HPI4009: Health Systems Governance
Summary of the module
Maastricht University
Faculty of Health, Medicine and Life Sciences (FHML)
MSc Healthcare Policy, Innovation and Management
,Table of contents
1. Health systems analysis ....................................................................................................................................... 3
1.1 The health system context and the task environment ................................................................................. 7
1.2 Health system functions ............................................................................................................................... 8
1.3 Health system goals .................................................................................................................................... 10
1.4 Interrelations of the health system analytic framework ............................................................................ 13
2. Governance in healthcare policymaking ........................................................................................................... 14
2.1 Main actors in health systems .................................................................................................................... 17
2.2 TAPIC framework ........................................................................................................................................ 19
2.3 ‘Ideal-type’ governance modes .................................................................................................................. 21
2.3.1 Hierarchy as a coordination mechanism............................................................................................. 24
2.3.2 Markets as a coordination mechanism ............................................................................................... 25
2.3.3 Networks as a coordination mechanism............................................................................................. 26
2.3.4 Self-governance model ....................................................................................................................... 28
2.4 The development of health systems governance ....................................................................................... 29
2.4.1 Actors-Centered Institutionalism (ACI) ............................................................................................... 32
2.4.2 Institutional layering ........................................................................................................................... 38
3. Health policy making ......................................................................................................................................... 41
3.1 Agenda setting ............................................................................................................................................ 44
3.2 Policy formulation/ development............................................................................................................... 52
4. Paradigms of health........................................................................................................................................... 60
4.1 Models to define health ............................................................................................................................. 61
4.2 New perspectives on health ....................................................................................................................... 72
4.3 Implications of how we define health for the organization of health systems .......................................... 75
5. Solidarity in healthcare financing ...................................................................................................................... 76
5.1 Theories on solidarity ................................................................................................................................. 78
5.2 Motives for solidarity.................................................................................................................................. 81
5.3 Relation between solidarity and justice ..................................................................................................... 89
5.4 Increased emphasis on individual responsibility – Rawls theory of justice ................................................ 91
5.5 Limits to solidarity in healthcare ................................................................................................................ 94
2
,1. Health systems analysis
Literature
Analytic model for health systems analysis (Duran et al., 2012)
Overview of the course
3
, Defining a health systems and its boundaries
There is not one simple definitions for health systems. They vary a lot, especially in the wat that
boundaries are defined.
- Narrow definitions à medical care with patients, clear exit and entry points and services
regarding disease, disability and death.
- Broad definitions à all those determinants that contribute directly or indirectly to health.
à 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
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
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:
o Personal services are delivered to individuals on a one-to-one basic and can be
curative, preventive or promotional.
o Population services are delivered to a group or an entire population and can only be
preventive or promotional.
4
Summary of the module
Maastricht University
Faculty of Health, Medicine and Life Sciences (FHML)
MSc Healthcare Policy, Innovation and Management
,Table of contents
1. Health systems analysis ....................................................................................................................................... 3
1.1 The health system context and the task environment ................................................................................. 7
1.2 Health system functions ............................................................................................................................... 8
1.3 Health system goals .................................................................................................................................... 10
1.4 Interrelations of the health system analytic framework ............................................................................ 13
2. Governance in healthcare policymaking ........................................................................................................... 14
2.1 Main actors in health systems .................................................................................................................... 17
2.2 TAPIC framework ........................................................................................................................................ 19
2.3 ‘Ideal-type’ governance modes .................................................................................................................. 21
2.3.1 Hierarchy as a coordination mechanism............................................................................................. 24
2.3.2 Markets as a coordination mechanism ............................................................................................... 25
2.3.3 Networks as a coordination mechanism............................................................................................. 26
2.3.4 Self-governance model ....................................................................................................................... 28
2.4 The development of health systems governance ....................................................................................... 29
2.4.1 Actors-Centered Institutionalism (ACI) ............................................................................................... 32
2.4.2 Institutional layering ........................................................................................................................... 38
3. Health policy making ......................................................................................................................................... 41
3.1 Agenda setting ............................................................................................................................................ 44
3.2 Policy formulation/ development............................................................................................................... 52
4. Paradigms of health........................................................................................................................................... 60
4.1 Models to define health ............................................................................................................................. 61
4.2 New perspectives on health ....................................................................................................................... 72
4.3 Implications of how we define health for the organization of health systems .......................................... 75
5. Solidarity in healthcare financing ...................................................................................................................... 76
5.1 Theories on solidarity ................................................................................................................................. 78
5.2 Motives for solidarity.................................................................................................................................. 81
5.3 Relation between solidarity and justice ..................................................................................................... 89
5.4 Increased emphasis on individual responsibility – Rawls theory of justice ................................................ 91
5.5 Limits to solidarity in healthcare ................................................................................................................ 94
2
,1. Health systems analysis
Literature
Analytic model for health systems analysis (Duran et al., 2012)
Overview of the course
3
, Defining a health systems and its boundaries
There is not one simple definitions for health systems. They vary a lot, especially in the wat that
boundaries are defined.
- Narrow definitions à medical care with patients, clear exit and entry points and services
regarding disease, disability and death.
- Broad definitions à all those determinants that contribute directly or indirectly to health.
à 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
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
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:
o Personal services are delivered to individuals on a one-to-one basic and can be
curative, preventive or promotional.
o Population services are delivered to a group or an entire population and can only be
preventive or promotional.
4
