Health system
A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.
There is a wide variety of health systems around the world, with as many histories and
In certain nations, the orchestration of health system planning is decentralized, with various stakeholders in the market assuming responsibilities. In contrast, in other regions, a collaborative endeavor exists among governmental entities, labor unions, philanthropic organizations, religious institutions, or other organized bodies, aimed at the meticulous provision of healthcare services tailored to the specific needs of their respective populations. Nevertheless, it is noteworthy that the process of healthcare planning is frequently characterized as an evolutionary progression rather than a revolutionary transformation.[2][3]
As with other social institutional structures, health systems are likely to reflect the history, culture and economics of the states in which they evolve. These peculiarities bedevil and complicate international comparisons and preclude any universal standard of performance.
Goals
According to the
Definitions
Often health system has been defined with a reductionist perspective. Some authors[7] have developed arguments to expand the concept of health systems, indicating additional dimensions that should be considered:
- Health systems should not be expressed in terms of their components only, but also of their interrelationships;
- Health systems should include not only the institutional or supply side of the health system but also the population;
- Health systems must be seen in terms of their goals, which include not only health improvement, but also equity, responsiveness to legitimate expectations, respect of dignity, and fair financing, among others;
- Health systems must also be defined in terms of their functions, including the direct provision of services, whether they are medical or public health services, but also "other enabling functions, such as stewardship, financing, and resource generation, including what is probably the most complex of all challenges, the health workforce."[7]
World Health Organization definition
The World Health Organization defines health systems as follows:
A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is, therefore, more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behaviour change programmes; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well-known determinant of better health.[8]
Financial resources
There are generally five primary methods of funding health systems:[9]
- general taxationto the state, county or municipality
- national health insurance
- voluntary or private health insurance
- out-of-pocket payments
- charities
Universal | Non-universal | |||
---|---|---|---|---|
Single payer | Multi-payer | Multi-payer | No insurance | |
Single provider | Beveridge Model, Semashko model
|
|||
Multiple Providers | National Health Insurance | Bismarck model | Private health insurance | Out-of-pocket |
Most countries' systems feature a mix of all five models. One study[10] based on data from the OECD concluded that all types of health care finance "are compatible with" an efficient health system. The study also found no relationship between financing and cost control.[citation needed] Another study examining single payer and multi payer systems in OECD countries found that single payer systems have significantly less hospital beds per 100,000 people than in multi payer systems.[11]
The term health insurance is generally used to describe a form of
Through the calculation of the comprehensive cost of healthcare expenditures, it becomes feasible to construct a standard financial framework, which may involve mechanisms like monthly premiums or annual taxes. This ensures the availability of funds to cover the healthcare benefits delineated in the insurance agreement. Typically, the administration of these benefits is overseen by a government agency, a nonprofit health fund, or a commercial corporation.[12]
Many commercial health insurers control their costs by restricting the benefits provided, by such means as
Many forms of social insurance systems control their costs by using the bargaining power of the community they are intended to serve to control costs in the health care delivery system. They may attempt to do so by, for example, negotiating drug prices directly with pharmaceutical companies, negotiating standard fees with the medical profession, or reducing unnecessary health care costs. Social systems sometimes feature contributions related to earnings as part of a system to deliver universal health care, which may or may not also involve the use of commercial and non-commercial insurers. Essentially the wealthier users pay proportionately more into the system to cover the needs of the poorer users who therefore contribute proportionately less. There are usually caps on the contributions of the wealthy and minimum payments that must be made by the insured (often in the form of a minimum contribution, similar to a deductible in commercial insurance models).[citation needed]
In addition to these traditional health care financing methods, some lower income countries and development partners are also implementing non-traditional or
Payment models
In most countries, wage costs for healthcare practitioners are estimated to represent between 65% and 80% of renewable health system expenditures.[15][16] There are three ways to pay medical practitioners: fee for service, capitation, and salary. There has been growing interest in blending elements of these systems.[17]
Fee-for-service
Fee-for-service arrangements pay general practitioners (GPs) based on the service.[17] They are even more widely used for specialists working in ambulatory care.[17]
There are two ways to set fee levels:[17]
- By individual practitioners.
