Summary of the course HPI4009 Health systems governance (previously called HPI4003 Healthcare governance, ethics and law, however the content is still the same), including all essential elements to study for the exam:
- Summary per case
- Learning goals per case
- Overview lecture as a guide for th...
Give the definition of health from the medical model
Answer: Health = the absence of disease or infirmity
2.
Give the definition of health from the holistic (WHO) model
Answer: Health = a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
3.
Name three reasons why health is political
Answer: 1. There is an unequal distribution of health across social groups
2. Health is a fundamental right to everyone
3. Health is dependent on political (in)action
4.
Give the definition of health from the wellness model
Answer: Health = health promotion and progress towards higher functioning, energy, comfort and integration of mind, body and spirit
(or: health = well-being, energy and ability to work
5.
Give the definition of health from the environmental model
Answer: Health = succesful adaptation to physical and social surroundings - a balance free from undue pain, discomfort or disability
(or: health = the ability to grow, function and thrive
6.
Give the definition of health from Huber
Answer: Health = ability to adapt and self-manage in the face of social, physical and emotional challenges
7.
Define self-management
Answer: Active participation of patients in their treatment
Questions Case 5 Solidarity in healthcare financing
Flashcards39 Flashcards
$3.740 sales
Flashcards39 Flashcards
$3.740 sales
Some examples from this set of practice questions
1.
Explain the difference between justice and solidarity
Answer: Justice is about rights, needs and duties, while solidarity is about relations, recognition and reciprocity
Where justice concerns the rights and liberties of autonomous, self-interested individuals, solidarity concerns the mutual recognition and well-being of the members who are connected in the life world
2.
Explain utilitarianism
Answer: Doing the greatest possible good to the greatest number of people
3.
Explain preference utilitarianism
Answer: Value and even maximise individuals preference satisfaction > if we can prevent something bad without sacrifice of something of equal moral importance, we are morally obliged doing so
4.
Explain libertarianism
Answer: Every individuals liberty is most important > individuals may not be sacrificed or used for the achieving of other ends without their consent
5.
Explain the theory of justice
Answer: In imagining sitting behind a veil of ignorance (not knowing who you will be in society), design society so that everyone will have equal opportunities
6.
Explain the two principles of justice
Answer: 1. Each person has an equal claim to a fully adequate scheme of basic rights and liberties
2. Social and economic inequalities are to be attached to positions and offices open to all under conditions of fair equality of opportunity and are to be to the greatest benefit of the least advantaged members of society
7.
Explain procedural justice
Answer: Decision making processes should be transparent with clear, relevant arguments
8.
Explain solidarity
Answer: Solidarity = an actual state of interrelations between individuals, groups and the larger society, which enables the collective interest to take priority over the interests of individuals over sub-collectivities
9.
Explain shared identity
Answer: Members of the same collectivity feel a mutual sense of belonging and responsibility
10.
Explain shared utility
Answer: People need each other to realise their life opportunities
Content preview
Maastricht University – Master Healthcare Policy, Innovation and Management 2016-2017
HPI4003 Healthcare governance, ethics and law
Summary
Case 1 The analysis of health systems and their reform
Health
Health system
Analytical model for health system review
Public health
Application of the analytical model to a country
Case 2 Governance in healthcare policymaking
Defining governance
The role of governance in health care
Modes of governance
Dimensions of governance
Governance by market mechanisms in health care
Case 3 Priority setting: Procedures, politics and ethics
Defining priority setting
Models for policy making
Models on priority setting (political economy approach)
Methods for priority setting
Factors influencing priority setting
Priority setting and coverage
Legitimacy of priority setting
The role of the institutional context
Case 4 Solidarity in healthcare financing
Defining solidarity
Solidarity and justice
Motives for solidarity
Theories on solidarity: Sociological theories
Theories on solidarity: Rawlsian theories
Motives for non-solidarity and limitations
Solidarity in healthcare
Financial arrangements
Extra information theories on solidarity
Case 5 The politics of health
Models for conceptualizing health
The new conceptualization of health
The impact on health systems
Self-management
Case 6 Governance by performance measurement: What happens when things go wrong
Performance measurement
Governance by performance measurement
Perverse effects of governance by performance measurement
Limitations to performance measurement
, Case 1 The analysis of health systems and their reform
1. What is health?
2. What is public health and what are the aspects of public health model?
3. What is a health system?
4. Explain the analytical model for health system reviews.
5. Apply the analytical model for health system reviews on Germany/UK/Netherlands/US.
Health
Defining ‘health’:
- Health was first defined by the WHO (1984): Health is a state of complete physical, mental
and social well-being and not merely the absence of disease or infirmity. This definition is
doubtful, because according to this, today you can be healthy and tomorrow maybe not.
