Health Systems: Goals, Functions, Actors

Course objectives/ Learning outcomes:

The aim of the course is to enable students to systematically understand, analyse and evaluate heath systems in different countries of the world. The course will introduce the main frameworks, concepts, and ideas of international health systems research to lay the theoretical foundations for students to work in this field. It will highlight links to other courses of the MPH/MPhil programme. In addition, students will be expected to use the theoretical concepts to illustrate and analyse the functioning of health systems in different regions of the world.

 

The course provides a structured overview of the main building blocks and goals of health systems, following the health systems framework of the World Health Organization (WHO). Following a general introduction, the first part of the course covers (1) health systems financing (briefly), (2) workforce, (3) service delivery, (4) medical Products, vaccines and technologies, (5) leadership/governance. The second part focuses on the goals of health systems, including intermediate goals (access/coverage, quality/safety) and final goals (improved health, responsiveness, social and financial risk-protection, and improved efficiency). The course consists of lectures and exercises with group work, where students use the introduced concepts to analyse health systems in various countries.

 

Exams

Examination will be based on group presentation (20%) + written mid-term exam (20%) and written final exam (60%).

Grading system

Fail = below 50%

Grade C = 50% – 59%

Grade B = 60% – 69%

Grade A = 70% and above

 

 

1st Semester – Week 1
1W1	Monday	Tuesday	Wednesday	Thursday	Friday
08:00 - 10:00	Public Holiday + Arrival of non-KNUST student participants		Frameworks 2/Financing (triangle)	Service delivery
10:30 - 12:30			Financing	Medical products and technologies
13:00 - 15:00		Introduction, expectations, groups	Health workforce	Group work (triangle Ghana health system)	Leadership/ governance
15:30 - 17:30		Frameworks 1	Information	Optional supervised group work	Preliminary summary

1st Semester – Week 2
1W2
08:00 - 10:00			Improved health	Efficiency and responsiveness	Departure of non-KNUST student participants
10:30 - 12:30		Access and coverage	Financial protection and equity in financing	Health system performance assessment (summary)
13:00 - 15:00		Group work (access, coverage – Ghana health system in cube)	Group work (health system goals, ranking, weighting)	Revision
15:30 - 17:30	Group work presentation (graded)	Quality and safety	Self-study for mid-semester exam	Mid-term exam (30 min) + final questions

 

 

 

Introduction and frameworks

Papanicolas I (2013). International frameworks for health system comparison. In I. Papanicolas & P. C. Smith (Eds.), Health System Performance Comparison. An agenda for policy, information and research, pp. 31-75. Berkshire: Open University Press.

World Health Organization (2000). World Health Report Health systems: improving performance. Geneva: WHO Document Production Services. http://www.who.int/whr/2000/en/

World Health Organization (2007). Everybody’s business: Strengthening health systems to improve health outcomes. WHO’s framework for action. Geneva: WHO Document Production Services. http://www.who.int/healthsystems/strategy/everybodys_business.pdf

 

Health care financing

Thomson S., Foubister T., Mossialos E. (2009.) Health care financing in the European Union. In S. Thomson, T. Foubister, E. Mossialos (Eds.), Financing health care in the European Union. Challenges and policy responses, pp. 23-26. Copenhagen. http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm 

Kutzin J. (2008). Health financing policy: a guide for decision-makers. Health financing policy paper. Copenhagen: WHO Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0004/78871/E91422.pdf

Mills A (2014). Health Care Systems in Low- and Middle- Income Countries. The New England Journal of Medicine 370 (6): 552-557 http://www.nejm.org/doi/full/10.1056/NEJMra1110897#t=article

World Health organization (2010). Health Systems Financing. The path to universal coverage. Geneva: WHO Press. Retrieved from http://www.who.int/whr/2010/10_summary_en.pdf?ua=1.

Busse R. Figueras, J., Robinson R., & Jakubowski E. (2007). Strategic purchasing to improve health system performance: key issues and international trends. HealthCare papers, 8, 62-76. https://www.mig.tu-berlin.de/fileadmin/a38331600/2007.publications/HP_vol8_SpIssue_busse_purchasing.pdf

Mathauer I, Dale E, Meessen B. Strategic purchasing for Universal Health Coverage: key policy issues  and  questions.  A  summary  from  expert  and  practitioners’  discussions  Geneva:  World  Health  Organization; 2017. http://apps.who.int/iris/bitstream/10665/259423/1/9789241513319-eng.pdf

Ellis, R. P. & Miller, M. M. 2009. Provider Payment Methods and Incentives. In: CARRIN, G. (ed.) Health systems policy, finance, and organization. Amsterdam: Elsevier Academic Press:

Kronick R, Casalino LP, Bindman AB (2015): Introduction. Apple Pickers or Federal Judges: Strong versus Weak Incentives in Physician Payment. Health Serv Res. 2015 50(2):2049-56

Mathauer I, Wittenbecher F (2013): Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries. Bulletin of the World Health Organization 2013;91:746-756A. doi: dx.doi.org/10.2471/BLT.12.115931

Quentin, W., D. Scheller-Kreinsen, M. Blumel, A. Geissler and R. Busse (2013). "Hospital payment based on diagnosis-related groups differs in Europe and holds lessons for the United States." Health Aff (Millwood) 32(4): 713-723.

