians provide more services and raise prices with no limit on extra-billing, medical care expenses increase at a rapid rate. The patient’s co-payment increases accordingly. There is a national network of public-sector facilities (including about 700 hospitals) that provide integrated health services. The public facilities are financed by local government units, but the funding does not support their operating costs. Many, if not most, are in poor condition and lack up-to-date technology. The shortfalls are covered by payments from the PHIC and user fees. There has been some privatization of public hospitals in recent years. The health care workforce is in crisis. Sixty percent of Filipinos die without professional medical attention. In March 2010 it was reported that 200 hospitals have closed and 800 are partially closed due the lack of health personnel. Most of these are in the poorest states and are run by local government units or by the national government. It has been suggested that “a commercial market philosophy pervades all programs of teaching and training institutions-including the best of government-supported agencies such as the University of the Philippines Manila.” The country produces approximately 2000 doctors per year from 30 schools. The number of medical graduates is actually declining, with a decrease in the number of students and the closing of some medical schools. It should be noted that the quality of medical education is considered to be high. At the same time the number of nursing schools (350) and students has steadily increased, with the nursing curriculum clearly designed for labor export. Each year between 5000 and 8000 nurses leave the country. Around 4000 of the nursing students are doctors preparing to leave the country. They constitute 76% of the foreign nurse graduates in the US. A low percentage of the graduates pass the licensure examination, and 70% of those that do obtain foreign employment. Many of those that remain within the country will not work in public facilities because of the low pay. Rural clinics tend to be staffed by midwives. Seventy percent of all health workers are estimated to be employed in the private health sector, which serves only the 20-30% of the population who can pay. They are almost all in the three largest metropolitan areas (Metro Manila, Cebu and Davao) where the best private hospitals and most of the public hospitals are concentrated. Fifty percent of the members of the Philippine College of Physicians are in Metro Manila. Only ten percent of the country’s doctors, dentists, pharmacists, 20 percent of medical technicians, and 35 % of nurses work in rural areas. The private hospital/medical center sector is thriving, operating in a world that is distinct from that described above. A recent University of the Philippines report characterized the private sector as “dominated by commercial interests of a segment of the system that is not really about health outcomes, but is primarily about bottom-line profits.” The number of hospitals is difficult to clarify. According to some reports, there are approximately 1180 private hospitals with about 85,000 beds. Other data report a recent drop to 595. Some are owned by corporations with investments in several unrelated fields. Two-thirds of the

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reimbursements by PhilHealth are to private hospitals. Private hospitals are required to provide emergency treatment to poor patients and are expected to transfer them to government facilities when stable. Comment: It is an interesting market in that most of the hospital administrators are practicing doctors. There has been a small shift in the private sector with big facilities hiring from the business sector. The graduate program at the University of the Philippines has been operating for many years. Most of the graduates are physicians who work in the public sector. The Philippine College of Hospital Administrators has limited impact outside of the yearly conference. Abstracted from: Bernabe, K. (2010, April 13). Health Care Beyond Reach of Poor, Say Critics. Philippine Daily Inquirer Headlines .

Center for Legislative Development. (2009, August 26). A Study on the Financing Burden of Health Care in the Philippines. Prepared for the Health Policy Network, Manila .

Center for Legislative Development. (2006, Manila). Issues and Problems on Access to Health Services: A Policy Perspective. Prepared for the Health Policy Network .

Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/

Conde, C. (October 2004). A Sick Health Care System. Bulatlat , Vol. IV., No. 37.

University of the Phlippines Forum. (July-August 2010). Blueprint for Universal Health Care 2010-2015. Manila: University of the Phlippines.

World Health Organization. (2008). Philippines: Country Health Information. Geneva: World Health Organization. 

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Philippines: Programs Country Philippines

Institution Ateneo de Manila University

Program(s) Master of Business Administration in Health

Website http://www.admu.edu.ph/

Address Katipunan Avenue, Loyola Heights, Quezon City 1108, Philippines

Telephone/Fax (+632) 426 6001

Affiliations Unknown

University Contact(s) Name and Title

Alberto L. Buenviaje, MBA – Dean, AGSB; Executive Director Ma. Eufemia C. Yap, MD, M.Sc – Director, Health Unit

Email abuenviaje@aps.ateneo.edu meyap@aps.ateneo.edu

Language(s) English

Country Philippines

Institution University of the Philippines Manila College of Public Health

Program(s) (1) Master of Hospital Management (2) Master of Arts in Health Policy Studies

Website http://www.upcph.info/DHPA.htm

Address Department of Health Policy & Administration College of Public Health 625 P. Gil Street Ermita Manila

Telephone/Fax Tel: +63 (0)2 524 27 03 Fax: +63 (0)2 523 13 94

Affiliations Unknown

University Contact(s) Name and Title

Dr. Nina G. Gloriani – Dean, College of Public Health Dr. Ma. Susan E. Yanga – Mabunga – Chair, Department of Health Policy and Administration

Telephone/Fax +63 (2) 524 2703

Email ninagloriani@gmail.com

Language(s) English

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Country Philippines

Institution University of Santo Thomas

Program(s) Master of Arts major in Hospital Administration

Website http://graduateschool.ust.edu.ph

Address Manila, Philippines

Telephone/Fax (632) 740-9732

Affiliations Unknown

University Contact(s) Name and Title

Lilian J. Sison, Ph.D. – Dean

Email odgs@mnl.ust.edu.ph

Language(s) English

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Saudi Arabia 

POPULATION

% Urban Data not found

% Rural Data not found

Age Structure 0-14 years: 38% (male 5,657,533/female 5,435,799) 15-64 years: 59.5% (male 9,731,831/female 7,655,385) 65 years and over: 2.5% (male 369,538/female 357,191)\

Population 29,207,277

HEALTH STATUS

Infant Mortality Rate

Total: 11.2 deaths/1,000 live births Male: 12.73 deaths/1,000 live births Female: 9.6 deaths/1,000 live births

Life Expectancy at Birth

Total population: 76.51 years Male: 74.41 years Female: 78.71 years

CHARACTERISTICS

Religions Muslim 100%

Languages Arabic

Geographic Size

Total: 2,149,690 sq km Land: 2,149,690 sq km Water: 0 sq km

ECONOMY

Economy

Saudi Arabia is encouraging the growth of the private sector in order to diversify its economy and to employ more Saudi nationals. Efforts are focused on diversification in sectors such as power generation, telecommunications, natural gas exploration, and petrochemical sectors. There are approximately 5.5 million foreign workers that play an important role in the Saudi economy, particularly in the oil and service sectors. Saudi officials are focused on the future employment of its youth population, which currently lacks the education and technical skills the private sector needs. Riyadh has substantially boosted spending on job training and education, most recently with the opening of the King Abdallah University of Science and Technology - Saudi Arabia's first co-educational university. The government has begun establishing six "economic cities" in different regions of the country to promote economic development.

GDP Per Capita $20,400 (2009 est.) GOVERNMENT

Type Monarchy

Components 13 provinces

Form Legal System: Based on Sharia Law, several secular codes have been introduced; commercial

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disputes handled by special committees; has not accepted compulsory ICJ jurisdiction Executive Branch: Chief of State: King and Prime Minister Abdallah bin Abd al-Aziz Al Saud (since 1 August 2005); Heir Apparent Crown Prince Sultan bin Abd al- Aziz Al Saud (half brother of the monarch) Legislative Branch: Consultative Council or Majlis al-Shura (150 members and a chairman appointed by the monarch to serve four-year terms) Judicial Branch: Supreme Council of Justice

Government Departments Involved In Health Care

Ministry of Health (MOH) Ministry of Defense and Aviation (MODA) Ministry of the Interior (MOI) National Guard (SANG)

HEALTH CARE SPENDING

% of GDP 3.4% (Est. 2007) FACILITIES

Hospitals

Public 220 operated through MOH

Private 87 facilities, 622 dispensaries, 785 clinics, 45 laboratories and 11 physiotherapy centers

Health Centers 1,925

Others

THE HEALTH CARE SYSTEM

Description

Saudi Arabia has the largest health care sector in the Middle East and it is destined to grow substantially in the next few years. Health and social affairs comprise 11.3 % of the 2010 State Budget, an increase of 51% over the 2009 budget when health and social affairs accounted for 8.5% of the total. Most of the increase is for staffing the large and growing number of hospitals and medical centers. Up to 92 new hospitals may be added to the system. A vast expansion of the primary care network is also underway, with emphasis on reorganization of the infrastructure, strengthening the referral system, integration of preventive programs and coordination with other health sectors. The Saudi healthcare system is in effect a national health care system that is decentralized through a number of national government agencies. Overall authority for the public system and regulation of the private sector rests with the Ministry of Health. The MOH provides services through 220 general and specialized hospitals and a network of 1,925 health centers. MOH hospitals have 63% of the beds. The MOH hospitals follow a standard design of 150, 250 and

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350 beds located in population centers, supplemented by 20/50-bed clinics in small towns. There are three other large national systems that provide comprehensive services to define security and armed forces populations. They are the Ministry of Defense and Aviation (MODA) with 8% of the beds, the Ministry of the Interior, with 7% of the beds (MOI) and the National Guard, 3% (SANG). There are a number of other smaller systems that provide comprehensive services to students, mental health services, sports programs, universities, the national oil company (ARAMCO) and airlines. The military hospitals are usually around 350 beds and are mainly primary care facilities. There are also three 600-650 bed military referral hospitals. The National Guard has a network of four teaching hospitals and more than 60 outpatient clinics with the 1000 bed King Abdulaziz teaching hospital at its center. The government also finances and provides care on a referral basis at two famous referral hospitals, King Faisal Specialist Hospital and Research Center and King Khalid Eye Specialist Hospital. The private sector is an important provider of services. In 2000, there were 87 private investor owned hospitals with about 19% of the total beds. In addition, the sector included 622 dispensaries, 785 clinics, 45 laboratories and 11 physiotherapy centers. There is strong evidence of considerable expansion since then in response to the insurance mandate and the growth of private insurance companies. It is interesting to note that that national policy promotes JCI accreditation in both the public and private sector. There are 31 JCI accredited hospitals and more in preparation. The health system is supported by the national government and paid for by the sale of natural resources, as there is no tax system. The basic mechanism for paying public providers is through budget transfers from the Ministry of Finance based on line item allocations. Managers are generally prohibited from moving funds among line items. A major change in the health care system was introduced in 2004 as part of the health care reform plan, compulsory health insurance for the 8 million expatriates, who constitute about 28% of the population. It is being phased in, and there is concern that the millions of low paid workers will not be able to afford it. Abstracted from: Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/

International Hospitals Recruitment, Inc. (2004). Health Care in the Kingdom of Saudi Arabia. Retrieved November 2010, from International Hospitals Recruitment, Inc.: http://www.ihrcanada.com/ Walker, L. (2009, May). The Right to Health in Saudi Arabia: Right to Health in the Middle East project, Law School, University of Aberdeen. Retrieved October 2010,

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from University of Aberdeen: http://www.abdn.ac.uk/law/documents/Saudi%20_Arabia_Report.pdf

Wikipedia. (2010, March 17). Saudi Arabia: Health Care Balance. Retrieved November 2010, from Wikipedia: http://www.wikipedia.org

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Saudi Arabia: Programs Country Saudi Arabia

Institution King Abdulaziz University

Program(s) Master of Health Services and Hospital Management

Website http://www.kau.edu.sa/home_english.aspx

Address Deanship of Post Graduate Studies King Abdulaziz University 21589 Jeddah Kingdom of Saudi Arabia

Telephone/Fax 6400000-6952000-6402000

Affiliations Unknown

University Contact(s) Name and Title

Professor Hussein Borie Dr. Muhammad Tanweer Abdullah – Professor Health Services, Faculty of Economics and Administration

Email Hboraie@yahoo.com mtabdullah@hotmail.com

Language(s) Arabic

Country Saudi Arabia

Institution King Saud University Health Management – Health Sciences Division

Program(s) Health Management

Website http://colleges.ksu.edu.sa/HealthScience/default.aspx

Address Abdullah A. Al-Othman King Saud University Rector P.O. BOX 2454 ,Riyadh 11451

Telephone/Fax Tel: +966 1 4670888

Affiliations Unknown

University Contact(s) Name and Title

Professor Khalid S.Bin Saeed – Hospital and Health Administration Professor Khalid Mohammed Alaiban – Public and Health Administration

Email Dr_binsaeed@hotmail.com kalaiban@yahoo.com

Language(s) Arabic

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Singapore

POPULATION

% Urban Not available

% Rural Not available

Age Structure 0-14 years: 14.1% (male 343,424/female 319,277) 15-64 years: 76.9% (male 1,758,670/female 1,856,862) 65 years and over: 9% (male 188,667/female 234,169) (2010 est.)