- Central negotiations (as in Japan, Germany, Canada and in France) or hybrid model (such as in Australia, France's sector 2, and New Zealand) where GPs can charge extra fees on top of standardized patient reimbursement rates.
Capitation
In capitation payment systems, GPs are paid for each patient on their "list", usually with adjustments for factors such as age and gender.[17] According to OECD (Organization for Economic Co-operation and Development), "these systems are used in Italy (with some fees), in all four countries of the United Kingdom (with some fees and allowances for specific services), Austria (with fees for specific services), Denmark (one third of income with remainder fee for service), Ireland (since 1989), the Netherlands (fee-for-service for privately insured patients and public employees) and Sweden (from 1994). Capitation payments have become more frequent in "managed care" environments in the United States."[17]
According to OECD, "capitation systems allow funders to control the overall level of primary health expenditures, and the allocation of funding among GPs is determined by patient registrations". However, under this approach, GPs may register too many patients and under-serve them, select the better risks and refer on patients who could have been treated by the GP directly. Freedom of consumer choice over doctors, coupled with the principle of "money following the patient" may moderate some of these risks. Aside from selection, these problems are likely to be less marked than under salary-type arrangements.'[citation needed]
Salary arrangements
In several OECD countries, general practitioners (GPs) are employed on salaries for the government.[17] According to OECD, "Salary arrangements allow funders to control primary care costs directly; however, they may lead to under-provision of services (to ease workloads), excessive referrals to secondary providers and lack of attention to the preferences of patients."[17] There has been movement away from this system.[17]
Value-based care
In recent years, providers have been switching from fee-for-service payment models to a value-based care payment system, where they are compensated for providing value to patients. In this system, providers are given incentives to close gaps in care and provide better quality care for patients. [18]
Spending
Expand the OECD charts below to see the breakdown:
- "Government/compulsory": Government spending and compulsory health insurance.
- "Voluntary": Voluntary health insurance and private funds such as households' out-of-pocket payments, NGOs and private corporations.
- They are represented by columns starting at zero. They are not stacked. The 2 are combined to get the total.
- At the source you can run your cursor over the columns to get the year and the total for that country.[19]
- Click the table tab at the source to get 3 lists (one after another) of amounts by country: "Total", "Government/compulsory", and "Voluntary".[19]
Information resources
Sound information plays an increasingly critical role in the delivery of modern health care and efficiency of health systems. Health informatics – the intersection of
The use of health information lies at the root of evidence-based policy and evidence-based management in health care. Increasingly, information and communication technologies are being utilised to improve health systems in developing countries through: the standardisation of health information; computer-aided diagnosis and treatment monitoring; informing population groups on health and treatment.[21]
Management
The management of any health system is typically directed through a set of
Public health is concerned with threats to the overall health of a community based on
Today, most governments recognize the importance of public health programs in reducing the incidence of disease, disability, the effects of ageing and health inequities, although public health generally receives significantly less government funding compared with medicine. For example, most countries have a vaccination policy, supporting public health programs in providing vaccinations to promote health. Vaccinations are voluntary in some countries and mandatory in some countries. Some governments pay all or part of the costs for vaccines in a national vaccination schedule.[citation needed]
The rapid emergence of many
Health systems performance
