HPI4009 Health Systems Governance
Summary Year 2018-2019
Content
Case 1 Health System Analysis ................................................................................................................ 1
Workshop theory .................................................................................................................................... 4
Case 2 Governance in healthcare policy-making .................................................................................... 5
Case 3 Health policy: content, process, actors and context ................................................................. 11
Case 4 The politics of health ................................................................................................................. 14
Case 5 Solidarity in healthcare financing .............................................................................................. 19
,Case 1 Health System Analysis
Duran
Murray
Input - Conversion - Output - Feedback
Input from task environment and context
Conversion through functions creating intermediate objectives to achieve goals
Output achieved by goals
Feedback from output to task environment to input again
Task environment: arises from health system goals, and contains all different health environments
(acute diseases, chronic conditions, prevention) in a country that influence the health system and
what its objectives should be.
Context and task environment have an (in)direct influence on health systems (Case 4,5)
In Duran's model: health system = healthcare system
Advances in medical technology have raised expectations about what health systems can deliver,
causing continuing upward pressure on costs.
The definition of a health system can be narrow (healthcare) or broad (all that influences health)
(Case 4). A balance between these definitions is created by the definition of the WHO that states
that the health system includes everything that has as primary intent to improve health: ‘a health
system consists of all organizations, people and institutions producing actions whose primary intent
is to promote, restore or maintain health’.
Including:
o Health services
o Governance/stewardship
1
, Country specific health systems have a broad structural variation, while there exists a functional
equivalence. Duran's analytical model builds on these functions and allows for comparisons of
health systems between countries.
Resource generation: investment and training
Wealth for knowledge, technology, training and infrastructure
Service delivery: how is care offered
Personal services: on a one-to-one basis --> curative, preventive, promotional
Population-based services: to a group or entire population --> public health;
campaigns, promotion, cigarette labels
Health protection
Financing: collecting revenues (turnover, sales) from society, pooling to share risk, using
money in risk pools to purchase services from health providers
Governance: oversight, regulation, monitoring, policy
Steering - leading and providing vision, rather than managing all operations
Governing - ensuring clear rules and good use of resources
Accountability - for both performance outcomes and fair/reasonable processes
Government does not always have direct responsibility for healthcare
services, responsibilities often lie with non-state actors --> health insurance
funds (NHS), private providers
These functions should be organized in such a way that intermediate (instrumental) objectives can
be reached. Instrumental objectives must be normative/operational (effective) to reach the health
system goals (improving health status – equity & gain, and social welfare – financial &
responsiveness).
These different objectives and goals are ambiguous and open to multiple and changing
interpretation depending on the countries context and thus task environment
o e.g. Equity in finance is very dependent on context/culture
Not all objectives and goals can be met in an optimal way, a balance must be created.
o e.g. Choice must be limited to allow for efficiency
Goals can be reached by creating policy (=instrument);
o Effective coverage of demand, access, quality
2
Summary Year 2018-2019
Content
Case 1 Health System Analysis ................................................................................................................ 1
Workshop theory .................................................................................................................................... 4
Case 2 Governance in healthcare policy-making .................................................................................... 5
Case 3 Health policy: content, process, actors and context ................................................................. 11
Case 4 The politics of health ................................................................................................................. 14
Case 5 Solidarity in healthcare financing .............................................................................................. 19
,Case 1 Health System Analysis
Duran
Murray
Input - Conversion - Output - Feedback
Input from task environment and context
Conversion through functions creating intermediate objectives to achieve goals
Output achieved by goals
Feedback from output to task environment to input again
Task environment: arises from health system goals, and contains all different health environments
(acute diseases, chronic conditions, prevention) in a country that influence the health system and
what its objectives should be.
Context and task environment have an (in)direct influence on health systems (Case 4,5)
In Duran's model: health system = healthcare system
Advances in medical technology have raised expectations about what health systems can deliver,
causing continuing upward pressure on costs.
The definition of a health system can be narrow (healthcare) or broad (all that influences health)
(Case 4). A balance between these definitions is created by the definition of the WHO that states
that the health system includes everything that has as primary intent to improve health: ‘a health
system consists of all organizations, people and institutions producing actions whose primary intent
is to promote, restore or maintain health’.
Including:
o Health services
o Governance/stewardship
1
, Country specific health systems have a broad structural variation, while there exists a functional
equivalence. Duran's analytical model builds on these functions and allows for comparisons of
health systems between countries.
Resource generation: investment and training
Wealth for knowledge, technology, training and infrastructure
Service delivery: how is care offered
Personal services: on a one-to-one basis --> curative, preventive, promotional
Population-based services: to a group or entire population --> public health;
campaigns, promotion, cigarette labels
Health protection
Financing: collecting revenues (turnover, sales) from society, pooling to share risk, using
money in risk pools to purchase services from health providers
Governance: oversight, regulation, monitoring, policy
Steering - leading and providing vision, rather than managing all operations
Governing - ensuring clear rules and good use of resources
Accountability - for both performance outcomes and fair/reasonable processes
Government does not always have direct responsibility for healthcare
services, responsibilities often lie with non-state actors --> health insurance
funds (NHS), private providers
These functions should be organized in such a way that intermediate (instrumental) objectives can
be reached. Instrumental objectives must be normative/operational (effective) to reach the health
system goals (improving health status – equity & gain, and social welfare – financial &
responsiveness).
These different objectives and goals are ambiguous and open to multiple and changing
interpretation depending on the countries context and thus task environment
o e.g. Equity in finance is very dependent on context/culture
Not all objectives and goals can be met in an optimal way, a balance must be created.
o e.g. Choice must be limited to allow for efficiency
Goals can be reached by creating policy (=instrument);
o Effective coverage of demand, access, quality
2