Population 4,701,069 (July 2010 est.) HEALTH STATUS

Infant Mortality Rate

Total: 2.32 deaths/1,000 live births Male: 2.52 deaths/1,000 live births Female: 2.1 deaths/1,000 live births (2010 est.)

Life Expectancy at Birth

Total population: 82.06 years Male: 79.45 years Female: 84.87 years (2010 est.)

CHARACTERISTICS

Religions Buddhist 42.5%, Muslim 14.9%, Taoist 8.5%, Hindu 4%, Catholic 4.8%, other Christian 9.8%, other 0.7%, none 14.8% (2000 census)

Languages Mandarin 35%, English 23%, Malay 14.1%, Hokkien 11.4%, Cantonese 5.7%, Teochew 4.9%, Tamil 3.2%, other Chinese dialects 1.8%, other 0.9% (2000 census)

Geographic Size

Total: 697 sq km Land: 687 sq km Water: 10 sq km

ECONOMY

Economy

Singapore has a highly developed and successful free-market economy. It has a remarkably open and corruption-free environment, stable prices, and a per capita GDP higher than that of most developed countries. The economy has begun to rebound in 2010, and the government predicts growth of 3-5% for the year. Singapore has attracted major investments in pharmaceuticals and medical technology production and will continue efforts to establish Singapore as Southeast Asia's financial and high-tech hub.

GDP Per Capita $50,300 (2009 est.) GOVERNMENT

Type Parliamentary Republic

Form

Legal System: Based on English common law; has not accepted compulsory ICJ jurisdiction Executive Branch: Chief of State: President S R Nathan (since 1 September 1999) Head of Government: Prime Minister Lee Hsien Loong (since 12 August 2004)

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Legislative Branch:Unicameral Parliament (84 seats; members elected by popular vote to serve five-year terms) Judicial Branch: Supreme Court (chief justice is appointed by the president with the advice of the prime minister, other judges are appointed by the president with the advice of the chief justice); Court of Appeals

Government Departments Involved In Health Care

Ministry of Health

HEALTH CARE SPENDING

% of GDP 3.1% (Est. 2007) FACILITIES

Hospitals

Public 13 facilities with 75 % of the country’s beds

Private 16 facilities and 1400 private ambulatory clinics

Health Centers N/A

Others Residential and community-based services available

THE HEALTH CARE SYSTEM

Description

Singapore is a city-state with a population under five million and is considered to have among the best medical care in the world. The government of Singapore promotes personal responsibility for health and health care provision through a comprehensive insurance structure that underpins both the public and private sectors. The four insurance schemes help Singaporeans “co-pay” medical expenses. The system is overseen by the Ministry of Health which is responsible for providing preventive, curative and rehabilitative health services. The MOH formulates national health policies, coordinates the development and planning of the private and public health sectors and regulates health standards. As cost containment, the MOH controls the introduction of new technologies and expansion of beds. The key to financing the system is that the government forces people to save to cover medical expenses. Eighty-five percent of Singaporeans are covered by Medisave, a compulsory and portable HSA model program of tax-free, interest earning accounts that are part of one’s estate. Funds can be used for hospitalization, surgery, radiotherapy, and outpatient treatment for four chronic diseases. MediSave is supported by age-adjusted salary deductions of between 6.5 and 8.5 of pre-tax income. People can buy optional catastrophic insurance, MediShield that helps cover major or prolonged illnesses, which can be very expensive in the context of

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Singapore’s high-deductible and high co-payment insurance system. Many middle and higher income people purchase integrated private insurance policies for treatment in the private sector. There is also a government MediFund that is the ultimate safety net for the poor (about 10% of the population) whose costs exceed the coverage of the other funds. Private practitioners provide 80% of primary care with 18 government polyclinics providing the rest. There are about 1400 private ambulatory clinics, all of which are equipped to provide primary care, post-hospital follow-up, screening, etc. Singapore controls medical costs by controlling the number of doctors by limiting the number of medical school graduates, the number of foreign schools whose degrees are recognized (28) and the proportion of physicians who practice as specialists to 40%. “Public” hospitals provide 80% of acute hospital care with private facilities providing the rest. Patients in the public hospitals can choose different classes of ward accommodations ranging from single rooms to open wards with 8 or more beds. Patients in private or semi-private rooms pay the full cost, while patients in 4-bed rooms pay 80% and those in open dormitories pay 20%. The government promotes competition among public and private hospitals by publishing the costs of common treatments. It also caps prices on all services and procedures in public hospitals. There are no restrictions on private hospital pricing. There are a total of 13 public sector hospitals, ranging from 185 to 2,064 beds, with 74% of the beds in the country. They include six national specialty centers. Specialty services are concentrated in the Singapore General Hospital and the National University Hospital. The “public” facilities are organized in two integrated networks; both are government owned, but operate as nonprofit private corporations with a high degree of autonomy. The National Healthcare Group (NHG) covers the western side of the city and Singapore Health Services (SingHealth) the eastern side. The MOH said that these clusters “provide cooperation amongst the institutions within the cluster, foster vertical integration of services, and enhance synergy and economies of scale. The friendly competition between the two clusters spurs them to innovate and improve quality of care while ensuring that medical costs remain affordable.” Each of the networks benchmarks against international standards and publishes exhaustive performance data. Thirteen public and private hospitals are accredited by JCI. There are 16 private hospitals with between 16 and 505 beds. Besides tertiary, secondary and primary services, there is a comprehensive range of residential and community-based services that cater to the intermediate and long-term needs of the elderly. These services are managed either by not-for-profit organizations (voluntary welfare organizations) or private operators. They include community hospitals, chronic-sick hospitals, nursing homes, sheltered psychiatric homes, inpatient hospices, day-care centers and rehabilitation homes. Medical tourism is increasing. More than 400,000 patients came to Singapore in 2006. The Agency for Integrated Care facilitates the smooth transition of patients among care settings.

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Abstracted from: Callick, R. (May-June 2008). The Singapore Model. The American. Washington.

Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/

Karvounis, N. (2008, July 31). Health Care in Singapore. Retrieved October 2010, from A Century Foundation Group Blog: http://takingnote.tcf.org/

Ministry of Health Singapore. (2007). Healthcare System Overview. Retrieved October 2010, from Ministry of Health Singapore: http://www.moh.gov.sg

World Health Organization Western Pacific Region. (2007). Singapore Health System. Geneva: World Health Organization.

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Singapore: Programs Country Singapore

Institution Parkway College *Coursework offered through Flinders University (Aus)

Program(s) (1) Graduate Diploma in Healthcare Management (GHM) (2) Master of Health Administration (MHA)

Website http://www.parkwaycollege.edu.sg/

Address 168 Jalan Bukit Merah, Surbana One #04-01, S(150168)

Telephone/Fax Tel: (+65) 6508 6914 Fax: (+65) 6278 6075

Affiliations ACHSE

University Contact(s) Name and Title

General Inquiries – Parkway College Contacts at Flinders University: Ms. Janny Maddern – Head, Department of Health Care Management Prof. Judith Dwyer- Head of Research, Department of Health Care Management Mrs. Pam Maslin – Administrative Officer, Department of Health Care Management

Email SHM@parkwaycollege.edu.sg Janny.Maddern@flinders.edu.au Judith.Dwyer@flinders.edu.au Pam.Maslin@flinders.edu.au

Language(s) English

Duration of Each Program

(1) 9 months, (2) 12 months

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South Africa

POPULATION

% Urban Not available

% Rural Not available

Age Structure 0-14 years: 28.6% (male 7,043,566/female 7,007,484) 15-64 years: 65.9% (male 16,340,284/female 16,007,248) 65 years and over: 5.5% (male 1,100,202/female 1,610,32

Population 49,109,107

HEALTH STATUS

Infant Mortality Rate

Total: 43.78 deaths/1,000 live births Male: 47.88 deaths/1,000 live births Female: 39.59 deaths/1,000 live births

Life Expectancy at Birth

Total population: 49.2 years Male: 50.08 years Female: 48.29 years

CHARACTERISTICS

Religions Zion Christian 11.1%, Pentecostal/Charismatic 8.2%, Catholic 7.1%, Methodist 6.8%, Dutch Reformed 6.7%, Anglican 3.8%, Muslim 1.5%, other Christian 36%, other 2.3%, unspecified 1.4%, none 15.1%

Languages IsiZulu 23.8%, IsiXhosa 17.6%, Afrikaans 13.3%, Sepedi 9.4%, English 8.2%, Setswana 8.2%, Sesotho 7.9%, Xitsonga 4.4%, other 7.2%

Geographic Size

Total: 1,219,090 sq km Land: 1,214,470 sq km Water: 4,620 sq km

ECONOMY

Economy

The country still faces economic problems as a result of apartheid - particularly poverty, lack of economic empowerment among the disadvantaged groups, and a shortage of public transportation. South Africa's former economic policy was fiscally conservative, focusing on controlling inflation, and attaining a budget surplus. The current government largely follows the same policies, but must contend with the impact of the global crisis and is growing pressures from special interest groups to deliver basic services to low-income areas through state-owned enterprises. The hope is that the dispersal of such services will bring more jobs to several communities. More than one-quarter of South Africa's population currently receives social grants.

GDP Per Capita $10,100 (2009 est.) GOVERNMENT

Type Republic

Components 9 provinces

Form Executive Branch: Chief of State: President Jacob Zuma (since 9 May 2009); Executive Deputy

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President Kgalema Motlanthe (since 11 May 2009) Legislative Branch: Bicameral Parliament consisting of the National Council of Provinces Judicial Branch: Constitutional Court, Supreme Court of Appeals, and High Courts

Government Departments Involved In Health Care

National Health Insurance

HEALTH CARE SPENDING

% of GDP 8.7% (Est. 2007)

Government State contributes 40% of all expenditures

Private Data not available FACILITIES

Hospitals

Public 400 hospitals and 4100 clinics and health centers

Private 205 (28,361 beds)

Others Mining industry – 60 hospitals and clinics

THE HEALTH CARE SYSTEM

Description

The health system can be viewed as consisting of dichotomies; between a few urban centers and the largely rural country and between the small private systems and public care. It has been described as a “small rich country surrounded by a large poor country”. There is no national health insurance. National Health Insurance (NHI) is one of the key priorities of the health sector Programme of Action; to be implemented in phases from 2012 over a fourteen year period. T he implementation plan is to systematically address infrastructure backlogs, poor quality of care, strengthening accreditation and the workforce shortage. HIV/AIDS is a major challenge to the health system. In 2006 it was estimated that 18.8% (5.54 million) of the adult population were infected, with an unusual concentration in rural areas. The public sector is under-resourced and over-used. The state contributes about 40% of all expenditures, but the public sector serves 80% of the population. Public health consumes about 11% of the national budget (8.7% of GDP) and is allocated to the nine provinces and 284 municipalities. The provinces mainly provide hospitals and the local governments provide primary care through 400 hospitals and 4100 clinics and health centers. There are significant variations in access and quality among and within the provinces. There has been a recent structural transformation. Hundreds of new facilities have been built or rehabilitated. Five major public hospitals are being upgraded in a massive

