Health Systems: Goals, Functions, Actors
|Course Title||Health Systems:
Goals, Functions, Actors|
|Course code||HSRM 551|
|Teaching/learning methods||Lectures and Group work|
|Assessment methods||Exam questions + group work
|Semester (1 / 2)||1|
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.
|Length of course||Block course for 2 weeks|
Oct 3rd |
|Venue||SPH combined class (in the School of
Medical Sciences (SMS) building)|
|Lecturer(s)||Wilm Quentin & Daniel Opoku (TU
|Course coordinator||Daniel Opoku (TU Berlin),
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.
Examination will be based on group presentation (10%) + written mid-term exam (20%) and written final exam (70%).
below 50% ||Grade C = 50% –
59% ||Grade B = 60% –
69% ||Grade A = 70% and above
||Subject (Time) |
||Introduction, expectations, groups  |
Frameworks 1 
|25.09.2019 ||Frameworks 2/
Financing 1 (triangle)  |
Financing 2 + 3 
Health workforce 
delivery Medical products and technologies
Group work (triangle Ghana health system)
||Leadership, governance, stewardship Preliminary
work presentation (graded)|
and coverage |
Group work (access, coverage – Ghana health system in cube) Quality and safety
|02.10.2019 ||Improved health
Financial protection and equity in financing Group
work (health system goals, ranking, weighting)|
Self-study for mid-semester exam
||Efficiency and responsiveness Health system
performance assessment (summary) Mid-term exam (30 min) +
final questions |
of non-KNUST students|
|1st Semester – Week
|08:00 - 10:00
delivery ||Leadership, governance,
||Medical products and technologies
||Group work (graded presentation) |
|13:00 - 15:00 ||Short
course introduction for exchange students
||Frameworks 1 ||Health
workforce ||Group work (triangle Ghana health
17:30 ||Introduction, expectations,
groups ||Frameworks 2/Financing
|1st Semester – Week
|08:00 - 10:00
|| ||Efficiency and
responsiveness ||Holiday |
|10:30 - 12:30
||Improved health ||Health system
performance assessment (summary) |
|13:00 - 15:00
work (access, coverage – Ghana health system in
cube) ||Financial protection and equity in
financing ||Mid-term exam (30 min) + final
17:30 ||Access and coverage
||Quality and safety ||Group work
(health system goals, ranking, weighting)
Literature (required/additional readings)
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.
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.
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.
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.
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 .
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 
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
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%20system%20performance_2013.pdf