Lectures (Public) Health Care Systems in the EU
1, Course introduction and health system theory
When it comes to health care “Speed, price, quality: you may choose two” they say!
Healthcare brings together multiple parties within a forcefield of incentives.
Policies determine what these incentives are.
Patients, providers, and payers all seek multiple health-related and financial
outcomes.
Health system
A system is an interconnected set of elements that is coherently organized in a way
that achieves something. It must consist of three things: elements, interconnections
and a function or purpose.
A health system consists of all the organizations, institutions, resources, and people
whose primary purpose is to improve health. This is complex.
Coronavirus showed what can happen when health systems are overwhelmed. Yet
maintaining a health system even under normal conditions is difficult.
Health systems are a means to an end, plus they are open systems.
There are negative and positive feedback loops.
Health systems have static complexity and dynamic complexity:
- Non-linearity
- Interconnectedness
- Time lag between cause and effect
- Multiple interactions rather than one change
- Different impact on different parts of system
- Short term vs long term consequences
Complex adaptive systems
Unpredictability, contagion, modularity, redundance resilience.
We use health system thinking to find solutions to wicked problems and to make
innovation work.
,Types of interventions
o Vertical interventions
o Horizontal interventions
o Diagonal approach
,2, Types of health systems
System definition
Set of elements
Forming integrated structure (work together)
Interacting (operating with each other)
Interconnected (dependent on each other)
Functioning with a specific purpose
Structure and order to achieve objectives
Element connected in a certain structure that produce a certain type of behaviour
Elements coordinated according to a specified plan
Objective is real or stated
System theory
Need of any organization to interacts with its external environment.
Inputs transformed into outputs and exported to the environment.
Health system includes:
o Organizations or policies in place that are designed to plan and provide
medical care for people.
o All activities and structures that impact or determine health in its broadest
sense within a given society.
o All organizations, people, and actions whose primary intent is to promote,
restore or maintain health.
Health system boundaries
, The health system triangle
First the system was linear. There was only the people and the providers.
Later policy making and funding agencies started to play a role.
Financing:
- Taxation
- Social contributions
- Risk related premium
- Community rating
Coverage: People
- Population coverage
- Service coverage
- Cost coverage
Access to services:
- Open/restricted access
- Out-of-pocket payments
Allocation (payment to providers):
- Per time period (salary)
- Per service fee
- Per patient (capitation)
- Per case of illness
- Per output (value-based)
Benefits to patients: Funding agencies
- Cash benefits
- Coverage
Cost control measures
Capital investments
1, Course introduction and health system theory
When it comes to health care “Speed, price, quality: you may choose two” they say!
Healthcare brings together multiple parties within a forcefield of incentives.
Policies determine what these incentives are.
Patients, providers, and payers all seek multiple health-related and financial
outcomes.
Health system
A system is an interconnected set of elements that is coherently organized in a way
that achieves something. It must consist of three things: elements, interconnections
and a function or purpose.
A health system consists of all the organizations, institutions, resources, and people
whose primary purpose is to improve health. This is complex.
Coronavirus showed what can happen when health systems are overwhelmed. Yet
maintaining a health system even under normal conditions is difficult.
Health systems are a means to an end, plus they are open systems.
There are negative and positive feedback loops.
Health systems have static complexity and dynamic complexity:
- Non-linearity
- Interconnectedness
- Time lag between cause and effect
- Multiple interactions rather than one change
- Different impact on different parts of system
- Short term vs long term consequences
Complex adaptive systems
Unpredictability, contagion, modularity, redundance resilience.
We use health system thinking to find solutions to wicked problems and to make
innovation work.
,Types of interventions
o Vertical interventions
o Horizontal interventions
o Diagonal approach
,2, Types of health systems
System definition
Set of elements
Forming integrated structure (work together)
Interacting (operating with each other)
Interconnected (dependent on each other)
Functioning with a specific purpose
Structure and order to achieve objectives
Element connected in a certain structure that produce a certain type of behaviour
Elements coordinated according to a specified plan
Objective is real or stated
System theory
Need of any organization to interacts with its external environment.
Inputs transformed into outputs and exported to the environment.
Health system includes:
o Organizations or policies in place that are designed to plan and provide
medical care for people.
o All activities and structures that impact or determine health in its broadest
sense within a given society.
o All organizations, people, and actions whose primary intent is to promote,
restore or maintain health.
Health system boundaries
, The health system triangle
First the system was linear. There was only the people and the providers.
Later policy making and funding agencies started to play a role.
Financing:
- Taxation
- Social contributions
- Risk related premium
- Community rating
Coverage: People
- Population coverage
- Service coverage
- Cost coverage
Access to services:
- Open/restricted access
- Out-of-pocket payments
Allocation (payment to providers):
- Per time period (salary)
- Per service fee
- Per patient (capitation)
- Per case of illness
- Per output (value-based)
Benefits to patients: Funding agencies
- Cash benefits
- Coverage
Cost control measures
Capital investments
