Case 1: Health systems analysis
Learning goals
1. How can a health system – and its boundaries – be defined, and what are the strengths and
limitations of different definitions?
2. What is meant by the health system context (including the task environment) and how does
it influence (and/or is influenced by) other elements of the health system analytic
framework?
3. Which health system functions can be distinguished and what do these functions entail?
4. What are health system goals, both intermediary objectives and end goals, and how do these
interrelate?
5. How do each of the elements of the health system analytic framework interrelate (i.e.,
explain the feedback loop)?
Literature
- Dúran A,Kutzin J,Martin-Moreno J M,Travis. Understanding Health Systems: scope, functions
and objectives. In: Figueras J, McKee M. Health systems, health, wealth and societal well-
being. Assessing the case for investing in health systems. Berkshire: Open University Press;
2012: 19-37.
- Murray CJ L,Frenk J.A framework for assessing the performance of health systems. Bulletin of
the World Health Organization, 2000;78(6):717-731.
Analytic model for health systems
, 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 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.
Learning goals
1. How can a health system – and its boundaries – be defined, and what are the strengths and
limitations of different definitions?
2. What is meant by the health system context (including the task environment) and how does
it influence (and/or is influenced by) other elements of the health system analytic
framework?
3. Which health system functions can be distinguished and what do these functions entail?
4. What are health system goals, both intermediary objectives and end goals, and how do these
interrelate?
5. How do each of the elements of the health system analytic framework interrelate (i.e.,
explain the feedback loop)?
Literature
- Dúran A,Kutzin J,Martin-Moreno J M,Travis. Understanding Health Systems: scope, functions
and objectives. In: Figueras J, McKee M. Health systems, health, wealth and societal well-
being. Assessing the case for investing in health systems. Berkshire: Open University Press;
2012: 19-37.
- Murray CJ L,Frenk J.A framework for assessing the performance of health systems. Bulletin of
the World Health Organization, 2000;78(6):717-731.
Analytic model for health systems
, 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 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.
