Case 1 Health Systems Analysis
Governance (Hoppe, 2010): process of deliberately using power in order to coordinate sizeable
groups of people’s performances to bring about desirable results and avoidance of risk and
undesirable outcomes
o Constructed in different ways depending on the perspective that authors, scientists or other
thinkers have.
o Governance is a construct that is filled in differently with different disciplines (e.g. sociology,
political science, economics, law and health services research)
o Health system is the subject of health systems governance (HSG): being steered and being
coordinated
Health systems governance:
Greer et al, 2016 definition: systematic, patterned way in which decisions are made and
implemented
Giamo, 2009 definition: the way that policymakers try to manage, coordinate or control the activities
of healthcare actors
Bartoloni, 2011: the specific mode of production of norms (decision, rules, policies) that can be
called co-production where co-producers are different kind of actors (private and public)
o None of these is more right than the other, however they emphasize different elements of
what governance entails
o Simply put: governance is about how things are done in the health system; who makes
decisions, who is accountable, who do we coordinate services, financing etc.
How resilient health systems are, is important in challenges that we are faced with in healthcare
nowadays. The governance of a health system shapes its ability to respond to various challenges that
health systems face today
o Challenges are both manifold and complex
How much do you want to spend on healthcare as individuals and governments? There is increasing
scarcity
Analytic model ‘’Analytic Framework’’ for health systems (Duran et al, 2012): overview what health
system is and function, objectives and context in which they operate. No matter in which country you
are, you can use this analytic model. (You do not need to memorize specific details of countries in
governing)
Because health system is the object we have to know what a health system is and its boundaries
1
, Health systems do not exist in a vacuum but operate in a specific context which has an impact
(indirect and direct) on the task environment of the health system. This model, which is based on a
framework developed by the World Health Organization (WHO), is structured as an input-output
model. It shows, first of all, that health systems function in a broader environment, which consists of
two parts: the task environment and the context
Contexts health system: culture, technology, economy, politics, demography and
internationalization affect the health system (type and extend of services that can be offered).
-> Contextual factors are relevant
Task environment: includes all of the different health problems (acute, episodic, long term) that
citizens have and visit a healthcare professional for. The healthcare demands existing in the task
environment are inputs into the health system (=input that flows into the healthcare system). There,
they are turned into outputs during a process called conversion.
o Context could have both direct and indirect influence on this.
Outputs: can be either of an intermediate or final nature
- -Intermediate objectives: quality, efficiency and transparency/accountability e.g.
- -Final health system goals: health gain, equity in health and finance e.g.
The analytic model also includes a feedback loop to indicate that outputs can flow back into the
health system as new inputs.
Example of the functioning of this model: Over the past decades, the prevalence of chronic
conditions, such diabetes, COPD, cardiovascular disease and depression, has increased rapidly. These
conditions can be viewed as the task environment of health systems. They result in a certain demand
for health care that serves as input flowing into a given health system. Subsequently, within this
system, certain processes occur (i.e. conversion) that are focused on offering treatment to people
with chronic conditions. Healthcare delivery is an obvious part of such processes, but so are all kinds
of other activities, including healthcare financing and governance. Intermediate outputs in this
2
Governance (Hoppe, 2010): process of deliberately using power in order to coordinate sizeable
groups of people’s performances to bring about desirable results and avoidance of risk and
undesirable outcomes
o Constructed in different ways depending on the perspective that authors, scientists or other
thinkers have.
o Governance is a construct that is filled in differently with different disciplines (e.g. sociology,
political science, economics, law and health services research)
o Health system is the subject of health systems governance (HSG): being steered and being
coordinated
Health systems governance:
Greer et al, 2016 definition: systematic, patterned way in which decisions are made and
implemented
Giamo, 2009 definition: the way that policymakers try to manage, coordinate or control the activities
of healthcare actors
Bartoloni, 2011: the specific mode of production of norms (decision, rules, policies) that can be
called co-production where co-producers are different kind of actors (private and public)
o None of these is more right than the other, however they emphasize different elements of
what governance entails
o Simply put: governance is about how things are done in the health system; who makes
decisions, who is accountable, who do we coordinate services, financing etc.
How resilient health systems are, is important in challenges that we are faced with in healthcare
nowadays. The governance of a health system shapes its ability to respond to various challenges that
health systems face today
o Challenges are both manifold and complex
How much do you want to spend on healthcare as individuals and governments? There is increasing
scarcity
Analytic model ‘’Analytic Framework’’ for health systems (Duran et al, 2012): overview what health
system is and function, objectives and context in which they operate. No matter in which country you
are, you can use this analytic model. (You do not need to memorize specific details of countries in
governing)
Because health system is the object we have to know what a health system is and its boundaries
1
, Health systems do not exist in a vacuum but operate in a specific context which has an impact
(indirect and direct) on the task environment of the health system. This model, which is based on a
framework developed by the World Health Organization (WHO), is structured as an input-output
model. It shows, first of all, that health systems function in a broader environment, which consists of
two parts: the task environment and the context
Contexts health system: culture, technology, economy, politics, demography and
internationalization affect the health system (type and extend of services that can be offered).
-> Contextual factors are relevant
Task environment: includes all of the different health problems (acute, episodic, long term) that
citizens have and visit a healthcare professional for. The healthcare demands existing in the task
environment are inputs into the health system (=input that flows into the healthcare system). There,
they are turned into outputs during a process called conversion.
o Context could have both direct and indirect influence on this.
Outputs: can be either of an intermediate or final nature
- -Intermediate objectives: quality, efficiency and transparency/accountability e.g.
- -Final health system goals: health gain, equity in health and finance e.g.
The analytic model also includes a feedback loop to indicate that outputs can flow back into the
health system as new inputs.
Example of the functioning of this model: Over the past decades, the prevalence of chronic
conditions, such diabetes, COPD, cardiovascular disease and depression, has increased rapidly. These
conditions can be viewed as the task environment of health systems. They result in a certain demand
for health care that serves as input flowing into a given health system. Subsequently, within this
system, certain processes occur (i.e. conversion) that are focused on offering treatment to people
with chronic conditions. Healthcare delivery is an obvious part of such processes, but so are all kinds
of other activities, including healthcare financing and governance. Intermediate outputs in this
2
