Learning Objectives
To understand the notion of Health system Difference between Health system and Health care system Evolution of health system Goals and functions of health system Health systems performance assessment
Economic system
A collection of economic units, agents, and institutions that interact coherently; adapting and adjusting to the social and physical environment
System
Health System
Definition: all the activities whose primary purpose is to promote, restore or maintain health
Professional delivery of Personal medical care Traditional healers Home care of sick Health promotion Health prevention Environmental interventions to improve health
History
Health system is as old as mans deliberations to protect health Traditional practice can. . . Thousands of years
Chinese medicine 3000 years
Organized health system - - - a century ago Before 19th century hospitals were run by charitable organizations 19th century industrial revolution- - recognition of workers health
Cont;
Germany 1883 - - law requiring employers to contribute to health coverage of low wage workers- - 1st example of state mandated social insurance Late 1800s - - Russia - - network of provincial hospitals 2nd world war destroyed health infrastructure but lead to development of new as well
national emergency service became in 1948, the National Health Service
Costa Rica 1941 put foundation of universal health insurance Post war period states adopted modern modern comprehensive health systems with heavy state participation India developed five year health plan
2nd generation
Promotion of primary health care Disease control projects were launched Emergence of community health workers Inadequate funding, insufficient training and equipment, poor referral system, continued investment in the tertiary care Mismatch between demands and needs
3rd generation
New universalism
High quality of delivery of essential care Cost-effective Universal
Priority interventions Thorough training Regulated and guaranteed finance and subsidies Adequate health care personnel, capital and resources
of ill-health.
Responsiveness
Second intrinsic goal is to enhance the responsiveness of the health system to the legitimate expectations Two key sub-components:
Respect of persons Client orientation
Fair Financing
Common goals for all systems Key Challenges
households should not become impoverished or pay an excessive share of their income in obtaining needed health care poor households should pay less towards the health system than rich households
Functions
Stewardship Creating resources
Investment and training
Financing
Collecting, pooling and purchasing
Delivering services
Stewardship
Sets the context and policy framework Usually (but not always) a governmental responsibility Generates appropriate data for policymaking
Creating resources
Assembling of essential resources for delivering health services Human resources medications, and medical equipment Generally outside the immediate control of health system policy makers
Financing
Revenue collection: collection of money to pay for health care services
Mechanisms
General taxation Development Assistance for Health Mandatory payroll contributions Premiums Direct household out-of-pocket expenditures
Service Delivery
Most visible product of the health care system Delivering health services is thus an essential part of what the system doesbut it is not what the system is
Measure of responsiveness
Respect for persons
Respect for dignity Confidentiality Autonomy
Client orientation
Prompt attention Quality of amenities Access to social support networks Choice of provider
Workforce
Infrastructure
Technology
Information
Service provision