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HPI4009 Health system governance summary
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HPI4009 health system governance summary
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Summary HPI4009 Health systems governanceCase 1 Health system analysis
Lecture
Origin of the word governance: Plato process of deliberately using power in order to
coordinate sizeable groups of peoples performances to bring about desirable aggregate
results and avoidance of risk and undesirable outcomes (Hoppe, 2010)
Governance: Political science sociology, economics, law, health services
Health system governance = how things are done
Systematic patterned way in which decisions are made and implemented
The way that policymakers try to manage, coordinate or control the activities of
healthcare actors
Feedback loop: Input – Conversion – Output – Feedback
Two main application for policymakers:
- To describe and compare individual health systems
- To support decision making on national level
o Health system reform strategy backward approach
o Performance measurement forward approach
Institution ≠ organization
• Scharpf (1997): ‘system of formal and informal rules that structure the course of actions
that a set of actors may choose’
,What is public policy? ‘What should be done’
• An organized and purposeful activity to tackle (or ‘resolve’) public policy problems.
Applying the network to individual countries
The fundamental and instrumental goals and functions are generic in the sense that they
apply to all health systems.
Challenges (policy and managerial issues) with implementing the framework
, - Assessing the performance of a system when its main goal (health) is influenced
strongly by external factors and activities with impacts that are difficult to
disentangle from that of the health system
- Operationalize the health system goals in practice
- Each function composes challenges
- Accountability: ministers responsibilities vary widely, he should be held accountable
for influencing primary intent actions in other sectors.
Frenk, J., and Murray, C. J. L. (2000). A framework for assessing the performance of health
systems. Bulletin Of The World Health Organization, 78(6), 717-731.
Several frameworks for measuring health system performance have been proposed and are
testimony to the importance given to this enterprise.
Boundaries of the health system
A health action is defined to be any set of activities whose primary intent is to improve or
maintain health. And a health system includes the resources, actors, institutions related to
the financing, regulation and provision of health actions. the definition of health system
given boundaries to what the health system can do.
Intrinsic and instrumental goals
Intrinsic: goals valued in themselves. They fulfil the following criteria
- It is possible to raise the level of attainment of the goal while holding the level of all
other intrinsic goals constant
- Raising a level of attainment of an intrinsic goal is desirable. If it is not it is probably
an instrumental goal
Instrumental: whose pursuit is really a means to another end.
Health system goals:
Health
o Improve health of population
Responsiveness
o Enhance the responsiveness of health system to legitimate expectations of
the population. It has two major components:
Respect for persons
Respect for dignity
Respect for individual autonomy
Respect for confidentiality
Client orientation
Prompt attention to helaht needs
Basic amenities
Access to social support networks for individual receiving
Choice of institution and individual providing care
Fairness in financial contribution
, o Households should not become impoverished or pay excessive share of their
income
o Poor households should pay less towards the health system than rich
households
Instrumental care: access to care, community involvement, innovation or sustainability
Health system financing is the process by which revenues are collected from primary and
secondary sources, accumulated in fund pools and allocated to provider activities. It is useful
to divide health system financing in 3 subfunctions
Provision of health services refers to the combination of inputs into a production process
that takes place ina particular organisational setting and that leads to the delivery of a series
of intevrentions.
Personal: deals with relationship of each provider organisation with its environment
Nonpersonal: extent to which single organisations provide a wide array of
nonpersonal health services.
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