Module: Health systems, economics and policy

Topic 3


Topic 3: Understanding Health System Goals and System Performance

 

Objectives/learning outcomes

 

Students will be able to:

Recognise, understand and critically examine concepts of health system performance assessment.


 

Seminar: What are the normative implications of post-2000 functions for health systems

Health system performance assessment requires choice of functions and objectives. Four functions were laid down in the World Health Report 2000. What are their policy implications? 300 words for class discussion. Short presentation of two or three minutes.

 


Lecture: Describing and evaluating health care systems

 

We saw in the previous lecture that policy objectives (including economic growth objectives) influence the ways in which health systems are conceptualized and defined. The same point holds true for health system performance assessment. Choices about evaluative frameworks and performance metrics depend on the wider context of government health policy goals (to the extent that these are clearly established).

Health systems are complex. They have a huge range of actors and possible purposes and functions. Governments assume different degrees of control over them. They can be analysed at a number of different levels (as a complete system or in terms of various sub-systems such as financing and administration, hospital systems or primary care) and there is a growing industry in international performance comparison. Common performance criteria are equity, effectiveness, efficiency and quality.

In this lecture we critically examine international attempts to standardize performance criteria noting the focus on outputs outcomes and benchmarking and the distancing of process measures.

 

Set Reading

 

Nolte M, McKee M and Wait S (2005) Describing and evaluating health systems. In Bowling A and Ebrahim S (eds). Handbook of health research methods. Maidenhead: Open University Press. (read it here)

Mills AJ, Ransom K (2006) The design of health systems in Merson MH, Black RE, Mills AJ (eds) International public health, diseases, programs, systems, and policies. Gaithersburg, MD: Aspen. (read it here)

World Health Organisation (2005) Strengthened health systems save more lives. An insight into WHO’s European health systems’ strategy. Copenhagen: WHO. (read it here)

Black N and Gruen R (2005) Understanding health services. Maidenhead: Open University Press. (Section 5) (read it here)

Braveman P (2006) ‘Health disparities and health equity: concepts and measurement.’ Annual Review of Public Health; 27: 167-94. (read it here)

 


Lecture Summary

Health systems are complex with a huge range of actors and possible purposes and different degrees of government involvement. They can be analysed at a number of different levels (as a complete system or in terms of various sub-systems such as financing and administration, hospital systems or primary care) and there is growing interest in international performance comparison.

 

The type of analysis affects the descriptive categories used. (For a standard account of the building blocks of health care systems students are referred to Black and Gruen (2005: 143ff)). Performance evaluation criteria frequently reflect the policy goals adopted by governments. Common performance criteria are equity, effectiveness, efficiency and quality.

Health system performance is a very broad concept and the framework for it depends on the type of questions asked and the goals governments have for health systems (to the extent that they profess to have any goals). In this lecture we will consider some of the main approaches to and problems associated with describing, comparing and assessing health systems.

Lecture Powerpoint