Health Systems - Introduction

Summary

In this lecture, Robert Yates explores the concept of health systems and their crucial role in delivering universal health coverage. He explains that health systems encompass all organizations, people, and actions aimed at promoting, restoring, and maintaining health. Key goals include improving health indicators, ensuring responsiveness to public needs, and promoting fair financial contributions. Yates discusses the vital functions of health systems—resource creation, service delivery, financing, and stewardship—emphasizing the importance of state involvement. He also delves into the public and private sector balance and the importance of efficient system performance measurement to improve health outcomes.

Takeaways

• 😀 A health system includes all organizations, people, and actions whose primary intent is to promote, restore, or maintain health. This encompasses public and private healthcare providers, preventive care, and broader health-promoting activities.
• 😀 Health systems aim to improve health indicators (e.g., life expectancy and mortality rates), ensure equity, and offer fair financial contributions towards healthcare.
• 😀 The World Health Organization outlines three major goals of health systems: improving health outcomes, ensuring responsiveness to people's needs, and promoting fairness in financial contributions.
• 😀 Four key functions of a health system are creating resources (e.g., medicines, healthcare workers), delivering services efficiently, financing the system, and ensuring proper stewardship through state oversight.
• 😀 Stewardship in health systems involves government responsibility to regulate, monitor performance, and ensure accountability, preventing exploitation in free market systems.
• 😀 The role of the state in a health system is crucial, as health should be a national priority. Governments must be involved in setting rules and managing the system to ensure equitable access to services.
• 😀 Free markets in healthcare often fail to deliver equitable health outcomes, as private providers may exploit patients due to information asymmetry.
• 😀 The private sector plays a significant role in healthcare, particularly in service provision and resource generation (e.g., producing medicines), but the public sector is primarily responsible for oversight and stewardship.
• 😀 To achieve universal health coverage, a health system needs to be predominantly publicly financed, though private providers may be involved in service delivery.
• 😀 Measuring health system performance involves assessing health outcomes, financial protection, and responsiveness. Global rankings, like those by WHO and the Commonwealth Fund, highlight discrepancies in performance despite differing spending levels across countries.
• 😀 The United States, despite spending significantly more on healthcare, ranks poorly in global comparisons due to inequitable access and performance issues, while countries like the UK (with predominantly public financing) perform better on equity and outcomes.

Q & A

What is the definition of a health system according to the World Health Organization?

According to the World Health Organization, a health system consists of all organizations, people, and actions whose primary intent is to promote, restore, or maintain health. This includes influencing health determinants and direct health-improving activities.

What does the health system include beyond hospitals and public health units?

A health system includes the private health sector (both for-profit and non-governmental providers), people caring for sick relatives at home, preventive health care activities (such as vector control programs and behavior change), and occupational health and safety legislation.

Why is intersectional action important for health systems?

Intersectional action is important because it involves interventions that improve health through non-health sectors. For example, educating girls, implementing road safety measures, and encouraging legislation to reduce harmful consumption of tobacco, alcohol, and sugar can significantly improve health outcomes.

What are the three major goals of a health system as identified by the World Health Organization in their 2000 report?

The three major goals of a health system are: 1) improving health indicators (e.g., life expectancy, mortality rates, and health equality), 2) ensuring responsiveness to people's non-medical expectations (e.g., respect and timely treatment), and 3) achieving fairness in financial contributions towards health system financing.

What are the four key functions of a health system as outlined by the World Health Organization?

The four key functions of a health system are: 1) creating resources (e.g., medicines, health workers), 2) delivering efficient and equitable services, 3) financing the health system (raising finances, pooling resources, purchasing services), and 4) stewardship (management and oversight, with a role for the state).

Why is state involvement important in the stewardship of health systems?

State involvement is crucial in the stewardship of health systems because health is a national priority. Governments are needed to set regulations, oversee performance, and ensure accountability in the system, particularly because free markets in health services do not deliver equitable outcomes.

What role does the private sector play in health systems?

The private sector plays an important role in the production of inputs for the health system (e.g., medicines and medical equipment) and, in many countries, in the provision of health services, which are often contracted using public financing.

What challenges arise from relying on private sector providers in health systems?

Relying on private sector providers can lead to issues such as market failures, where providers have more information than users, potentially exploiting patients. This is why a balanced approach between the public and private sectors is necessary, with clear regulations and oversight from the state.

What controversy surrounds measuring health service performance, and how do organizations like the Commonwealth Fund assess it?

Measuring health service performance is controversial because it involves complex indicators like health outcomes, access, equity, and efficiency. Organizations like the Commonwealth Fund assess performance by comparing countries' quality of care, system efficiency, access to services, and equity, ranking countries based on these factors.

What is the key finding from the Commonwealth Fund's recent study on health system performance?

The key finding from the Commonwealth Fund's study is that the British National Health Service (NHS) ranked the highest in performance among high-income countries. The study also highlighted that the United States, despite spending more than twice as much on healthcare, ranked the lowest, primarily due to inequitable access to services.