- Therefore, the Dutch Health Council and ZonMw came up with a new definition (2010), in
which they concluded the following:
o Be aware of the subjectivity of health.
o Health being dynamic instead of ‘a state of’.
o Health being an ability to adapt (resilience).
o Health is strongly context dependent: E.g. including the perspective of children or
elderly.
- The new definition of health is called positive health: Health as the ability to adapt and to
self-manage, in the face of social, physical and emotional challenges.
- 6 dimensions of health:
o Functioning of the body.
o Mental functioning and well-being.
o Spiritual dimension.
o Quality of life.
o Social participation.
o Daily functioning.
Health system
Defining ‘health system’ (Duran):
- Definition WHO: A health system consists of all organizations, people and institutions
producing actions whose primary intent is to promote, restore or maintain health.
- About the definition:
o This definition includes:
§ Health services (personal and population based) and the activities to enable
their delivery provided by finance, resource generation and stewardship
functions.
, § Stewardship, which includes activities seeking to influence positive health
impact of other sectors, even though improving health is not the primary
purpose of these sectors.
The definition can be narrow (talking about the absence of disease as health) or
broad (a holistic view on health).
o Primary intent criterion (WHO): The term ‘primary intent’ is included to enable a
comparison/ranking of all national health systems worldwide. When defining what a
health system is, is can be questioned what the boundaries are. A broad definition of
health systems includes everything that has effect, but this makes it too difficult to
manage. A narrower definition lead to the making of the primary intent criterion.
o Warning notice about the definition: It does not imply any particular degree of
integration, nor that anyone is in overall charge of the activities that compose it.
- Categorization of services by the WHO (which is both generic (applicable across a wide
variety of contexts) and managerially relevant):
o Personal services: Delivered on a one-to-one basis.
o Population-based services: Delivered to a group or entire population.
Goals and functions of health systems:
- 2 dimensions:
o Normative: What health systems should try to achieve, i.e. their goals.
o Rationale: About a social welfare function in which health is an intrinsic component
of welfare, most notably through the impact of good or bad health on incomes.
- Health is one of several social systems (e.g. education, economic, political), each with a
defining goal (i.e. the reason why the system exists).
o Defining goal of a health system: To improve health, although this may affect the
defining goals of other systems.
o The health system also has other goals contributing to social welfare:
§ Improving the health status of the population: The average level of health
and equity in the distribution of health.
§ Improving both the average level and distribution of system responsiveness
when individuals come into contact with the health system: Respect for
persons (ensuring patient dignity, confidentiality and autonomy) and client
(service-user) orientation (prompt attention, basic amenities, choice).
§ Improving fairness in financial contributions, incorporating both avoidance of
impoverishment as a consequence of ‘catastrophic’ health payments and
equitable distribution of the burden of funding the system.
- Function: A group of interdependent activities that every health system undertakes in order
to achieve its goals. Functions are interconnected: Each function is linked with all the others.
o The production of health services: The purpose production of services is at the core
of all health systems. Poor coordination between institutions, people and resources
(which are intended to improve health) could lead to waste and inefficiency.
o Financing: Dealing with the sources, accumulation and allocation of funds used for
the health system (revenue collection), pooling and purchasing (allocation of
resources from the pool to providers).
, o Identification, creation and development of the resources required to produce
health services and to build a health system: Knowledge, staff, facilities, technology.
o Stewardship (rentmeester, geld- of goedbeheerder): The ensemble of activities aimed
at ensuring that health actions have a clear direction and are carried out in ways that
maximize the likelihood of achieving the systems goals.
- Difference between goals and functions:
o Goals: Normative and value-driven, i.e. what health systems should try to achieve.
o Functions: Positive, i.e. a value-free descriptive tool, and generic (applicable to all).