Since 2000, more and more initiatives have been taken at the international and national levels in order to strengthen national health systems as the core components of the global health system. Having this scope in mind, it is essential to have a clear, and unrestricted, vision of national health systems that might generate further progress in global health. The elaboration and the selection of performance indicators are indeed both highly dependent on the conceptual framework adopted for the evaluation of the health systems performance.[26] Like most social systems, health systems are complex adaptive systems where change does not necessarily follow rigid management models.[27] In complex systems path dependency, emergent properties and other non-linear patterns are seen,[28] which can lead to the development of inappropriate guidelines for developing responsive health systems.[29]
An increasing number of tools and guidelines are being published by international agencies and development partners to assist health system decision-makers to monitor and assess health systems strengthening
Health Policy and Systems Research (HPSR) is an emerging multidisciplinary field that challenges 'disciplinary capture' by dominant health research traditions, arguing that these traditions generate premature and inappropriately narrow definitions that impede rather than enhance health systems strengthening.[34] HPSR focuses on low- and middle-income countries and draws on the relativist social science paradigm which recognises that all phenomena are constructed through human behaviour and interpretation. In using this approach, HPSR offers insight into health systems by generating a complex understanding of context in order to enhance health policy learning.[35] HPSR calls for greater involvement of local actors, including policy makers, civil society and researchers, in decisions that are made around funding health policy research and health systems strengthening.[36]
International comparisons
Health systems can vary substantially from country to country, and in the last few years, comparisons have been made on an international basis. The
Direct comparisons of health statistics across nations are complex. The
Ipsos MORI produces an annual study of public perceptions of healthcare services across 30 countries. [48]
Country | Life expectancy[49] | Infant mortality rate[50] | Preventable deaths per 100,000 people in 2007[51] | Physicians per 1000 people | Nurses per 1000 people
|
Per capita expenditure on health (USD PPP) | Healthcare costs as a percent of GDP | % of government revenue spent on health | % of health costs paid by government |
---|---|---|---|---|---|---|---|---|---|
Australia | 83.0 | 4.49 | 57 | 2.8 | 10.1 | 3,353 | 8.5 | 17.7 | 67.5 |
Canada
|
82.0 | 4.78 | 77[52] | 2.2 | 9.0 | 3,844 | 10.0 | 16.7 | 70.2 |
Finland | 79.5 | 2.6 | 2.7 | 15.5 | 3,008 | 8.4 | |||
France | 82.0 | 3.34 | 55 | 3.3 | 7.7 | 3,679 | 11.6 | 14.2 | 78.3 |
Germany
|
81.0 | 3.48 | 76 | 3.5 | 10.5 | 3,724 | 10.4 | 17.6 | 76.4 |
Italy
|
83.0 | 3.33 | 60 | 4.2 | 6.1 | 2,771 | 8.7 | 14.1 | 76.6 |
Japan
|
84.0 | 2.17 | 61 | 2.1 | 9.4 | 2,750 | 8.2 | 16.8 | 80.4 |
Norway | 83.0 | 3.47 | 64 | 3.8 | 16.2 | 4,885 | 8.9 | 17.9 | 84.1 |
Spain | 83.0 | 3.30 | 74 | 3.8 | 5.3 | 3,248 | 8.9 | 15.1 | 73.6 |
Sweden | 82.0 | 2.73 | 61 | 3.6 | 10.8 | 3,432 | 8.9 | 13.6 | 81.4 |
UK
|
81.6 | 4.5 | 83 | 2.5 | 9.5 | 3,051 | 8.4 | 15.8 | 81.3 |
US
|
78.74 | 5.9 | 96 | 2.4 | 10.6 | 7,437 | 16.0 | 18.5 | 45.1 |
Physicians and hospital beds per 1000 inhabitants vs Health Care Spending in 2008 for OECD Countries. The data source is OECD.org - OECD.[44][45]
See also
- Acronyms in healthcare
- Catholic Church and health care
- Clinical Health Promotion
- Community health
- Comparison of the health care systems in Canada and the United States
- Consumer-driven health care
- Cultural competence in health care
- Global health
- Genetic testing
- List of countries by health insurance coverage
- Health administration
- Health care
- Health care provider
- Health care reform
- Health crisis
- Health economics
- Health equity
- Health human resources
- Health insurance
- Health policy
- Health promotion
- Health services research
- Healthy city
- Hospital network
- Medicine
- National health insurance
- Occupational safety and health
- Philosophy of healthcare
- Primary care
- Primary health care
- Public health
- Publicly funded health care
- Single-payer health care
- Social determinants of health
- Socialized medicine
- Timeline of global health
- Two-tier health care
- Universal health care
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External links
- World Health Organization: Health Systems
- HRC/Eldis Health Systems Resource Guide research and other resources on health systems in developing countries
- OECD: Health policies, a list of latest publications by OECD