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Summary - HPI4009 Health System Governance
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This summary is based on case notes, lectures and literature and was written in academic year 2019/2020.
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Summary and case notes forHealth systems governance
HPI4009
7 dec 2019
Healthcare policy innovation and management – Maastricht university
,Contents
Summary.......................................................................................................................1
Case 1........................................................................................................................1
Case 2........................................................................................................................3
Case 3........................................................................................................................7
Case 4......................................................................................................................11
Case 5......................................................................................................................13
Case notes...................................................................................................................16
Health System Governance Learning goals................................................................16
Case 1: Health System analysis..............................................................................16
Case 2: Governance in healthcare policymaking: actors and institutions...............16
Case 3: Case 3 Health policy: puzzling and/or powering?......................................16
Case 4: The politics of health..................................................................................16
Case 5: Solidarity in healthcare financing...............................................................16
Case 1 Health systems analysis.................................................................................17
Case 2 Governance in healthcare policymaking.........................................................22
Case 3 Health policy: puzzling and powering.............................................................29
Case 4 Politics of health..............................................................................................34
Case 5 Solidarity in healthcare financing....................................................................39
,Summary
Case 1
The Health systems model (Duran et al.) consist of 5 main components. Each of
these help describe and compare systems and support in decision making on a
national level. Decision making can be on in a backward approach (reform strategies)
and in forward approach (measurements). The components in detail are:
Functions
These are independent actions to be done to achieve the goals in a health system.
Priority setting is important in deciding which actions to do.
- Governance (stewardship): Coordination of the health system. Policymaking,
implementing and monitoring. The governance function is in charge of
coordination the other functions and guiding them to achieving health goals.
- Financing: This function is concerned with monetary resources: revenue
collection, risk pooling and purchasing.
- Resource generation: All resource that cannot be considered financial, for
example: Knowledge, health workers, technologies, etc.
- Service delivery: The delivery of care services and how this is done. These
can be personal health services on an individual level or non-personal health
services for a population.
1
, Intermediate objectives
Also called instrumental goals. These are the objectives that will lead a system to
health goals, hence the ‘intermediate’. These are usually generic but feasible. The
examinations might ask you to compare intermediate objectives.
The ones displayed in the model are:
- Quality (of services)
- Equity in utilization & resource distribution
- Efficiency
- Transparency & accountability
- Choice (for patients)
Health system goals
These are the end-goals that a health system wishes to achieve. Once these goals
are completed, they can be replaced with new goals for the system, which is part of
the feedback loop.
- Health gain
- Equity in health
- Equity in finance
- Financial protection (Solidarity; case 5)
- Responsiveness (reduced waiting time and improved access to healthcare)
Task environment
Is where the creation of input for the health system is done. It can be influenced by
the context and by the output of the system.
Context
The context describes the culture, technology, economy, demography, politics,
internationalization, etc. of a health system. Or broadly put, the indirect influences on
the health system (case 4 and 5). It is placed with the task environment because it
can play an important role in the feedback loop by selecting new health goals for the
system.
Feedback loop
The feedback loop describes the flow of the arrows through the model. Conversion in
the system means: Input Conversion Output Feedback. In this, input is the
creation of new intermediate of end goals. The output is the completion or partial
completion of an intermediate or end goal.
When a goal is completed, the task environment can decide on a new goal. The
context of a health system can play an important role in shaping the goal.
It is possible for output (goal) to become input. For example, when a previously
deadly disease becomes manageable. A new health goal could be to improve quality
of life.
Boundaries
2
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