 

Workforce

Sidibé M, Campbell J (2015) Reversing a global health workforce crisis. Bulletin of the World Health Organization, Geneva: 93:3. Available at: http://www.who.int/workforcealliance/media/news/2015/reversing_crisis/en/

The Economist (2012). Squeezing out the doctor. The role of physicians at the centre of health care is under pressure. Retrieved from http://www.economist.com/node/21556227.

The Guardian (2014). Task shifting explained: a viable solution to health worker shortage?, Retrieved from https://www.theguardian.com/global-development-professionals-network/2014/may/12/task-shifting-health-development-shortage.

 

Leadership and governance

Greer L S., Wismar M., Figueras J. (2016). Strengthening Health System Governace. Better policies, stronger performance. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0004/307939/Strengthening-health-system-governance-better-policies-stronger-performance.pdf.

Busse R., von der Grinten T., Svensson P. (2002). Regulating entrepreneurial behaviour in hospitals: theory and practice. In Saltman R. B., Busse R., & Mossialos, E. (Eds.), Regulating entrepreneurial behaviour in European health care systems, pp. 126-146. Buckingham: Open University Press.

 

Provision

Masseria C., Irwin R., Thomson S., Gemmill M. & Mossialos E. (2009). Primary care in Europe. Policy brief. Retrieved from https://lms.fu-berlin.de/bbcswebdav/pid-3266487-dt-content-rid-5323452_2/courses/CUB_BSPH_Sem2_HPE1/LSE%20%282009%29%20Primary%20care%20in%20Europe_policy%20brief.pdf.

OECD (2017). Health at a Glance 2015: OECD Indicators. Paris: OECD Publishing. Retrieved from http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

 

Medical products and technologies

Panteli D, Arickx F, Cleemput I, Dedet G, Eckhardt H, Fogarty E, Gerkens S, Henschke C, Hislop J, Jommi C, Kaitelidou D, Kawalec P, Keskimäki I, Kroneman M, Lopez Bastida J, Pita Barros P, Ramsberg J, Schneider P, Spillane S, Vogler S, Vuorenkoski L, Wallach Kildemoes H, Wouters O, Busse R. (2016). Pharmaceutical regulation in 15 European countries: Review. Health Systems in Transition, 18(5):1–118, http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/special-edition-pharmaceutical-regulation-in-15-european-countries-2016.

 

Coverage and access

World Health Organization (2013). Research for Universal Health Coverage. Available at: http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf?ua=1

Evans B. D., Hsu J., Boerma T. (2013). Universal health coverage and universal access. Bulletin of the World Health Organization, 91, 546-546A. doi: http://dx.doi.org/10.2471/BLT.13.125450 [PDF]

Cotlear, D., Nagpal S., Smith O., Tandon A., Cortez R. (2015). Going Universal: How 24 Developing Countries are Implementing Universal Health Coverage Reforms from the Bottom Up. Washington, DC: World Bank.

 

Quality

Legido-Quigley H., McKee M., Nolte E., A Glinos I. (2008). Quality of care: an overview. In Legido-Quigley H., McKee M., Nolte E., A Glinos I. (Eds.), Assuring the quality of health care in the European Union, pp. 1-15. Geneva: WHO Press.

 

Financial protection

Moreno-Serra R., Millett C., Smith P. C. (2011). Towards improved measurement of financial protection in health. PLoS Med, 8(9), e1001087.

Saksena P, Hsu J, Evans DB (2014) Financial Risk Protection and Universal Health Coverage: Evidence and Measurement Challenges. PLOS Medicine 11(9): e1001701. https://doi.org/10.1371/journal.pmed.1001701

Thomson S., Figueras J., Evetovits T., Jowett M., Mladovsky P., Maresso A., Cylus J., Karanikolos M., Kluge H. (2014). Economic crisis, health systems and health in Europe: impact and implications for policy. Policy summary. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/257579/Economic-crisis-health-systems-Europe-impact-implications-policy.pdf?ua=1.

 

Improved Health

Murray, C. J., Salomon, J. A., & Mathers, C. (2000). A critical examination of summary measures of population health. Bulletin of the World Health Organization, 78(8), 981-994. http://apps.who.int/iris/bitstream/10665/57524/1/99-0102.pdf

Mackenbach, Johan P., et al. "Using ‘amenable mortality’as indicator of healthcare effectiveness in international comparisons: results of a validation study." J Epidemiol Community Health (2012): jech-2012. https://www.researchgate.net/publication/231212106_Using_'Amenable_Mortality'_as_Indicator_of_Healthcare_Effectiveness_in_International_Comparisons_Results_

of_a_Validation_Study

 

Efficiency

Cylus, J., Papanicolas, I., & Smith, P. C. (2016). A framework for thinking about health system efficiency. Health System Efficiency, 1. http://www.euro.who.int/__data/assets/pdf_file/0004/324283/Health-System-Efficiency-How-make-measurement-matter-policy-management.pdf?ua=1#page=24

 

Responsiveness

Busse, R. (2013). Understanding satisfaction, responsiveness and experience with the health system. Health System Performance Comparison: An Agenda for Policy, Information and Research, 255-80. http://www.euro.who.int/__data/assets/pdf_file/0009/244836/Health-System-Performance-Comparison.pdf

 

Health System Performance Assessment

Papanicolas I, Smith P (2013): Health system performance comparison: an agenda for policy, information and research. Policy summary , 4 . Open University Press, Maidenhead, UK. http://eprints.lse.ac.uk/54802/1/__libfile_REPOSITORY_Content_Papanicolas,%20I_Health%20system%20performance_Papanicolas_Health%20

system%20performance_2013.pdf