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program that is based upon the construction experience of the World Cup. It is important to note that a national workforce development program that was phased in over 2004 to 2009 included capacity building programs for managers. There is little delegation of management authority from the provincial to the local levels. Competent managers are frustrated by the lack of autonomy and leave, while the provinces are reluctant to devolve management authority to junior or less competent managers. The capacity building program includes tools for budgeting and expenditure analysis. The private sector caters to middle- and high-income individuals who tend to be members of the 122 not-for-profit medical aid schemes (18% of the population) and to medical tourists. The schemes are administered by medical scheme administration companies, six of which control 75% of the market. Almost five times as much is spent on each person on medical aid as is spent on a person in the public sector. The schemes do not provide very comprehensive coverage and members pay hospitals and general practitioners considerable amounts out-of-pocket. The medical aid market has been static since 1994, and there is little prospect for growth other than to supply services to the public sector. There are 205 private hospitals with 28,361 beds that are used almost exclusively by medical scheme members. The mining industry also has 60 hospitals and clinics. Over 76% of the beds are in hospitals that are owned by three companies: Netcare (49 hospitals, 30.6% of the beds); Life (49 hospitals, 25.0% of the beds) and Mediclinic (40 hospitals, 21.1% of the beds). The 67 independent hospitals have 23.2% of the beds. The private sector has more MRI and CT scanners per million than do Canada, France, Germany, the UK and other countries. It is widely agreed that the sector is over-capitalized, and that there is no competition among the three large groups. The role of hospital accreditation is interesting. The Council for Health Service Accreditation of Southern Africa (COHSASA) has engaged 553 public and private facilities over the past year. It was developed in 1994 to support efforts by the new government to provide equity. There are standards for hospitals, hospices, and primary care and for HIV management. The Council has two strategies that recognize the need to work with hospitals with disadvantaged backgrounds to improve quality of care over the long-run. They are the Facilitated Accreditation Programme and the Graded Recognition Programme. Eighty-nine private hospitals are accredited. The workforce shortage is a pervasive crisis. The ratio of doctors and nurses to population falls far below all international standards. It has been characterized as a nurse-based health system. The country exports doctors and nurses. Most of the country’s health professionals, except nurses, work in the private sector in the largest metropolitan areas. Gauteng, for example, has 21% of the population, 37% of the medical scheme members and 45% of the private sector doctors, dentists and pharmacists In 2007, the government determined to introduce NHI. NHI is intended to achieve a unified and integrated system from which all South Africans can benefit,

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whether or not they make mandatory insurance contributions. It would be funded by a combination of general tax revenue and mandatory insurance contributions. The funds would be pooled in a fund that would purchase a uniform package of services. The proposal envisages that geographic structures (e.g. provincial, regional and district health authorities) would purchase services for their entire populations being, in effect, a single purchaser in each area. The main provider mechanism will be some form of capitation. Abstracted from: Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/

Harrison, D. (January 2010). An Overview of Health and Health Care in South Africa 1994-2010: Priorities, Progress and Prospects for New Gains. Washington: Henry J. Kaiser Family Foundation.

McIntyre, D. (2010, July). Private Sector Involvement in Funding and Providing Health Services in South Africa: Implications for Equity and Access to Health Care. Retrieved October 2010, from Equinet Africa: http://www.equinetafrica.org/bibl/docs/DIS84privfin%20mcintyre.pdf

National Health Insurance. (2010). NHI in South Africa 2010. Retrieved October 2010, from COHSASA: http://www.imsa.org.za/national_health_insurance_NHISA_2010_1.html

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South Africa: Programs Country South Africa

Institution University of Limpopo National School of Public Health

Program(s) (1) Master of Public Health (MPH) Specialize in Health System

Management (2) Doctor of Public Health (Dr.PH) Specialize in Health System

Management

Website http://www.ul.ac.za/index.php?Entity=dep_hsmp

Address

Head of the Department of Health System Management and Policy Prof. Supa Pengpid PO Box 215, MEDUNSA 0204 Ga-rankuwa, Pretoria Tel: (+ 27) 012 521 5036 Fax: (+27) 012 5600172

Telephone/Fax Tel: (+ 27) 012 521 5036

Affiliations Unknown

University Contact(s) Name and Title

Professor Supa Pengpid

Telephone/Fax Phone: (+27) 012 -5215036

Email supa_pengpid@embanet.com

Language(s) English

Country South Africa

Institution University of Pretoria School of Health Systems and Public Health

Program(s) Master of Public Health (MPH)

Website http://web.up.ac.za/default.asp?ipkCategoryID=1339

Address

Faculty of Medicine P.O. Box 667 University of Pretoria Pretoria 0001 South Africa

Telephone/ Fax Tel: +27 (0)12 841 3346 or (0)12 354 1472 Fax: +27 (0)12 841 3308

Affiliations N/A

University Contact(s) Name and Title

Tiaan de Jager, PhD - Chairperson

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Email tiaan.dejager@up.ac.za

Language(s) English

Duration of Each Program

Two to four years

Country South Africa

Institution University of South Africa

Program(s)

(1) Bachelor of the Arts (Health Sciences and Social Services) with Specialization in Health Services Management and Public Administration

(2) Master of Public Health (MPH)

Website http://www.unisa.ac.za

Address P O Box 392 Unisa 0003

Telephone/Fax Tel: 27 11 670-9000

Affiliations Unknown

University Contact(s) Name and Title

Professor Martha Catharina Bezuidenhout – Academic Chairperson: Department of Health Studies

Telephone/Fax +27 15 962 8424

Email bezuimc@unisa.ac.za

Language(s) English

Country South Africa

Institution University of the Free State

Program(s) Advanced University Diploma in Health Service Management

Website http://www.uovs.ac.za/

Address

University of the Free State 205 Nelson Mandela Drive Park West Bloemfontein 9301

Telephone/Fax 27 (051) 401 3219

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Affiliations Unknown

University Contact(s) Name and Title

Professor Gert Van Zyl – Dean of Health Sciences

Telephone/Fax +27-(0)51 4053012/

Email Not available

Language(s) Afrikaanse and English

Country South Africa

Institution University of the Witwatersrand

Program(s) (1) Diploma in Public Health (2) Diploma in Health Services Management

Website http://web.wits.ac.za

Address

Faculty of Health Sciences Dept of Community Health Medical School 7 York Rd Parktown 2193 South Africa

Telephone/ Fax Tel: +27 (0)11 717 10 00 Fax: +27 (0)11 717 10 65

Affiliations Unknown

University Contact(s) Name and Title

Sharon Fonn – Professor and Head, School of Public Health

Telephone/ Fax Tel: 27 11 717-2075/2076

Email health.pg@wits.ac.za General Inquiries fonns@sph.wits.ac.za

Language(s) English

Duration of Each Program

(1) 1 to 2 years, (2) 1 year full-time

Country South Africa

Institution Mthatha: Walter Sisulu University Faculty of Health Sciences

Program(s) Diploma District Health Services Management and Leadership

Website http://www.wsu.ac.za/faculties/fhs/fhsaddhsnl.htm

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Address

Faculty of Health Sciences Walter Sisulu University Private Bag X1 Mthatha 5117 Eastern Cape South Africa

Telephone/Fax Tel: +27 (0)47 502 24 83 Fax: +27 (0)47 502 22 35

Affiliations Unknown

University Contact(s) Name and Title

Prof Malusi Marcus Balintulo - Vice Chancellor

Email vc@wsu.ac.za

Language(s) English

Duration of Each Program

One year, full-time

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Spain

POPULATION

% Urban Data not available

% Rural Data not available

Age Structure

0-14 years: 14.5% (male 3,034,315/female 2,854,287) 15-64 years: 67.1% (male 13,660,912/female 13,552,221) 65 years and over: 18.4% (male 3,111,644/female 4,335,374) (2010 est.)

Population 40,548,753 (July 2010 est.) HEALTH STATUS

Infant Mortality Rate

Total: 4.16 deaths/1,000 live births Male: 4.54 deaths/1,000 live births Female: 3.76 deaths/1,000 live births (2010 est.)

Life Expectancy at Birth

Total Population: 80.18 years Male: 76.88 years Female: 83.7 years (2010 est.)

CHARACTERISTICS

Religions Roman Catholic 94%, other 6%

Languages Castilian Spanish (official) 74%, Catalan 17%, Galician 7%, Basque 2%, are official regionally

Geographic Size

Total: 505,370 sq km Land: 498,980 sq km Water: 6,390 sq km

ECONOMY

Economy

Spain's mixed capitalist economy is the 12th largest in the world, and its per capita income roughly matches that of Germany and France. The economy is projected to resume modest growth sometime in 2010, making Spain the last major economy to emerge from the global recession. Government efforts to boost the economy through stimulus spending, extended unemployment benefits, and loan guarantees have not prevented a sharp rise in the unemployment rate, which was the highest in the EU in 2009.

GDP Per Capita $33,700 (2009 est.)

GOVERNMENT

Type Parliamentary Monarchy

Components 17 autonomous communities

Form

Executive Branch: Chief of State: King Juan Carlos I (since 22 November 1975); Heir Apparent Prince Felipe, son of the monarch, born 30 January 1968 Legislative Branch: Bicameral; General Courts or Las Cortes Generales consists of the Senate or

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Senado and the Congress of Deputies or Congreso de los Diputados Judicial Branch: Supreme Court or Tribunal Supremo

Government Departments Involved In Health Care

INSALUD

HEALTH CARE SPENDING

% of GDP 8.5% (Est. 2007)

Government Data not provided

Private Data not provided

FACILITIES

Hospitals

Public Data not provided

Private 800 facilities (160,000 beds)

Health Centers 2,913 public primary care centers and 10,178 basic medical centers in small towns

Others N/A

THE HEALTH CARE SYSTEM

Description

The health status of the Spanish population is among the world’s highest, surpassing the US in several measures. In 2007 Spain ranked sixth among the thirty OECD countries in life expectancy after birth. In 2009 infant mortality ranked seventeenth out of 224 nations (the US was forty-fifth). This has been achieved with 8.5 % of GDP. There is wide agreement that the key to these numbers is that the system is built upon two levels: primary care and specialist care. The primary care system is close to the US patient-centered medical home model. The constitution of 1978 established the right to health protection and a free national health system with equal access to preventive, curative and rehabilitative services. General taxes fund all health benefits and a portion of pharmaceutical benefits. The tax is shared with the autonomous communities according to a complex formula. The basic benefit package is defined annually by the national government and each community then designs a service plan with that as the minimum. Authority over health care was vested in the Instituto Nacional de Salud (INSALUD). In 1981 authority was decentralized to the seventeen Autonomous Communities. The central government retains responsibility for general policy, coordination, certain national standards, health professionals, information systems, research and pharmaceutical policy. The law defines a core set of functions common to all autonomous health services. INSALUD includes the National Institute

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of Health Management that manages some programs and implementation of some national laws. The Autonomous Communities control health planning, public health and the management of health services, most of which are decentralized through Health Areas and Basic Health Zones. Health Areas are responsible for the management of facilities, services and benefits for a population of 200,000 to 250,000 people. A Health Area is composed of several Basic Health Zones, which are the framework for primary care Delivery Zones typically include between 5,000 and 20,000 inhabitants. Each Health Area is related to a general hospital and specialist center, access to which is through the “gate keeper” primary care system. The basic benefit package includes acute and chronic medical care, health promotion and preventive care, rehabilitation and home-based care. The health center is the core service delivery entity of the system. It is staffed by a family or general medicine team. In 2008, there were 2,913 public primary care centers and 10,178 basic medical centers in small towns. The goal of having a primary care center within 15 minutes of every citizen has nearly been met. These centers provide more than 70% of all health care visits in the country. In Spain, the term clinic is often used to describe private hospitals, of which there are many, most of which are affiliated with or primarily service individuals who have private health insurance. Many have contracts with governments to provide covered services. There are a total of about 800 hospitals, of which 120 (with 19,980 beds) are not-for-profit and 349 for-profit (33,458 beds) of a total of 160,000 beds. All citizens have digital health insurance cards that provide access to patient’s comprehensive electronic records by swiping them through a card reader at any facility in the country. Ninety-eight per cent of primary care consultations are covered by the cards. In the next stage, an integrated Health Electronic Record is being implemented throughout Spain to promote free exchange of information across regional boundaries. Abstracted from: Borkan, J. (2010). Renewing Primary Care: Lessons Learned from the Spanish Health Care System. Health Affairs , 29 (8); 1432-1440.

Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/

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Spain: Programs Country Spain

Institution ESADE

Program(s) Integrated Healthcare Management Executive Masters in Public Administration (EMPA)

Website http://www.esade.edu/exed/eng

Address School of Management Av.Pedralbes, 60-62 E-08034 Barcelona

Telephone/Fax Tel +34 932 806 162

Affiliations EMHA, Equis

University Contact(s) Name and Title

Manel Peiró Posadas, Program Director Barcelona and Madrid Felicia Skira Laplace, Program Manager Barcelona

Telephone/Fax +34 932 806 162

Email manel.peiro@esade.edu felicia.skira@esade.edu

Language(s) Spanish and English

Country Spain

Institution Escuela Valenciana de Estudios para la Salud The Valencian School for Health Studies (EVES)

Program(s) Healthcare Management/Administration

Website http://www.eves.san.gva.es/portal/indexEng.jsp

Address C/ Juan de Garay nº. 21 46017-Valencia-España

Telephone/Fax Tel.: +34 963 869 369

Affiliations Unknown

University Contact(s) Name and Title

Joaquin Ibarra Huesa, Director

Email formacion_eves@gva.es

Language(s) Spanish

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Sweden 

POPULATION

% Urban 83%

% Rural 17%

Age Structure

0-14 years: 15.5% (male 725,864/female 684,459) 15-64 years: 65.2% (male 2,994,552/female 2,920,481) 65 years and over: 19.3% (male 777,219/female 971,480)

HEALTH STATUS

Infant Mortality Rate

Total: 2.74 deaths/1,000 live births

Life Expectancy at Birth

Total population: 80.97 years Male: 78.69 years Female: 83.4 years

CHARACTERISTICS

Religions Lutheran 87%, other (includes Roman Catholic, Orthodox, Baptist, Muslim, Jewish, and Buddhist) 13%

Languages Swedish, small Sami- and Finnish-speaking minorities

Geographic Size

Total: 450,295 sq km Land: 410,335 sq km Water: 39,960 sq km

ECONOMY

Economy

Aided by peace and neutrality for the whole of the 20th century, Sweden has achieved an enviable standard of living under a mixed system of high-tech capitalism and extensive welfare benefits. In September 2003, Swedish voters turned down entry into the euro system concerned about the impact on the economy and sovereignty. The Swedish economy slid into recession in 2008 and the first half of 2009 due to a reduced demand on Swedish exports.

GDP Per Capita $36,800 (2009 est.)

GOVERNMENT

Type Constitutional Monarchy

Components 21 counties

Form

Legal System: Civil law system influenced by customary law; accepts compulsory ICJ jurisdiction with reservations Executive Branch: Chief of State: King Carl XVI Gustaf (since 19 September 1973); Heir Apparent Princess Victoria Ingrid Alice Desiree, daughter of the monarch (born 14 July

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1977) Head of Government: Prime Minister Fredrik Reinfeldt (since 5 October 2006) Legislative Branch: Unicameral Parliament or Riksdag (349 seats; members are elected by popular vote on a proportional representation basis to serve four-year terms) Judicial Branch: Supreme Court or Hogsta Domstolen (judges are appointed by the prime minister and the cabinet)

Government Departments Involved In Health Care

HEALTH CARE SPENDING

% of GDP 9.1%

Government N/A

Private N/A

FACILITIES

Hospitals

Public Data not available

Private 21,000 total beds in the private hospital sector

Health Centers N/A

Others

THE HEALTH CARE SYSTEM

Description The three levels of government are involved in health care. The central government determines overall objectives and regulation. Local county councils and municipalities determine how services are delivered. As a result there is considerable variation across the country. Healthcare comprises around 90% of the work of the 21 county councils. The publicly-financed health care system covers: public health and preventive services; inpatient and outpatient hospital care; primary care; inpatient and outpatient drugs; mental health care; dental care for young people; rehabilitation; disability support services; transport support services; home care; and nursing home care. The system is supported by a combination of national and local taxation. County councils and municipalities level taxes. The federal government pays prescription drug subsidies and makes grants to county councils and municipalities for targeted adjustments. The county councils provide funding for mental health care, primary care and specialist services in hospitals. Municipalities cover home care, home services and nursing home care. Overall public funding accounted for 85% of total health expenditure in 2005.

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There is limited cost-sharing for most services up to a national annual cap of about $137 for health services and about $274 for outpatient pharmaceuticals. Each county council sets its own fees but patients pay up to about $23 per visit to a primary care doctor, up to about $46 for a specialist or emergency care and up to about $12 per day for hospitalization. When a physician certifies that a patient is ill for any reason, the patient is paid a percentage of their daily wage from the second day. Dental care is not included in the system but is partly subsidized by the government. About 2.5% of the population is covered by supplemental private health insurance. In 2005, it accounted for less than 1% of total health expenditures. The coverage does provide faster access to care in the private sector. Private insurance coverage has been increasing (up 50% from 2004 to 2007) as hospitals are now permitted to operate at a profit and some employers have begun to offer employees private insurance. Almost all hospitals are owned and operated by the county councils. There are no private wings in public hospitals. The private hospitals mainly specialize in elective surgery and contract with the county councils. The hospitals have traditionally had large outpatient departments, reflecting low levels of investment in primary care. The county councils are divided into six regions, each with at least one university hospital, for tertiary care. Hospitals are usually paid on DRGs with global budgets. Physicians are salaried employees. Most health centers are owned and operated by county councils and general practitioners and other staffs are employees. Primary care has no formal gate keeping function. Residents can go directly to hospitals or to the private specialists contracted b the county councils. By agreement between the county councils and the central government, all non-acute patients should be able to see a primary care physician within seven days, a specialist within 90 days of referral and obtain treatment within 90 days of prescription by a specialist. Abstracted from: Anell, A. (2008, February). The Swedish Health Care System. Swedish Health Care Consulting Information Sheet. Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/

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Sweden: Programs Country Sweden

Institution Karolinska Institute

Program(s) Public Health Sciences - Health Economics, Policy and Management

Website http://ki.se/ki/jsp/polopoly.jsp?d=26167&a=71505&l=en

Address Box 17070, SE-104 62 Stockholm Visit: Västgötagatan 2, Stockholm

Telephone/Fax + 46 (0)8-524 800 00

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email info@kfa.ki.se

Language(s) English, Swedish

Country Sweden

Institution Karolinska Institute Medical Management Center

Program(s) Medical Management

Website http://ki.se/ki/jsp/polopoly.jsp?d=15009&a=39773&l=en

Address Berzelius väg 3, 5th floor Campus Solna

Telephone/Fax +46 08 524 800 00

Affiliations Unknown

University Contact(s) Name and Title

(1) Prof. John Overlveit (2) Prof. Mats Brommels – Visiting Professor, Depart. Of Learning,

Informatics, Management and Ethics (3) Prof. Hans Rosling, Prof of International Health, (4) Johan Thor – Project Manager, Dept. of Learning, Informatics,

Management and Ethics (5) Christina Bjorklund – Dept. of Public Health Science, Division of

Intervention and Implementation Research

Telephone/Fax

Email jovret@aol.com mats.brommels@ki.se hans.rosling@ki.se johan.thor@ki.se

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Christina.bjorklund@ki.se

Language(s) English, Swedish

Country Sweden

Institution Uppsala University, Department of Public Health

Program(s) Certificate Health Programme Management in an International Perspective

Website http://www.selma.uu.se

Address International Maternal and Child Health (IMCH), University Hospital Entrance 11 751 85 Uppsala Sweden

Telephone/Fax Tel: +46 (0)18 611 59 97 Fax: +46 (0)18 50 80 13

Affiliations Unknown

University Contact(s) Name and Title

Bjorn Smedby, MD, PhD – Professor Emeritus

Email Bjorn.smedby@nordclass.uu.se

Language(s) English

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Turkey 

POPULATION

% Urban 23% of the population live in 3 major cities

% Rural 54%

Age Structure

0-14 years: 26.9% (male 10,708,999/female 10,229,102) 15-64 years: 66.9% (male 26,323,403/female 25,747,740) 65 years and over: 6.2% (male 2,190,593/female 2,604,285

Population 77,804,122

HEALTH STATUS

Infant Mortality Rate

Total: 24.84 deaths/1,000 live births Male: 25.89 deaths/1,000 live births Female: 23.73 deaths/1,000 live births

Life Expectancy at Birth

Total population: 72.23 years Male: 70.37 years Female: 74.19 years

CHARACTERISTICS

Religions Muslim 99.8% (mostly Sunni), other 0.2% (mostly Christians and Jews)

Languages Turkish (official), Kurdish, other minority languages

ECONOMY

Economy

Turkey's financial markets and banking system were able to weather the 2009 global financial crisis due to banking and structural reforms implemented as a result of the country’s 2001 financial crisis. However, as the demand for Turkish exports declines, the country may be faced with a weaker economic outlook in 2010.

GDP Per Capita $11,200 GOVERNMENT

Type Republican Parliamentary Democracy

Components 81 provinces

Form

Executive Branch: Chief Of State: President Abdullah GUL (since 28 August 2007)

Head of Government: Prime Minister Recep Tayyip Erdogan (since 14 March 2003)

Legislative Branch: unicameral Grand National Assembly of Turkey or Turkiye Buyuk Millet Meclisi (550 seats; members elected by popular vote to serve four-year terms) Judicial Branch: Constitutional Court; High Court of Appeals (Yargitay); Council of State

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(Danistay); Court of Accounts (Sayistay); Military High Court of Appeals; Military High Administrative Court

Government Departments Involved In Health Care

Ministry of Health Social Security Institute

HEALTH CARE SPENDING

% of GDP 5.7%

Government Data not provided

Private Data not provided FACILITIES

Hospitals

Public 850

Private 260

Health Centers Data not provided

Others Data not provided

THE HEALTH CARE SYSTEM

Description

Health service provision includes 1198 hospitals, of which 66% (850) are public (Ministry of Health), 4% university, and 24% (260) private (including 16 class A).The public hospitals account for 72 % of discharges. The Turkish health system is in transition. The Health Transformation Program (HTP) is planned for implementation in the period 2002-13. The situation is dynamic. Factors include World Bank loan support, International Finance Corporation (WB) investment in private sector hospitals and changing governments. The HTP is designed to address long-standing problems: 1) lagging health outcomes; 2) inequities in access; 3) fragmentation in financing and delivery services and 4) poor quality and limited patient responsiveness. The key changes envisioned under the HTP include: • Restructuring the Ministry of Health to strengthen its stewardship function,

getting rid of its provider functions and increasing its capacity in regulation, planning, monitoring, evaluation and public health

• Establishing Universal Health Insurance (UHI) under the Social Security Institute (SSI) Enrolment will be mandatory with rates based upon ability to pay for a universal benefits package

• Reforming the delivery system by granting autonomy to public hospitals, expanding primary care and improving the quality of care in all facilities

There has been progress toward all of the objectives. For example, a claims and utilization management system has been established to process claims for all

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insurance funds. All public and private hospitals participate. The MOH has introduced a pay-for-performance scheme. In 2006, the SSI and MOH agreed on a capped annual budget (global budget) for all MOH hospitals. The MOH continues to be a very dominant purchaser and provider, funding and managing a very large network of primary care providers and hospitals. The relationship between SSI and university and private hospitals operates under a traditional purchaser-provider model, whereby SSI contracts with them individually to deliver the benefits package. The law allows “extra billing” by private providers whereby they will be allowed to charge up to 30% above the price paid by the SSI, to be paid on an out-of-pocket basis. The law sets out principles of hospital governance based upon a public-enterprise model. Hospitals would be governed by boards, but remain affiliated with the MOH. The law offers the possibility of hospitals forming regional systems for planning, budgeting and implementation. The systems would have greater autonomy and flexibility. Employees would no longer be public employees and no longer have the right to life-long employment in the health sector. It is important to note that the reforms have been underpinned by training programs for hospital managers. The OECD has placed a high priority on expanding the training programs to facilitate further implementation of the HTP. The private sector is strong and growing; SSI currently contracts with 350 private hospitals. The extra billing provision was to stimulate private sector interest in contracting. There is a new “certificate of need” regulation covering all new private hospitals, clinics and centers. What follows is an abstract of an important evidence-based assessment of aspects of the Turkish health system published in 2007 in Health Affairs: The complexity of the Turkish system results in a considerable amount of formal and informal out-of-pocket payment. The study provides a pessimistic prognosis for the value to the citizen of the anticipated reforms. The reservations are based upon a 2002 study of the payment pattern in a middle-sized city. About half of the population had health insurance, which is typical, as are the health services available in the city. The role and the impact on informal out-of-pocket payments for hospital and outpatient services is very great and is not expected to change under the reformed system. Such payments are found in many countries. They include:

• “Donations” that if not made could result in denial of services

• Physician services in private offices to access basic services to which the patient is entitled

• Surgical services that are covered but for which a “knife” payment is required

• Drugs that the in-patient is asked to buy outside and should have been

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provided by the hospital

• Payments to other staff such as nurses for services that are covered

The study was the first to document the extent of the practice. Seventy percent of out-of-pocket payments were formal payments for care, and 71.6% of that was cash. The payments were higher for outpatient care than for inpatient care but informal payments constituted a higher share (53%) of out-of-pocket payments for inpatient episodes. The importance of these findings is that: 1) Part-time or duel practice physicians who are employed part-time by the government engage in self-referral to their private offices or to private hospitals where they work. These payments were not to upgrade the basic services to which patients were entitled and were not to get additional services. 2) Underinsurance requires patients to purchase drugs, food, medical devices, etc. during hospitalization. This study informs the process of implementing the reforms but paints a bleak picture because the reforms do nothing to change the underlying systemic weaknesses. Two changes in underlying systems are necessary if the public and the health system are to benefit. Provider income and payments must be increased to reduce the motivation to depend on informal payments and laws against bribery must be enforced. Abstracted from: Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/

Tatar, M. (2007). Informal Payments in Health Sector: A Case Study from Turkey. Health Affairs , 26 (4); 1029-1039.

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Turkey: Programs

Country Turkey

Institution Ankara University

Program(s) Hospital Management

Website http://www.sagbilens.ankara.edu.tr/

Address Ankara Üniversitesi Dil Öğretim Merkezi (TÖMER) Türkçe Kursları Bölümü Ziya Gökalp Caddesi, No.18/1, Kızılay 06650 Ankara, TURKEY

Telephone/Fax +90 312 2159001

Affiliations Unknown

University Contact(s) Name and Title

Afsun Esatoglu – Faculty of Health Sciences Dilaver Tengilimouglu

Email esatoglu@health.ankara.edu.tr

Language(s) English

Country Turkey

Institution Baskent University School of Health Sciences

Program(s) Healthcare Management

Website http://www.baskent.edu.tr/english/fhealthealt.php

Address Baglica Kampusu Eskisehir Yolu Baglica 06530 Ankara

Telephone/Fax 213 234 10 10

Affiliations AUPHA

University Contact(s) Name and Title

Dr. Korkut Esroy – Chair, Department of Healthcare Management Professor Sahin Kavuncubasi Professor Adnan Kisa

Email korkut@baskent.edu.tr sahin@baskent.edu.tr akisa@baskent.edu.tr

Language(s) English

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Country Turkey

Institution Gazi University

Program(s) Hospital Management

Website http://www.sbf.gazi.edu.tr/

Address No. 16 Besevler/Ankara Dekanlik

Telephone/Fax +90 312 216 2601

Affiliations Unknown

University Contact(s) Name and Title

Professor Dr. A. Gulsan Turkoz Sucak Dilaver Tengilimouglu

Email aysucak@gazi.edu.tr dilaver@gazi.edu.tr

Language(s) English, Turkish

Country Turkey

Institution Hacettepe University

Program(s) Master of Healthcare Management

Website http://www.sid.hacettepe.edu.tr/index.shtml

Address Hacettepe Universitesi Tanitim Ofisi 06532 Beytepe-Ankara

Telephone/Fax +90 312 305 50 50

Affiliations EHMA, AUPHA

University Contact(s) Name and Title

Professor Mehtap Tautar Sidika Kaya Professor Hikmet Pekcan, Department of Public Health

Email mtautar@hacettepe.edu.tr sdkay@hacettepe.edu.tr hikmetp@hacettepe.edu.tr

Language(s) English

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United Kingdom 

POPULATION

% Urban 89% of population in England resides in urban areas

% Rural A NHS patient is defined as rural if they live more than 5 km (3.1 mi) from either a doctor or a dispensing chemist

Age Structure

0-14 years: 16.5% (male 5,189,037/female 4,943,328) 15-64 years: 67.1% (male 20,836,671/female 20,294,551) 65 years and over: 16.4% (male 4,336,685/female 5,684,534)

Population 61,284,806

HEALTH STATUS

Infant Mortality Rate

Total: 4.78 deaths/1,000 live births Male: 5.31 deaths/1,000 live births Female: 4.22 deaths/1,000 live births

Life Expectancy at Birth

Total population: 79.16 years Male: 76.66 years Female: 81.8 years

CHARACTERISTICS

Religions Christian (Anglican, Roman Catholic, Presbyterian, Methodist) 71.6%, Muslim 2.7%, Hindu 1%, other 1.6%, unspecified or none 23.1%

Languages English

Geographic Size

Total: 243,610 sq km Land: 241,930 sq km Water: 1,680 sq km

ECONOMY

Economy

The economic stability of the UK was hit hard as a result of weakened 2008 global financial market. Over the past couple years the country has experienced sharp declining home prices and high consumer debt. The global economic slowdown compounded Britain's economic problems, pushing the economy into recession in the latter half of 2008 resulting in the implementation of a number of measures to stimulate and stabilize the financial markets. These include nationalizing parts of the banking system, cutting taxes, suspending public sector borrowing rules, and moving forward public spending on capital projects. Public finances and employment, already in a weak financial state before the economic slowdown, continued to deteriorate throughout 2009.

GDP Per Capita $35,200

GOVERNMENT

Type Constitutional Monarchy And Commonwealth Realm

Components Great Britain: 27 two-tier counties, 32 London boroughs and 1 City of London or Greater

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London, 36 metropolitan districts, 56 unitary authoritiesNorthern Ireland: 26 district council areas Scotland: 32 council areas Wales: 22 unitary authorities

Form

Executive Branch: Chief of State: Queen Elizabeth II (since 6 February 1952); Heir Apparent Prince Charles (son of the queen, born 14 November 1948) Head of Government: Prime Minister David Cameron (since 11 May 2010) Legislative Branch: Bicameral Parliament consists of House of Lords Judicial Branch: • Supreme Court of the UK (established in October 2009 taking over appellate

jurisdiction formerly vested in the House of Lords)

• Senior Courts of England and Wales (comprising the Court of Appeal, the High Court of Justice, and the Crown Courts)

• Court of Judicature (Northern Ireland)

• Scotland's Court of Session and High Court of the Justiciary

Government Departments Involved In Health Care

National Health System (NHS) Department of Health

HEALTH CARE SPENDING

% of GDP 8.4% (Est. 2007)

Government Used increasingly to purchase care in the private sector

Private In 2008, 12% carried private health insurance

FACILITIES

Hospitals

Public Data not provided

Private 270

Health Centers Data not provided

THE HEALTH CARE SYSTEM

Description On July 12, 2010 the coalition government issued a White Paper, “Equality and Excellence: Liberating the NHS” which proposes the most significant changes in the National Health Service since it was founded it 1948. A proposal of this magnitude requires extensive consultation and negotiation, but it is highly likely to be enacted within a few months in essentially the proposed form because of the

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alignment of the coalition government and the Parliament. We quote the proposal at some length because of the impending impact on both the public and private health system in a short time (2010-2014) and the implications for the education and demand for health care administrators. It is important to note that the proposed reforms apply to England. It is not clear to what extent, if any, the other components of the UK will follow suit. In introducing the plan, the Secretary of State for Health said, in part, “the plan envisions broad decentralization. The government will phase out England’s 150 primary care trusts and 10 strategic health authorities. They will be replaced by approximately 500 general practitioner consortia. These consortia will be GP-led and be responsible for purchasing care on behalf of their patients and, in total, be responsible for more than 80% of the NHS spending. Patients will be given greater choice-including choice of provider, GP practice, and treatment as well as increased control over their personal care records. The proposal would also increase openness to the private sector, allowing private companies to compete with the NHS. The aim is to reduce management costs by more than 45% by 2014”. Abstracted from the White Paper: The NHS has an increasing strong focus on evidence-based medicine, supported by the National Institute for Health Research and the National Institute for Health and Clinical Excellence (NICE). Compared to other countries, however, the NHS has achieved relatively poor outcomes in some areas. The NHS also scores relatively poorly on being responsive to the patients it serves. The government will now establish improvement in quality and outcomes as the primary purpose of all NHS-funded care. The headquarters of the NHS will not be the Department of Health or the new NHS Commissioning Board, but, instead, power will be given to clinicians and patients. The government will liberate the NHS from excessive bureaucratic and political control. They will effect a radical simplification and remove layers of management. The NHS role will be much reduced and more strategic. It will focus on improving public health, tackling health inequalities and reforming adult social care. They will also increase NHS spending in real terms in each year of this Parliament. Despite this, local NHS organizations will need to achieve unprecedented efficiency gains. NHS will employ fewer staff at the end of the Parliament, although rebalanced towards clinical staffing and front-line support rather than excessive administration. The government will:

• Increase the current offer of choice of any provider significantly

• Create a presumption that all patients will have choice and control over their care and treatment, and choice of any willing provider

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• Begin to introduce choice for diagnostic testing and choice post-diagnosis They expect choice of treatment and provider to become a reality no later than 2013/14. The absence of an effective payment system severely restricts the ability of commissioners and providers to improve outcomes, increase efficiency and increase patient choice. The Department will implement a more comprehensive, transparent and sustainable structure of payment for performance so that the money follows the patient and reflects quality. If providers deliver excellent care the commissioner will be able to pay a quality increment. If providers deliver poor quality care, the commissioner will also be able to impose a contractual penalty. Consortia of GP practices will commission the great majority of services for their patients. The NHS Commissioning Board will calculate practice-level budgets and allocate these directly to consortia. GP consortia will include an accountability officer. The consortia will be responsible for managing the combined commissioning budgets of their GP practices. The consortia will receive a maximum management allowance to reflect the costs associated with commissioning with a premium for achieving high quality outcomes and for financial performance. The government’s intention is to free foundation trusts (which run hospitals) from constraints they are under so they can innovate to improve care. In future, they will be regulated in the same way as any other providers, whether from the private or voluntary sector. As all NHS trusts become foundation trusts (not-for-profit public bodies), staff will have the opportunity to transform their organizations into employee-led enterprises that they control, and freeing them to use their experience to structure services around what works best for patients. Foundation trusts will not be privatized. Ministers currently exercise substantial control over pay levels and contractual arrangements for NHS staff. In the future, all individual employers will have the right, as foundation trusts have now, to determine pay for the own staff. End of White Paper abstract. Some implications for management. The fundamental change is shifting power from the secondary care providers (trusts) to primary care consortia. There is an underlying impression that the government has a low level of confidence in managers to deliver cost-effective care and more confidence in general practitioners, patients and local officials. The Economist estimates that the 45% cut in management will mean the loss of 25,000 management jobs. At the same time, the approximately 500 new GP consortia (all GPs must join one) will be complex organizations that require managers. They may be hired from within the NHS or the management may be outsourced to private firms. It has been suggested that US companies such as UnitedHealth Group and Humana may enter the market. Concern has been expressed about the ability of GPs to oversee

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management in the revised system. All of the NHS hospitals will become relatively autonomous foundation trusts giving them control over management hiring and retention and retained earnings for service improvements. The NHS provides comprehensive preventive, curative and rehabilitative services. There are relatively few cost-sharing arrangements. Drugs are charged at a fixed rate, but 89% of the prescriptions are exempt for a variety of reasons. It is 76% funded by general taxation, 18% from national insurance contributions and only 3% from user charges. A DRG-like, activity-based funding system, Payment by Results, has been introduced in acute care hospitals and was to be extended across all providers before the announced reform. The impact going forward is not clear. Public funds are used increasingly to purchase care in the private sector. Some elective surgery and diagnostics are purchased from private facilities built for NHS contracting. There are also private units within NHS hospitals, where consultants (specialists) treat private patients using the hospital’s services. NHS prices are highly competitive and are recognized by private insurance plans. The income is used by the hospitals for improvements. In 2008, 12% (7 million+) of the population carried private health insurance. It is not intended to substitute for NHS care. It offers choice of specialists, faster access to elective surgery and higher standards of comfort and privacy. Patients have the right to opt for any NHS hospital or private hospital that offers care at NHS cost. In 2008, over 44,000 opted for private hospitals, and the number has been increasing. There are about 270 private hospitals dominated by three chains, with the prospect of NHS work an important factor in their recent expansion. Abstracted from: Black, N. (2010). Liberating the NHS - Another Attempt to Implement Market Forces in English Health Care. New England Journal of Medicine , 1103-1105.

