Case 1 Health system analysis 11-11-2022
1. How can a health system – and its boundaries – be defined, and what are the
strengths and limitations of different definitions?
There is not one simple definitions for health systems. They vary a lot, especially in the way
that boundaries are defined.
- Narrow definitions medical care with patients, clear exit and entry points and
services regarding disease, disability and death.
- Broad definitions all those determinants that contribute directly or indirectly to
health.
o Disadvantages of a broad definition can be solved to define the boundaries of
a health system.
In defining health systems, a balance should be found that include everything which might
improve well-being because this is eventually important for making operational decisions.
Defining health systems:
- “Systematic, patterned way in which decisions are made and implemented” (Greer et
al., 2016).
- “The way that policymakers try to manage, coordinate or control the activities of
healthcare actors” (Giamio, 2009).
, - “The specific mode of production of norms (decisions, rules, policies) that can be
called co-production where co-producers are different kind of actors (private and
public).
World Health Report (WHR) 2000 - WHO
‘A health system consists of all organizations, people and institutions producing actions
whose primary intent is to promote, restore or maintain health’.
Features of the analytic model in this definition:
- Stewardship
o Selected intersectoral actions in which steward of the health system take
responsibility to advocate for improvement in areas outside their direct
control, such as legislation.
- Health services
o Services are defined by their place in the evolution of a disease, technology
involved and who delivers them. Services can be categorized in personal and
population services:
Personal services are delivered to individuals on a one-to-one basic
and can be curative, preventive or promotional. E.g. a surgical
operation, a general practice consultation, individual counselling,
immunizing a child or supporting a mother in feeding a child.
Population services are delivered to a group or an entire population
and can only be preventive or promotional. E.g. immunization
campaigns, warning labels on cigarette packs and workplace health
promotion. This categorization of services depends on the mode of
delivery, it is driven by organizational and managerial concerns.
Not all factors that affect health are covered by the assigned bodies that are in charge of
health (e.g., immunization campaigns).
The criterion of primary intent can also create difficulties: it is arguable whether the
primary purpose of a specific action is health related and whether the primary intent is to
improve health (e.g., education).
Boundaries might be too narrow as not all factors are included, such as determinants that
indirectly impact health like social factors like education (high education -> high health
literacy -> less healthcare needed)
Include the pragmatic notion of mandate. This is done to adapt the boundaries of the
health system to national contexts. (Een mandaat is de bevoegdheid om in naam van een
bestuursorgaan besluiten te nemen)
The definition of WHR2000 does not imply any particular degree of integration, nor that
anyone is in overall charge of the activities that compose it. Integration is not necessarily
needed in national health systems to be a health system;
Every country has a health system, no matter how fragmented it may be among different
organizations or however unsystematically it may seem to operate.
Thus, integration does not determine the system but may greatly influence the
performance.
1. How can a health system – and its boundaries – be defined, and what are the
strengths and limitations of different definitions?
There is not one simple definitions for health systems. They vary a lot, especially in the way
that boundaries are defined.
- Narrow definitions medical care with patients, clear exit and entry points and
services regarding disease, disability and death.
- Broad definitions all those determinants that contribute directly or indirectly to
health.
o Disadvantages of a broad definition can be solved to define the boundaries of
a health system.
In defining health systems, a balance should be found that include everything which might
improve well-being because this is eventually important for making operational decisions.
Defining health systems:
- “Systematic, patterned way in which decisions are made and implemented” (Greer et
al., 2016).
- “The way that policymakers try to manage, coordinate or control the activities of
healthcare actors” (Giamio, 2009).
, - “The specific mode of production of norms (decisions, rules, policies) that can be
called co-production where co-producers are different kind of actors (private and
public).
World Health Report (WHR) 2000 - WHO
‘A health system consists of all organizations, people and institutions producing actions
whose primary intent is to promote, restore or maintain health’.
Features of the analytic model in this definition:
- Stewardship
o Selected intersectoral actions in which steward of the health system take
responsibility to advocate for improvement in areas outside their direct
control, such as legislation.
- Health services
o Services are defined by their place in the evolution of a disease, technology
involved and who delivers them. Services can be categorized in personal and
population services:
Personal services are delivered to individuals on a one-to-one basic
and can be curative, preventive or promotional. E.g. a surgical
operation, a general practice consultation, individual counselling,
immunizing a child or supporting a mother in feeding a child.
Population services are delivered to a group or an entire population
and can only be preventive or promotional. E.g. immunization
campaigns, warning labels on cigarette packs and workplace health
promotion. This categorization of services depends on the mode of
delivery, it is driven by organizational and managerial concerns.
Not all factors that affect health are covered by the assigned bodies that are in charge of
health (e.g., immunization campaigns).
The criterion of primary intent can also create difficulties: it is arguable whether the
primary purpose of a specific action is health related and whether the primary intent is to
improve health (e.g., education).
Boundaries might be too narrow as not all factors are included, such as determinants that
indirectly impact health like social factors like education (high education -> high health
literacy -> less healthcare needed)
Include the pragmatic notion of mandate. This is done to adapt the boundaries of the
health system to national contexts. (Een mandaat is de bevoegdheid om in naam van een
bestuursorgaan besluiten te nemen)
The definition of WHR2000 does not imply any particular degree of integration, nor that
anyone is in overall charge of the activities that compose it. Integration is not necessarily
needed in national health systems to be a health system;
Every country has a health system, no matter how fragmented it may be among different
organizations or however unsystematically it may seem to operate.
Thus, integration does not determine the system but may greatly influence the
performance.