§ Example of the interconnectedness of functions: some health promotion
services are personal (e.g. administering vaccine to an infant) and some are
population based (implementing a radio campaign). Both require specific
resources and funds in order for these to become health interventions
delivered to individuals or the community. Decisions on which services to
produce, in what numbers and under which regulatory conditions, are
influenced by the priorities of the health system concerned.
o Example: Every health system performs the functions, whether or not they are
recognized or explicit. But this does not mean that it is not possible to attempt a
more normative approach by describing the ideal. E.g. good health financing
responds to the health priorities of a country while providing the right incentives to
improve the performance of health professionals. Good purchasing should link
resource allocation to information on providers’ performance or the health needs of
the population being served. Similar reasoning could be applied to the characteristics
of the other functions (e.g. good resource generation, good service production).
Challenges to politicians, posed by health systems (Duran):
- Advances in medical technology: They have raised expectations about what health systems
can deliver, causing continuing upward pressure on costs.
- Ideas for reform hold out the promise of cost-containment but rarely manage to deliver.
- Outcomes achievable in theory are not always achieved in practice.
- Health ministers can be disadvantaged by the lack of clarity about the boundaries of the
health system.
- Frustrated managers by the apparent lack of mechanisms at their disposal to bring about
change, while the political dimension of health policies adds to the complexity: They often
assume responsibility for failure, but they may have little control over the necessary actions.
Analytical model for health system review
An analytical model for health system review:
- An analytical model offers a conceptual framework for systematic description to gain clear
insight into the structure of any health system – without drowning in an overwhelming
amount of detail. Such a model must provide attention to the main characteristics of the
structure, functioning and performance of a health system, while abstracting from all kinds
of specifics and exceptional situations.
, - A good analytic model is also indispensable (onmisbaar) when comparing international
health systems and the reforms made to those systems over time: it helps to identify the
distinctive features of health systems and to determine what the most important similarities
and differences are between systems; for the systematic description, analysis, comparison
and evaluation of health systems.
- 2 main applications of the analytical model (!):
o To describe and compare individual health systems: E.g. the health system of the
Netherlands, Germany, the UK or the USA. Each health care system has its own
characteristics: Not one health care system is the same.
o Usage of the framework to support national decision-making (Duran):
§ For development of a coherent, goal-oriented health reform strategy.
§ For performance assessment and monitoring.
The analytical model for health system review, developed by the WHO:
Linkage between the different parts of the framework (Duran):
, The analytical model for health system review, developed by the WHO:
- Structured as an input-output model: The process of turning inputs into outputs is called
conversion. So, the process goes: Input à Conversion à Output à Feedback (!). It includes
a feedback loop to indicate that outputs can flow back into the health system as new input:
- The analytic model constitutes a simplified and abstract representation of the complex
reality of health systems.
- The health systems function in a broader environment consists of several parts, in which the
health system is formed by the functions, intermediate objectives and health system goals.
o The context (the health system): A health system exists within a broader context.
The context are external factors which influence that system (see case 5). The
intermediate or final outputs. E.g. the socio-cultural background, demographics
(many old people, many chronic illnesses in the task environment). The health care
system needs to be designed to take care of many chronic illnesses. The context
(in)directly influences the health system (indirectly through the task environment).
o The task environment: The health problems that should be targeted by a health
system. The existing healthcare demands, which are inputs to the health system.
§ It is the operationalisation of health system goals in tangible things.
§ The task environment is a responsibility, a task of the health care system: A
health care system can solve or treat the task environment.
§ The task environment is defined by the context (e.g. demographic), so it
changes over time.
§ E.g. in a context with a very strong opinion about HIV/Aids, by not helping
people with that disease, then it is no part of the task environment.
o Functions: Everything that makes the health care system happen.
§ Governance (stewardship) (see case 2 and 3): Health system coordination.
Common in definitions is that is describes ‘how things are done’, ‘the rules of
the game’. Oversight. All other functions come together.
• Defining health care governance:
o Systematic, patterned way in which decisions are made and
implemented (Greer).
o The way that policymakers try to manage, coordinate or
control the activities of healthcare actors (Giaimo).
o Specific mode of production norms (decision, rules, politics)
that can be called co-production where co-producers are
different kind of actors (private and public) (Bartolini).
• Relevance for health care governance (!): It shapes its ability to
respond to the various challenges that health systems face today
(Greer). E.g. expensive drugs, global infectious disease outbreaks.
• There are different ways of governing: Hierarchy, market, or a form
in between.
• E.g. Inspectorate is part of governance.
§ Resource generation: E.g. investment and training, the pharmaceutical
company when they do research, as a company. The wealthier a health
system, the more resources that are available. E.g. through taxes, private
and public insurances.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller UniMaasAn. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $5.88. You're not tied to anything after your purchase.