Blesch, G. A. (2010). A New Round of Reform in the UK. Modern Healthcare, 32-33.

Central Intelligence Agency. (2010, November 10). The World Factbook. Retrieved November 27, 2010, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/ Dixon, A., & Robinson, R. (2002, April). The United Kingdom, Health Care Systems in Eight Countries: Trends and Challenges. European Observatory on Health Care Systems , pp. 104-114. Once More Into the Ring. (2010, July 17). The Economist, pp. 61-62.

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United Kingdom: Programs 

Country England

Institution Anglia Ruskin University

Program(s) Leadership and Management in Health & Social Care (FdSc)

Website www.anglia.ac.uk

Address

Faculty of Health and Social Care Victoria House Capital Park Fulbourn Cambridgeshire CB21 5XA

Telephone/Fax +44 (0) 1245 493131

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email answers@anglia.ac.uk

Language(s) English

Country England

Institution Bangor University

Program(s) (1) Postgraduate Certificate in Health and Social Care Leadership

(PGCert) (2) Postgraduate Diploma in Health and Social Care Leadership

(PGDip)

Website www.bangor.ac.uk

Address Bangor University Bangor Gwynedd LL57 2DG

Telephone/Fax +44 (0) 1248 38 3244

Affiliations Unknown

University Contact(s) Name and Title

Michael Rogerson – Postgraduate Marketing Officer

Email m.rogerson@bangor.ac.uk

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Language(s) English

Duration of Each Program

(1) 6 months, (2) 1 year

Country England

Institution Bath Spa University

Program(s)

(1) Health and Social Care Management (FdSc) (2) Postgraduate Certificate Health Studies/Health Care Management

(PGCert) (3) Postgraduate Diploma Health Studies/Health Care Management

(PGDip)

Website www.bathspa.ac.uk

Address Bath Spa University, Newton Park, Newton St Loe, Bath, BA2 9BN, UK

Telephone/Fax +44 1225 875875

Affiliations Unknown

University Contact(s) Name and Title

Dr. Mike McBeth, Course Director

Email m.mcbeth@bathspa.ac.uk

Language(s) English

Country England

Institution Birmingham City Business School

Program(s) Healthcare Administration (PhD)

Website www.bcu.ac.uk

Address Not available on website

Telephone/Fax 0121 331 5200

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email Business.school@bcu.ac.uk

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Language(s) English

Duration of Each Program

Part time 3 years

Country England

Institution Bournemouth University

Program(s) Postgraduate Diploma in Leadership and Management in Health and Social Care (PGDip)

Website www.bournemouth.ac.uk

Address

Fern Barrow Talbot Campus Poole Dorset BH12 5BB UK

Telephone/Fax +44 (0) 1202 52411

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email Enquiries@bournemouth.ac.uk

Language(s) English

Country England

Institution Bradford University School of Management

Program(s)

(1) Masters Health and Social Care Management (MSc) (2) Postgraduate Diploma Health and Social Care Management

(PGDip) (3) Masters in Leadership and Change Management in Health and

Social Care (MSc) (4) Postgraduate Diploma in Leadership and Change Management in

Health and Social Care (PGDip)

Website www.bradford.ac.uk

Address University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK

Telephone/Fax 01274 232323

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Affiliations Unknown

University Contact(s) Name and Title

Andrea Cassidy, Programme Leader

Email a.m.cassidy@bradford.ac.uk

Language(s) English

Duration of Each Program

(1) 12 months, (2) 12 months, (3) 12 months, (4) 12 months

Country England

Institution Brunel University Brunel Business School

Program(s) (1) Administration in Healthcare Management (MBA) (2) Healthcare Management (MBA)

Website www.brunel.ac.uk

Address Brunel University Kingston Lane Uxbridge Middlesex UB8 3PH

Telephone/Fax +44 (0) 1895 26589

Affiliations Unknown

University Contact(s) Name and Title

General inquiries

Email brunelmba@brunel.ac.uk

Language(s) English

Country England

Institution City University

Program(s) (1) Masters of Health Management (Evidence Based Management)

(MSc) (2) Masters of Health Management (Strategic Management and

Planning) (MSc)

Website ww.city.ac.uk

Address City University London Northampton Square London EC1V 0HB

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Telephone/Fax +44 (0)20 7040 5828

Affiliations Unknown

University Contact(s) Name and Title

Greg Layther, Programme Director

Email g.layther@city.ac.uk

Language(s) English

Duration of Each Program (1) 12 months full-time, (2) 12 months full-time

Country England

Institution City University

Program(s)

(1) Postgraduate Diploma Health Management (Evidence Based Management) (PGDip)

(2) Postgraduate Certificate Health Management (Evidence Based Management) (PG Cert)

(3) Postgraduate Diploma in Health Management (PGDip) (4) Postgraduate Certificate in Health Management (Strategic

Management and Planning) (PG Cert)

Website ww.city.ac.uk

Address City University London Northampton Square London EC1V 0HB

Telephone/Fax +44 (0)20 7040 5828

Affiliations Unknown

University Contact(s) Name and Title

Greg Layther, Programme Director

Email g.layther@city.ac.uk 

Language(s) English

Country England

Institution Edge Hill University

Program(s) Masters of Leadership Development (Clinical Leadership, Leadership and Management) (Msc)

Website www.edgehill.ac.uk

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Address Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK

Telephone/Fax 01695 575171

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email vaughanj@edgehill.ac.uk

Language(s) English

Country England

Institution Greenwich School of Management

Program(s) (1) EMBA Health Services Management (2) Masters In Leading and Managing in Healthcare Organizations

(MSc)

Website www.greenwich.ac.uk

Address

Greenwich School of Management Meridian House Royal Hill Greenwich London SE10 8RD United Kingdom

Telephone/Fax +44 (0) 208 516 7800

Affiliations Unknown

University Contact(s) Name and Title

Professor Leslie Johnson – Head of Business School

Email l.johnson@gre.ac.uk

Language(s) English

Country England

Institution Imperial College London Imperial College Business School

Program(s) MSc International Health Management

Website http://www3.imperial.ac.uk/business-school/programmes/msc-health-management

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Address

Commonwealth Building Hammersmith Hospital DuCane Road London W12 0DD United Kingdom

Telephone/Fax Tel: +44 (0)20 7594 9208

Affiliations Unknown

University Contact(s) Name and Title

Dr. Benita Cox – Programme Director, Senior Teaching Fellow

Telephone/Fax +44 (0)20 7594 9164

Email b.cox@imperial.ac.uk

Language(s) English

Duration of Each Program

One year, full-time

Country England

Institution Keele University Keele Management School

Program(s) (1) Postgraduate Diploma Health Services Management (PGDip) (2) MBA (Health Executive) (3) DBA Health Management

Website http://www.keele.ac.uk/depts/aa/postgraduate/ courses/healthservicesman.html

Address

Admissions and Recruitment Office (Postgraduate) Centre for Health Planning and Management Darwin Building Keele University, Keele, Staffordshire, ST5 5BG

Telephone/Fax Tel: +44 (0)1782 583 191

Affiliations Unknown

University Contact(s) Name and Title

Melanie Shaw

Email m.shaw@keele.ac.uk

Language(s) English

Duration of Each Program

(1) 1 year, (2) 2 years

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Country England

Institution Keele University Keele Management School

Program(s) (1) Postgraduate Diploma Health Services Management (PGDip) (2) MBA (Health Executive) (3) DBA Health Management

Website http://www.keele.ac.uk/depts/aa/postgraduate/ courses/healthservicesman.html

Address

Admissions and Recruitment Office (Postgraduate) Centre for Health Planning and Management Darwin Building Keele University, Keele, Staffordshire, ST5 5BG

Telephone/Fax Tel: +44 (0)1782 583 191

Affiliations Unknown

University Contact(s) Name and Title

Melanie Shaw

Email m.shaw@keele.ac.uk

Language(s) English

Duration of Each Program

(1) 1 year, (2) 2 years

Country England

Institution King’s College London

Program(s) (1) Postgraduate Certificate Advanced Practice (Leadership) (Pg Cert) (2) Postgraduate Diploma Advanced Practice (Leadership) (PGDip) (3) Masters of Advanced Practice (Leadership) (MSc)

Website www.kcl.ac.uk

Address King's College London, Strand, London WC2R 2LS, England, United Kingdom

Telephone/Fax +44 (0)20 8417 9000

Affiliations Unknown

University Contact(s) Name and Title

Dr. Margaret Edwards

Email Margaret.edwards@kcl.ac.uk

Language(s) English

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Country England

Institution Kingston University Kingston Business School

Program(s)

(1) Postgraduate Certificate in Leadership and Management in Health (PG Cert)

(2) Postgraduate Diploma in Leadership and Management in Health (PGDip)

(3) Masters in Leadership and Management in Health (MSc)

Website http://business.kingston.ac.uk

Address

Kingston University Kingston Hill Kingston Upon Thames London, KT2 7LB United Kingdom

Telephone/Fax +44 (0)20 8417 9000

Affiliations Unknown

University Contact(s) Name and Title

Dr. Jelena Petrovic

Email j.petrovic@kingston.ac.uk

Language(s) English

Country England

Institution Leeds University Nuffield Centre for International Health and Development

Program(s)

(1) Postgraduate Certificate in Health Management, Planning and Policy (PG Cert)

(2) Postgraduate Diploma in Health Management, Planning and Policy (PGDip)

(3) Masters in Health Management, Planning and Policy (MA)

Website http://www.leeds.ac.uk/lihs/nuffield/

Address

Leeds Institute of Health Sciences University of Leeds Charles Thackrah Building 101 Clarendon Road LS2 9LJ, Leeds United Kingdom

Telephone/Fax Tel: +44 (0)113 343 69 42 Fax: +44 (0)113 246 08 99

Affiliations Unknown

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University Contact(s) Name and Title

Mr. Tom Dessoffy – Course Director

Telephone/Fax Tel: + 44 (0) 113 343 4857/ Fax: 343 6997

Email t.r.dessoffy@leeds.ac.uk

Language(s) English

Duration of Each Program

(1) 3 months, (2) 9 months, (3) one year

Country England

Institution Leeds University Nuffield Centre for International Health and Development

Program(s) (1) Postgraduate Certificate in Hospital Management (PG Cert) (2) Postgraduate Diploma in Hospital Management (PGDip) (3) Master of Arts in Hospital Management(MA)

Website http://www.leeds.ac.uk/lihs/nuffield/

Address

Leeds Institute of Health Sciences University of Leeds Charles Thackrah Building 101 Clarendon Road LS2 9LJ, Leeds United Kingdom

