HPI4009 Health Systems Governance
Cases Year 2018-2019
Content
Case 1 Health System Analysis (+ UK specification) ................................................................................ 1
Case 2 Governance in healthcare policy-making .................................................................................... 8
Case 3 Health policy: content, process, actors and context ................................................................. 20
Case 4 The politics of health ................................................................................................................. 32
Case 5 Solidarity in healthcare financing .............................................................................................. 39
,Case 1 Health System Analysis (+ UK specification)
Duran
Murray
Country specific literature
Problem statement(s): What are the different health systems about? How do we analyse them?
What are the building blocks of a health system?
Brainstorm:
- Analytic model = system neutral
- Every country fits in this structure
- Balance between what’s important and what not
- Task environment
- Interrelation between elements (functions, objectives, goals)
- Many stakeholders
- Germany: choices vs. efficiency
- NL: equity, short length of stay
- Germany + NL: accessibility
- Biggest differences: financial, choices, service delivery (quality, prevention), transparency,
administration (codes like DOT/DBC), responsiveness
- UK: culture vs. government perspective
- Context: aging population, culture
Learning goals:
1. What are the elements/building blocks of the analytic model?
a. How are they related?
b. Explain the arrows in the model (context + task environment: functions, health
system goals, intermediate objectives)
c. How can you use this model to either create or redesign a system?
2. How do this model apply to a specific country (Germany, UK, NL)?
a. Context is less relevant
b. Focus on functions
c. Health system goals pretty similar between countries
d. Intermediate objectives is discussable?
1
, 1. What are the elements/building blocks of the analytical model?
a. How are they related?
b. Explain the arrows in the model (context + task environment: functions, health
system goals, intermediate objectives)
c. How can you use this model to either create or redesign a system?
Revenue (sales/turnover) is the amount of money that a company actually receives during a specific
period, including discounts and deductions for returned merchandise.
Health Systems
Advances in medical technology have raised expectations about what health systems can
deliver, causing continuing upward pressure on costs.
Health systems and its boundaries depending on the definitions
o Health
o Healthcare
o Health system WHO report (WHR) definition; ‘a health system consists of all
organizations, people and institutions producing actions whose primary intent is to
promote, restore or maintain health’.
The definition includes;
o Health services (personal and population based) and the activities to enable their
delivery provided by finance, resource generation and stewardship functions;
o Stewardship, which includes activities seeking to influence the positive health
impact of other sectors – even though the primary purpose of those sectors is not to
improve health.
2
, Goals of the health system
o Broad
o Intermediate objectives
Functions
Service delivery
Personal services (curative, preventive, promotional) are those that are delivered to individuals on a
one-to-one basis such as a surgical operation, a general practice consultation, individual counselling,
immunizing a child or supporting a mother in feeding a child. Population-based services (preventive
and promotional) are those delivered to a group or an entire population; these include immunization
campaigns, warning labels on cigarette packs and workplace health promotion.
The criterion of primary intent was employed for a specific reason: to create a definition that
enabled comparison (and therefore ranking) of all the national health systems worldwide.
Assigned responsibilities
In many countries, the national health ministry does not even have direct responsibility for
conventional health care services, which may be the responsibility of a range of non-state actors,
such as health insurance funds and private providers, or may be devolved to regional tiers of
government
The framework was created to compare and assess performance of the health system in different
countries. Performance refers to the gap between what is and what could be attained and hence is
a measure of overall health system efficiency
The defining goal of a health system is to improve health – other goals contributing to social welfare;
Improving the health status of the population: the average level of health and equity in the
distribution of health
Fairness in the financial contribution required to make the system work
Responsiveness of the system to the legitimate expectations of the population
Instrumental goals actionable by policy;
Effective coverage through (i) narrowing the gap between an individual’s need for a service
and his/her awareness of that need (demand), (ii) narrowing the gap between an individual’s
need for a service and their use of that service (access), and (iii) maximizing health gain from
the use of a service (quality).
Technical efficiency is instrumental in achieving all of the final goals in the sense that, by
reducing waste, systems can attain better health, greater equity and better financial
protection for a given total level of resources
Because of its overriding importance to the performance of the system, we note some elements of
good health stewardship. They apply to all interventions with a significant impact on health,
regardless of their primary purpose. These elements are steering (leading and providing vision,
rather than managing all operations), governing (ensuring clear rules and good use of resources) and
ensuring accountability (for both performance outcomes and fair/reasonable processes).
A health system exists within a specific context; culture, technology, economy, demography, politics,
etc. of a country. This context steered the creating of the current health system in a direct way. The
health system can be divided into different functions, through which certain intermediate objectives
and main goals are tried to be reached. The task environment represents the changing environment
in which the health system is active and to which it needs to adapt in an direct way.
