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Tutorials (Public) Health Care Systems in the EUCase 1: The building blocks of a health system, from theory to
practice
Health care systems and how they are designed
A health system is a set of activities whose primary purpose is to promote, restore and
maintain health. Health systems have the responsibility to improve a person’s health,
protecting them against the financial cost of illness, as well as treating them with dignity.
Existing health systems are a product of, and are influenced by, specific political, historical,
cultural, and socio-economic traditions. (Ferreira)
A health system consists of all the organizations, institutions, resources, and people whose
primary purpose is to improve health. This includes efforts to influence determinants of
health as well as more direct health-improvement activities.
The health system delivers preventive, promotive, curative, and rehabilitative interventions
through a combination of public health actions and the pyramid of health care facilities that
deliver personal health care by both State and non-State actors.
The actions of the health system should be responsive and financially fair, while treating
people respectably. (WHO)
Public health systems are unique and vital entities within health systems. (Jarvis)
Public health systems have not been clearly defined because (1) public health systems have
been conceptualized in various ways and (2) there is overlap in terminology with publicly
funded healthcare systems. (Jarvis)
Some define public health systems as all levels of governmental and non-governmental
entities which share in the responsibility for ensuring healthy social and physical
environments and consist of a variety of organisations that contribute to the core functions
of public health to protect and promote health within the community. (Jarvis)
It is hard to change system if it has been implemented for a long time.
It’s a complex puzzle, which means it’s hard to decide what everyone can benefit from.
The public health care system is not directly helping people but address the problems the
populations is facing. Public and private distinction is important.
Who is responsible:
Citizens as they benefit from the health system.
Health industry supply and oversee taking care of health systems.
Government gives ideas and makes sure citizens get the care they need.
It’s everyone responsibility but the rate changes depending on the country.
The EU has a fairly good health care system at the moment.
,Clearer goals would improve the system.
Health care system block framework
The WHO framework for health systems performance assessment
Describes health systems in terms of six core components or “building blocks”.
The six building blocks contribute to the strengthening of health systems in different ways.
1. Service delivery: comprehensive range of provided services, accessibility, coverage of a
defined target population, continuity of care across networks, high quality and patient-
centered care, active coordination, accountability, and efficiency.
2. Health workforce: responsive, fair, and efficient to achieve best health outcomes.
3. Health information systems: ensure production analysis, dissemination, and use of
reliable and timely information on health system performance.
4. Access to essential medicines: equitable access to essential medical products.
5. Financing: adequate funding to ensure the use of needed services and protection from
financial catastrophes.
6. Leadership and governance: strategic policy frameworks combined with effective
coalition building and regulation.
The ideal state is that the building blocks are all achieved, and you get the outcomes.
The framework is used to improve and assess health care systems in different countries in a
way that is universal. It helps to identify gaps in health care systems!
Main purpose of the framework was to design a health care system and guide the
investments of resources not to evaluate health care systems.
Some cross-cutting components, such as leadership/governance and health information
systems, provide the basis for the overall policy and regulation of all the other health system
blocks. Key input components to the health system include specifically, financing and the
health workforce.
,This framework focuses on health sector actions and underplays the importance of actions in
other sectors. It does not consider actions that influence peoples’ behaviors, both in
promoting and protecting health and the use of health-care services.
The framework does not address the underlying social and economic determinants of health,
such as gender inequities or education, and does not deal with the substantial and dynamic
links and interactions that exist across each component. There is a goal, but it is not as
specific as it could be. If you want to make it specific for a country, you need to look into
more detail since it doesn’t include context around the health care system.
Only indirectly addresses the foundational elements necessary for effective community
health. Although community-inclusive and community-led strategies may be more difficult,
complex, and require more widespread resources than facility-based strategies, their
exclusion from health systems frameworks leads to insufficient attention to elements that
need ex-ante efforts and investments to set community health effectively within systems.
It doesn’t consider the wider context like for instance workforce availability, work
improvement, or access to essential medicine.
It also does not address the substantial and dynamic interactions between components.
All the blocks weigh the equal amount.
On the other hand, focusing on these separate components helps put boundaries around this
complex construct and permits the identification of indicators and measurement strategies
for monitoring progress.
It helps to achieve a harmonized approach to monitoring, provides a simple and
understandable foundation for analysis, and allows for better monitoring of clearly defined
elements. It gives a solid base to what should be included in a healthcare system to function,
and most things can be measured.
Primarily, developing countries would benefit from the model.
Different classification, typologies, and frameworks
Classifying the EU health systems is important for three main reasons: first, it is a rational
way to label what is complex; second, classification across health systems allows for
international comparisons of not only their characteristics but also their performance; finally,
health system classification enables policy assessments and recommendations to be made
within each cluster. The classification of health systems further creates the potential to make
comparisons and to motivate future health policy assessments and policy recommendations
within each health system cluster. (Ferreira)
Typologies help researchers, students, and actors in the health policy arena to understand
the structures and processes that can be generalized beyond the unique features of each
individual healthcare system.
Break down those different health care systems in a way you can apply them to each
individual system.
Breaking down the systems allows the flaws to be better seen in system and better allocate
resources.
, Country specific problems in health care system need to be taken into account to classify
them.
Population health approach: Conceptual fit of public health systems within current health
systems
Aims to organize how public health currently fits within a health system. It is important to
note that public health is often equated to and touted as a steward of population health.
The wider determinants of health recognize the importance of social and political factors on
health.
A strength of the population health approach is that it recognizes that people are not passive
but are active participants in their own health outcomes. Individual health is supported by
both public health and healthcare activities and by how individuals interact with these
systems and their larger social environments. There is a constant exchange between
individuals, healthcare, public health, and the political and social systems they are embedded
in, with more resources, programmes and services targeted towards those identified as
vulnerable to try and establish a level of equity in health outcomes. (Jarvis)
For a broader perspective this model is better.
The limitation of this framework is that there is a possibility that certain data will not be
found. It can be possible that some EU countries don’t have data for the exact indicator you
are looking for.
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