Telephone/Fax Tel: +44 (0)113 343 69 42 Fax: +44 (0)113 246 08 99

Affiliations Unknown

University Contact(s) Name and Title

Mr. Tom Dessoffy – Course Director

Telephone/Fax Tel: + 44 (0) 113 343 4857/ Fax: 343 6997

Email t.r.dessoffy@leeds.ac.uk

Language(s) English

Duration of Each Program

(1) 3 months, (2) 9 months, (3) one year

Country England

Institution Liverpool John Moores University

Program(s) (1) Postgraduate Certificate in Healthcare Management (PG Cert) (2) Postgraduate Diploma in Healthcare Management (PGDip)

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(3) Masters of Healthcare Management (MA)

Website www.ljmu.ac.uk

Address Roscoe Court 4 Rodney Street Liverpool L1 2TZ

Telephone/Fax 0151 231 2121

Affiliations Unknown

University Contact(s) Name and Title

Dr. Colin Jones – Principal Lecturer, Advanced Practice Rohani Arshad – Associate Professor Jyoti Vithlani – Senior Lecturer

Email c.jones2@ljmu.ac.uk rohani@mahsa.edu.my j.k.vithlani@ljmu.ac.uk

Language(s) English

Duration of Each Program

3 years

Country England

Institution London Metropolitan University

Program(s)

(1) Postgraduate Diploma in Health and Social Care Management (PGDip)

(2) Postgraduate Certificate in Health and Social Care Management (PG Cert)

(3) Bachelors in Health Studies and Management (BA/BSc) (4) Masters in Health and Social Care Management (MA)

Website www.londonmet.ac.uk

Address London Metropolitan University 31 Jewry Street London

Telephone/Fax +44 (0)20 7423 0000

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email socialscience@londonmet.ac.uk

Language(s) English

Duration of Each Program

(1) 1 year, (2) 1 year, (3) 3 years, (4) 1 year

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Country England

Institution London School of Economics and Political Science

Program(s) Masters of Health Economics, Policy and Management (MSc)

Website www2.lse.ac.uk

Address

LSE Houghton Street London WC2A 2AE UK

Telephone/Fax +44(0)20 7955 7160

Affiliations Unknown

University Contact(s) Name and Title

Professor Elias Mossialos – Brian Abel-Smith Professor of Health Policy; Director, LSE Health; Co-Director, European Observatory on Heath Systems and Policies

Email e.a.mossialos@lse.ac.uk

Language(s) English

Country England

Institution University of Readying Henley Business School

Program(s)

(1) Postgraduate Certificate Health and Social Care Management (PG Cert)

(2) Postgraduate Diploma Health and Social Care Management (PGDip)

(3) Masters in Health and Social Care Management (MA)

Website www.henley.reading.ac.uk

Address Henley Business School University of Reading Whiteknights Reading, UK

Telephone/Fax 44118 378 5044

Affiliations Unknown

University Contact(s) Name and Title

Valerie Woodley

Email hscm@henley.reading.ac.uk

Language(s) English

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Country Scotland

Institution Glasgow Caledonian University

Program(s) Postgraduate Certificate in Health and Social Care (Leadership in Practice Learning) (PG Cert)

Website www.gcu.ac.uk

Address

Glasgow Caledonian University Cowcaddens Road Glasgow G4 0BA Scotland, UK

Telephone/Fax +44 (0)141 331 3000

Affiliations Unknown

University Contact(s) Name and Title

General Inquiries

Email postgraduate@gcu.ac.uk

Language(s) English

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APPENDIX C: CAHME SURVEY RESULTS

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If "Yes", please provide the name and location of the center: • The Program is currently accepting students into • Buffet Center and Global Health Initiatives • Global Health Management only as part of the Global Health MPH degree. The MHA

Program is located within the Department of Health Services within the School of Public Health. Global Health Management is a jointly taught course between the MHA Program and the Global Health MPH Program

• There is a "center" but healthcare management education is not delivered to HA students through the center.

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If "Yes", please describe: Type of Grant/Funding Focus/Activity Gates Foundation ▪Research & teaching USAID ▪Hospital performance indicator ▪Evaluation of sanitation and hard working programs Department of Commerce ▪International patients coming to the USA;

collaboration among hospitals; revenue generated Other Sources Not identified ▪Health workforce policy analysis ▪Research and Teaching ▪Quality and patient safety ▪Technical assistance for health management skill development ▪Studies on aging ▪Impact of HIV/AID testing and treatment ▪Healthcare workforce issues

▪Health care policy in EU ▪Visiting scholar ▪Causes and effects of cleft palate ▪Public policy and health care delivery ▪Develop DrPH Executive Program

Educational Exchange Program Study Abroad Development Grant ▪Student travel IHI Funding ▪Program evaluation CIBER Grant Faculty Travel Grants ▪Faculty exchanges NIH ▪Deliver research ethics courses

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Countries Specified Botswana Guatemala Slovakia China (2) Haiti South Africa (2) Democratic Republic of Congo Kenya Tanzania Ghana Libya United Kingdom Georgia Mexico Vietnam Germany Russia Zimbabwe Regions Africa Eastern Europe Middle East Asia (2) European Union

If "Yes", please describe other projects:

Type of Project/Activity Country

▪Evidence based public health Unknown ▪Study abroad & service learning China ▪Public health program development Unknown ▪Participate in international conference China (2)

Chile England Italy

▪Consulting for TB programs South Africa ▪Develop university programs Georgia ▪HME training programs Kazakhstan ▪Consulting with World Bank & USAID Kuwait

Iraq Uganda

▪Work with international companies South America Central America

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▪Director of International Health Unknown Economics Association ▪Hepatitus B screening China ▪Health information technology project China

India ▪International field experiences Unknown ▪Faculty projects (non specified) Sweden

China (2) Italy South Korea South Africa Saudi Arabia

▪Sabbatical Japan ▪Teaching affiliation programs Singapore

UAE France

▪c –section deliveries Peru ▪Reducing socioeconomic disparities

Type of Project/Activity Country Region ▪Prevention and control of infectious Canada Diseases (cost effectiveness analysis) ▪Consultant to CDC and governments Chile ▪Burmese Refugee Project Canada ▪Health system effectiveness and Sub-Sahara population preferences for healthcare Africa ▪Low income countries and healthcare Tanzania

Ethiopia Liberia Ghana

▪Maternal health preferences Unknown ▪Human resource shortages Unknown ▪Innovation and access to medicines Unknown in developing countries; new global patient laws; roles of public and private sectors ▪Case study development China ▪General consulting projects Middle East ▪Medical tourism Unknown ▪Hospice service Unknown ▪Educational programs in Argentina Health care Brazil

Uruguay ▪Field seminar course India

Vietnam ▪Guest lectures at European School of Public Health

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If "Yes", please describe: Research Activity Country ▪Quality improvement initiatives Unknown ▪Technology cost-benefit impacts of Unknown universal health coverage Research Activity Country ▪Gates Foundation Democratic Republic of Congo ▪USAID Grant Mali Burkina Faso Guatemala Kenya South Africa Zimbabwe Tanzania ▪PhD health services research Unknown ▪Impact of health outcomes Unknown ▪Long term care China ▪PhD dissertations Thailand China Saudi Arabia Nicaragua Nigeria ▪Collaboration Unknown ▪Work with business schools on Italy different research projects France ▪Research unspecified China (2) Haiti ▪Projects unspecified Estonia Bulgaria

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▪Study healthcare system Korea ▪Teaching Africa Haiti ▪Unspecified (4) ▪Do not know (1)

If “Yes”, please state location by city and country: • Madrid, Spain • China, Korea, Arab Emirates • We have collaborative programs in several international places, but NOT an official GSU

campus • Korea • Tokyo, Rome and partner MBA programs in Cali (Colombia), Paris, Beijing and Singapore • VCU has a campus in Qatar: School of the Arts

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• Programs with local representative in Taiwan and Singapore • Quedlinburg, Germany: Seville, Spain

If “Yes”, please list each course taught: • Mostly B-School courses • Working with Southern Medical University in China now such an initiative.

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• Currently only one- the program is phasing out • Zero

If "Yes", please describe: Location HM Partnerships Type Argentina (Buenos Aires) University Canada (2) Institute China (Beijing) University France (Paris (2) University Germany (3) University Georgia (Tbilisi) (4) University Italy (Rome) University Israel Unknown Paraguay University Singapore Institute South Korea Military Hospitals Taiwan Unknown UAE University

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Unspecified (N = 4) Unspecified Developing (N=5) Taiwan, China (3), India & Singapore

If “Yes”, in what country: Countries Afghanistan Argentina Australia (2) Austria Canada (2) China (3) France (5) Germany Honduras India Indonesia Iraq Italy (3) Japan (2) Kuwait

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Mauritius Mexico Oman Portugal Saudi Arabia Scotland (3) Spain Sweden Switzerland (3) Taiwan Thailand Turkey UK (3) Region Europe The State of Georgia does not permit sabbaticals People have used their sabbaticals to spend some time overseas Don’t know

If "Yes", please list journal(s): Name of Journal Journal of Health Management & Public Health Journal of World Health and Population Journal of Management and Health Policies International Journal of Public Policy Journal of Evaluation in Clinical Practice Bulletin of the WHO Journal of Global Medical Policy Health Economics Journal of Central Asia Health Services Research Health Policy International Journal of Pharmaceutical and Healthcare Marketing Journal of World Health and Population International Journal of Integrated Care International Journal of Health Management Education Journal for Education and Rehabilitation International Journal of Accounting International Journal of Information and Operations Management Education International Journal of Economic and Social Research

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Journal of Global Information Management Total Quality Management Journal Journal of Ethnicity and Health Don’t know (4)

If "Yes", please describe: • Providing in-kind support and founding editorial board assistance for on-line Journal of

Global Medical Policy • World Health and Population • Editor is a faculty member

If “Yes”, list the universities and type of appointments: University Country

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Chinese University of Hong Kong China University Jean Moulin Lyon France University of Bologna Italy Cambridge University England University of Ferrara Italy Ecole Supérieure des Affairs in Beirut Lebanon University Country Trnava University Slova Republic St. Elizabeth University Slovak Republic Georgia State University Georgia Tbilisi State Medical University Georgia Norwegian School of Economics Norway Lille Catholique University France Szechwan University China I believe so in a university in Korea Korea Don’t know/Not sure 5 responses

If “Yes”, please specify: Conference Country Xavier Leadership Group Unknown International Conferences on Healthcare Systems Mexico International Health Economics Association Turkey Unknown International Conference with Peking University China Center for International Business and Research (CIBER) Unknown Global Business Forum Unknown Not specified (3) Unknown

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If “Yes”, please list the name of each course: Type of Course Taught Frequency Comparative Health Care Systems 2 Health Care System of China Organizational Theory Healthcare Leadership Healthcare Finance 3 Human Resources Management 2 Healthcare Management 2 Long Term Care Administration Risk Management Ethics in Health Care Non-degree Executive Education (Asia, Europe and Middle East) Countries Region China Asia Georgia Europe Slovak Republic Middle East Netherlands Trinidad &Tobago

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If "Yes", please describe: Countries Region China Middle East India Asia Korea Saudi Arabia Taiwan Thailand Strategy To other Jesuit Universities abroad Focus on Clinical Research partnerships Don’t know, Unknown or Very General (5)

C A H M E | 183

C A H M E | 184

C A H M E | 185

Name of Course/Type of Course Frequency Business courses Non-credit seminars Comparative Health Care Systems Health Finance (3 credits) Human Resources Management (3 credits) International Comparative Health System (3 credits) International Health Marketing and Policy Long Term Care (3 credits) Leadership in Health Administration (3 credits) Ethics in Health Care (3 credits) Human Resource Management (3 credits) Healthcare Marketing (1 credit home & ½ credit abroad) Tailored Executive Education All courses of the foreign program None, no courses, not applicable 8 Countries Listed France Georgia Haiti Slovak Republic

Response Frequency Only Lectures 1 US and France: A Comparison of Health Systems 1 Risk Management 1 Health Care Systems for China 1 N/A or None 9

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If "Yes", please describe: • International health systems. A course that combines comparative health systems with the

analysis of health reform efforts in different countries and global health problems. • Competencies addressed are defined by the context in which they are taught. Course content

varies somewhat depending upon the program goals, audience, and culture. • Leadership in Health Care briefly discusses global health, more local orientation to local

needs. • Our courses look at issues associate with health care financing and delivery iin other countries • Don’t know