3
Cases Year 2018-2019
Content
Case 1 Health System Analysis (+ UK specification) ................................................................................ 1
Case 2 Governance in healthcare policy-making .................................................................................... 8
Case 3 Health policy: content, process, actors and context ................................................................. 20
Case 4 The politics of health ................................................................................................................. 32
Case 5 Solidarity in healthcare financing .............................................................................................. 39
,Case 1 Health System Analysis (+ UK specification)
Duran
Murray
Country specific literature
Problem statement(s): What are the different health systems about? How do we analyse them?
What are the building blocks of a health system?
Brainstorm:
- Analytic model = system neutral
- Every country fits in this structure
- Balance between what’s important and what not
- Task environment
- Interrelation between elements (functions, objectives, goals)
- Many stakeholders
- Germany: choices vs. efficiency
- NL: equity, short length of stay
- Germany + NL: accessibility
- Biggest differences: financial, choices, service delivery (quality, prevention), transparency,
administration (codes like DOT/DBC), responsiveness
- UK: culture vs. government perspective
- Context: aging population, culture
Learning goals:
1. What are the elements/building blocks of the analytic model?
a. How are they related?
b. Explain the arrows in the model (context + task environment: functions, health
system goals, intermediate objectives)
c. How can you use this model to either create or redesign a system?
2. How do this model apply to a specific country (Germany, UK, NL)?
a. Context is less relevant
b. Focus on functions
c. Health system goals pretty similar between countries
d. Intermediate objectives is discussable?
1
, 1. What are the elements/building blocks of the analytical model?
a. How are they related?
b. Explain the arrows in the model (context + task environment: functions, health
system goals, intermediate objectives)
c. How can you use this model to either create or redesign a system?
Revenue (sales/turnover) is the amount of money that a company actually receives during a specific
period, including discounts and deductions for returned merchandise.
Health Systems
Advances in medical technology have raised expectations about what health systems can
deliver, causing continuing upward pressure on costs.
Health systems and its boundaries depending on the definitions
o Health
o Healthcare
o Health system WHO report (WHR) definition; ‘a health system consists of all
organizations, people and institutions producing actions whose primary intent is to
promote, restore or maintain health’.
The definition includes;
o Health services (personal and population based) and the activities to enable their
delivery provided by finance, resource generation and stewardship functions;
o Stewardship, which includes activities seeking to influence the positive health
impact of other sectors – even though the primary purpose of those sectors is not to
improve health.
2
, Goals of the health system
o Broad
o Intermediate objectives
Functions
Service delivery
Personal services (curative, preventive, promotional) are those that are delivered to individuals on a
one-to-one basis such as a surgical operation, a general practice consultation, individual counselling,
immunizing a child or supporting a mother in feeding a child. Population-based services (preventive
and promotional) are those delivered to a group or an entire population; these include immunization
campaigns, warning labels on cigarette packs and workplace health promotion.
The criterion of primary intent was employed for a specific reason: to create a definition that
enabled comparison (and therefore ranking) of all the national health systems worldwide.
Assigned responsibilities
In many countries, the national health ministry does not even have direct responsibility for
conventional health care services, which may be the responsibility of a range of non-state actors,
such as health insurance funds and private providers, or may be devolved to regional tiers of
government
The framework was created to compare and assess performance of the health system in different
countries. Performance refers to the gap between what is and what could be attained and hence is
a measure of overall health system efficiency
The defining goal of a health system is to improve health – other goals contributing to social welfare;
Improving the health status of the population: the average level of health and equity in the
distribution of health
Fairness in the financial contribution required to make the system work
Responsiveness of the system to the legitimate expectations of the population
Instrumental goals actionable by policy;
Effective coverage through (i) narrowing the gap between an individual’s need for a service
and his/her awareness of that need (demand), (ii) narrowing the gap between an individual’s
need for a service and their use of that service (access), and (iii) maximizing health gain from
the use of a service (quality).
Technical efficiency is instrumental in achieving all of the final goals in the sense that, by
reducing waste, systems can attain better health, greater equity and better financial
protection for a given total level of resources
Because of its overriding importance to the performance of the system, we note some elements of
good health stewardship. They apply to all interventions with a significant impact on health,
regardless of their primary purpose. These elements are steering (leading and providing vision,
rather than managing all operations), governing (ensuring clear rules and good use of resources) and
ensuring accountability (for both performance outcomes and fair/reasonable processes).
A health system exists within a specific context; culture, technology, economy, demography, politics,
etc. of a country. This context steered the creating of the current health system in a direct way. The
health system can be divided into different functions, through which certain intermediate objectives
and main goals are tried to be reached. The task environment represents the changing environment
in which the health system is active and to which it needs to adapt in an direct way.
3