If "Yes", what courses are taught? Type of Track or Concentration Elective course Certificate in Globalization and Health (Several courses)

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Course on Globalization and Health Course on International Comparative Health Systems Type of Track or Concentration Other Public Health Courses Global Health Track in HPM Several courses Dual MBA/MPH with International Health at the School of Public Health Global Health Management and Leadership Course

If “Yes”, please list the countries: Country Frequency India 8 China 7 UK 5 France 3 Germany 3 Saudi Arabia 3

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Israel 2 Netherlands 2 Pakistan 2 Russia 2 Switzerland 2 Country Frequency Taiwan 2 Thailand 2 Afghanistan Albania Australia Bahrain Bangladesh Bermuda Cyprus Egypt Ghana Honduras Indonesia Iraq Ireland Ivory Coast Japan Kuwait Moldova New Zealand Nicaragua Nigeria Norway Palestine Panama Peru Portugal Qatar Rwanda South Korea Spain Tanzania Turkey Don’t know, not sure 5 Several countries 4

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If “Yes”, please list the countries: Country Frequency China 16 India 16 Saudi Arabia 8 Taiwan 8 Singapore 5 South Korea 5 Canada 3 Mexico 3 Philippines 3 Switzerland 3 Colombia 2 Hong Kong 2 Indonesia 2 Japan 2 Kenya 2 Nigeria 2 Thailand 2 Antigua Armenia Azerbaijan Belarus Bahamas Bahrain Brazil Bangladesh Columbia Democratic Republic of Congo Denmark Egypt

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Georgia Hungry Iceland Italy Jordan Kuwait Malaysia Moldova Mongolia Netherlands New Zealand Oman Pakistan Palestine Puerto Rico Qatar Russia South Africa Spain Turkey Turkistan UAE UK Ukraine Vietnam Many others, Difficult to track, too many 4 Many Africa Countries 2 None

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If “Yes”, do they have a special chapter? Association Frequency

• Overall for the Business School • Not at the Program level, yes at the School level • No 15

Range Frequency

1-25 23 26-50 2 51-100 3 Greater than 100 2

Very few 7 Unknown 12

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If “Yes”, please explain: • Students in domestic programs need to have an understanding of basic issues and concerns of

IHCM • Yes, but I think that the requirement needs to be phased in and to have sufficient conversation

with program directors before it is included. • However, the question is not specific enough for me to comment thoroughly. • A competent healthcare executive and graduate of a CAHME-accredited program would be

well served with basic sensitive to market conditions and considerations in countries other than the United States.

• Global Healthcare management is an indispensable perspective for all domestic and international health services. Health managers need to receive practical knowledge to learn from international experiences and to apply global healthcare lessons locally. They also need to understand the competencies needed to successful global healthcare practice.

• More globalization in general will require more research in how healthcare is delivered not only in the United States, but across the world.

• I don’t understand this question – international health care management education within domestic programs?

• System requirements too varied, no established international norms • Accreditation standards are for all CAHME programs where some may have very small

international collaborations and they may not need to be held up to the same standards as larger programs. If some programs are big on international education, they should include more content in this area without burdening other programs.

• Not unless programs have that as a mission • Don’t know • As an optional content area • If for no other reason to provide comparative perspectives of what is possible and what

works in health care management in other countries, some material should be included in our domestic programs even if students have no intention of being health care administrators outside of North America.

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• Not all university programs are prepared to do that. Many are too small. I think it is still a situation that has to be decided at the local level

• The line between domestic and international is increasingly blurred and our graduates need to be comfortable working at multiple points along the domestic-international continuum. This implies the need for that core exposure to international issues and contexts.

• Healthcare is rapidly becoming global • Our program is approached by many foreign students expressing an interest in developing

expertise to utilize in their home countries. • Only if it is a strong part of the program and fits the program’s mission, etc. • Not all programs the same • Yes, understanding global health care education, practice, implications, impact, etc. • Depends on the focus of the program. We are all different • Not sure I understand. Why would this be separate? All health education should have an

increasing emphasis on the global context

If “Yes”, please explain: • Again, I would want to have more background and specificity. • Not sure • I don’t understand this question – competencies for international programs or for domestic

programs catering to international health care management? • Competencies to do what? For example, current systems and entities are too varied to allow

for competency establishment related to individual and entity performance….where and in what role? Management public systems? Management public or private health care entities in different economic models/conditions?

• Not unless programs have that as a mission • On an optional basis for programs wishing to offer content in this area

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• Probably, so many unique features exist country by country, particularly in the regulatory/legal realm that a single North American standard would be unworkable and probably unwelcome.

• Perhaps, but it should be voluntary. • Existing competencies can be expanded to include international/multicultural applications.

There may be additional competencies, but generally they can be embedded within existing competencies.

• Assuming CAHME accreditation is recognized as an indicator of quality, these courses would be a form of ambassadorship for CAHME and so the quality should be monitored.

• To deal with cross cultural issues as healthcare becomes global • No because it implies that all programs have to teach to those competencies • Should have some general standards • Cultural competency, harmonization of standards, best practices • It depends on the focus of the program

If “Yes”, Please explain: • It's really their decision as to whether or not to do this. It would not be core to our program,

but may provide some affiliation opportunities with CAHME accredited programs in other countries...

• Health care is a growing international issue, problem, field...there are excellent universities overseas that it would be good to interact with and measure competencies worth.

• If appropriate, then yes. Many countries have highly regulated health systems, and the education of their leaders is also highly regulated, even licensed. Not sure what good CAHME could do in those countries. However, in countries where it makes sense for standards like CAHME, it is worth consideration. That said, it is a big strategic question for CAHME, with a big price tag. What's the benefit? What's the ROI? Don't just jump into this.

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• Health care is a global business • Good idea and could be a revenue source. • The CAHME accreditation process is already weak in reliability or consistency in judging

programs' performance on existing criteria. Why would we want to think that we have credibility in judging international programs?

• The 11 general competencies should apply to all health care programs. Required of all graduates from programs all over the globe.

• It depends on the status of the program, mission, etc. criteria and if the program is accredited domestically.

• This gives CAHME an opportunity to expand its reach beyond its current market. • If financially self-sustaining and invited by the programs. • You already accredit in Canada. • This should be acceptable, but CAHME criteria need to be responsive to cultural, financial,

and other differences. • Just to test to see if other countries would have any interest. • This would help improve international health management under the theory that a rising tide

lifts all boats. • This is a vast market that would allow valuable interchange across national boundaries. With

the expansion of medical tourism, global health, and international exchange generally, the extension of accreditation activities across the globe is now appropriate.

• Yes, it would elevate their programs. • We do in Canada now. If the foreign program want to apply, then CAHME should consider

approving them. • Since it is a quality measure, why not allow international universities to benefit from CAHME

accreditation. • This would need a detailed feasibility study, etc. However, it would seem to be a great

opportunity to expand the scope of CAHME and bring it to a scale that is more robust. Also, education approaches in many countries are still rote--lecture and test. CAHME could have great positive impact.

• If national/regional standards/norms can be identified...ie for EU. • Healthcare education should be global. • For programs meeting eligibility criteria. • It would provide an international standard for accreditation, similar to Joint Commission

International and The Joint Commission. • Not sure. • Actually, the answer is possibly, not yes. • To support quality healthcare management education. To promote relations between our

Programs and International quality health Administration Programs. • I do not have the expertise to respond knowledgably to this question. • The practice of healthcare management is generally consistent across populations and

societies. • In concert with local or regional professional associations.

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Please provide suggestions/comments: • Keep up the good work! • The questionnaire needs to include “NAP” or “Don’t Know” more often. I’m not sure how you

will count the answers that are left blank – simply unanswered. But you won’t know why. • I suggest you provide more specificity and context, e.g., question 33. Further context for this

questionnaire would be useful, e.g., is this a focus area of CAHME? What would the role of international systems be for U.S. based MHA programs.

• We should learn with more detail about curricula of the courses offered currently in our Programs. Also teaching methods, successful partnership strategies, student and faculty exchange mechanisms, international research opportunities, etc.

• Patient safety and quality improvement • How would you define international health management? Are these KSA needed to manage

health systems in other countries? Does it include knowledge of global health systems? • Since international healthcare systems can be very different than the US . . . how would

CAHME have to change to communicate and offer value to health management program’s in these countries

• It would be very useful to learn about the state of healthcare management in other countries, including qualifications of current leaders, educational background, scope of responsibilities, human resources management practices (e.g., how leaders more into and progress through the organization), compensation, the role of physicians and other health professionals in management. This information could provide information about variations in what is defined as healthcare management. Anecdotally, there is great variation globally.

• Future research: What areas of healthcare management are best taught cross-culturally? • Until all programs develop international focus in their programs, this should be treated as an

optional requirement.

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• There is so much variation in what is meant by global health and global health management • Develop some standards and content that could be basic to all programs. This is going to be

a big area in healthcare education • Survey too detailed and requested way too much information • Strongly recommend international experiences for graduate students in short term study tours. • Healthcare systems vary so dramatically from country to country that it is difficult to see how

CAHME could play a role. Most international or global health courses seem to take a macro public health view, rather than focusing on specific managerial or leadership knowledge or skills. This whole area is not well defined; so future research should examine 1) whether it’s worth spending any more time on this whole thing, and 2) which countries matter.

• I think the potential expansion of CAHME is the big opportunity. I would work on that. The attention to globally oriented courses as something different needing special separate attention I don’t understand yet.

• Business model and pro formats would be interesting.

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APPENDIX D: PRESENTATIONS AND CONFERENCES A listing of potential venues for publishing results of this study as well as presentations at national and international conferences. Publish The Chronicle of Higher Education Healthcare Executive Journal of Health Administration Education World Hospital and Health Systems Journal of Healthcare Management European Management Review World Health and Population International Journal of Public Policy International Journal of Health Services Presentations AUPHA Leaders Conference March 2011 Chicago AUPHA Annual Meeting June 2011 South Carolina Hospital Management Asian September 2011 Singapore World Hospital Congress November 2011 Dubai 2012 Congress on Healthcare Leadership 23rd International Conference on College Teaching and Learning February 2012 2012 EURAM Conference June 2012 9th Annual World Healthcare Congress April 2012 29th Annual Academic Chairpersons Conference April 2012 9th Annual Conference, Unite for Sight April 2012 Academy of Management APHA Annual Meeting and Conference October 2012 MGMA Annual Meeting and Conference October 2012 ACHE Annual Meeting and Conference March 2012 Chicago

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APPENDIX E: SAMPLE LETTER TO INFLUENTIAL LEADERS Date

Name Address E-Mail

Dear Dr.

I am writing to invite you to contribute to the global assessment of health administration education and practice that is described in the attached paper. We will soon complete the first part (the “supply side”) that is a survey of all of the university-based programs for health administration in India. We now need your opinions and observations to understand the demand side. It is very important to the study.

I am sure that in your position and as an advisor to JCI you have considered the performance of health executives/managers, how they are recruited and how they are trained and developed. If you will share some those ideas and observations, it will help us to understand the present and the future of health care administration as a profession/career in India.

Please provide brief answers to our questions. Your responses will be kept confidential.

1. In your opinion, what is the status of professional credentials (Master’s or Bachelor’s degrees or certificates), specifically in hospital or health administration? For employment in the public or private sector, is it recognized as a profession distinct from general business administration or medicine? Or is it recognized as a medical specialty, or public health specialty?

2. In your opinion, is there a demand at the present time in the hospital and service delivery field for people with the credentials? When they graduate with the specialty, do they find the kind of jobs that they are trained for? How does the supply of people relate to the demand?

3. Look ahead five years to 2016. Do you expect there to more recognition and demand for people with specific health administration credentials, or will it be less or the same as it is now?

4. Please add any comments that you have about what specific skills are needed and how they are best developed (by formal university degrees or on-the-job training) to meet the needs of health services organizations.

Your advice and ideas about any aspect of this study will be very welcome and appreciated.

Sincerely yours,

Professor Gary L. Filerman, Ph.D.

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