Case 1: building blocks of a health system: from theory to practice

Question 1

What is a system?

Answer 1

Interconnected set of elements that is organised in a way that achieves something.

Question 2

What must a system consist of?

Answer 2

1. elements
2. interconnections
3. fucntion/purpose

Question 3

What are the characteristics of a health system?

Answer 3

• are a means to an end
• open systems
• positive & negative feedback loops
• static complexity
• dynamic complexity

Question 4

.

Answer 4

.

Question 5

What is a health system?

Answer 5

Consists of organisations, institutions, resources & people whose primary purpose = improve health

Question 6

What goals are health systems focused on?

Answer 6

1. improving health of population
2. responding to citizens’ expectations
3. providing financial protection against costs of ill-health

Question 7

Why is it important to classify EU health systems?

Answer 7

1. rational way to label what is complex
2. allows for international comparisons of characteristics & performance
3. enables policy assessments & recommendations to be made

Question 8

What does health systems economic and social sustainability rely on?

Answer 8

1. policy makers ability to stress strengths of existing health system types
2. overcoming their weaknesses in terms of equitable & timely access to care.

Question 9

What are the 3 actors in the HC systems?

Answer 9

• state
• non-governmental actors
• Market

Question 10

What is the role of the EU in national health systems?

Answer 10

• Member States chose for a hands-off policy on health systems in 1992
• Now have cross-border care and economic reform (incl. healthcare)

Question 11

Why are there different systems in different countries?

Answer 11

• What the health issue are in country. E.g. in Europe much less attention to pandemics than now (health status)
• Funding
• Capacity
• Values
• Level of centralization

Question 12

*What is vertical integration?

Answer 12

IC brings together services at different stages of care

Question 13

How does the WHO framework describe health systems?

Answer 13

Describes health systems interms of 6 “building blocks”

Question 14

What are the WHO building blocks?

Answer 14

1. Service delivery
2. health workforce
3. health information systems
4. medical products, vaccines & technologies
5. financing
6. leadership/governance

Question 15

**What is the defintion of building block service delivery

WHO building block

Answer 15

• comprehensive range of provided services, accessibility, coverage of a defined target population, continuity of care across networks, high quality and patient-centred care, active coordination, accountability and efficiency

Question 16

List the characterisitcs of a good service delivery

WHO building blocks

Answer 16

1. Comprehensiveness - health services for needs of population
2. accessibility
3. coverage - defined target population
4. continuity -
5. quality -
6. Person-centeredness - services organized around person, not disease.
7. coordination
8. accountability & efficiency

Question 17

What is health workforce?

WHO building block

Answer 17

All people engaged in actions whose primary intent is to enhance health

Question 18

What is the purpose of health information systems?

WHO building block

Answer 18

Enable decision-makers at all levels of health system to identify problems & needs

Question 19

What are health information systems essential for?

WHO building block

Answer 19

• health system policy development and implementation
• governance and regulation,
• health research
• human resources development
• health education

Question 20

What key functions does health infromation systems have?

WHO building block

Answer 20

1. data generation
2. compilation
3. analysis and synthesis
4. communication and use

Question 21

Explain access to essential medicines building block

WHO building block

Answer 21

ensures equal access to medical products, vaccines & technologies, etc.

Question 22

What is the building block health financing?

WHO building blocks

Answer 22

• allocation of money to cover health needs of people
• make funding available
• set financial incentives to providers to make sure all individuals have access to effective PH & personal HC

Question 23

What does leadership & governance building block do?

WHO building blocks

Answer 23

Making sure strategic policy frameworks exist & are combined with:
- effective oversight
- coalition-building,
- regulation
- attention to system design
- accountability

Question 24

What are 2 types of indicators for measuring governance?

WHO building block

Answer 24

• ruels based indicators
• outcome based indicators

Question 25

What are strengths of the WHO building blocks framework?

Answer 25

* tool for planning, funding, decisions & establishing priorities. * Useful reference point for national & global policymakers * identify **indicators & measurements** to monitor & evaluate systems * make easier to **harmonize** systems which can help get rid of large differences between MS in EU

Question 26

What are limitations of the WHO building blocks framework?

Answer 26

* too static, not fully showing the complexity of health systems * All buidling blocks have some underlying factor that has nothing to do with HC system. e.g. workforce qualitifcation more linked to education system * Community organisations, societal partnerships, household production of health & information systems often **NOT** seen as part of the health system.

Question 27

How can we montior & evaluate health systems strengthening?

Answer 27

See pages

Question 28

What are **health** indicators for the performance of HC systems?

Answer 28

* **health of the population** * Life expectancy at birth * Total expenditure on health * mortality rate * infant mortality rate * life expectancy

Question 29

What are **economic indicators** for the performance of HC systems?

Answer 29

* HC expenditures per capita, HC expenditure as a percentage of GDP * satisfaction with health care

Question 30

Explain how to combine a tax-based & insruance based system? (Hybrid health system model)

Answer 30

* Multiple subsystems need to be governed centrally by providing right incentives for desired stakeholder behaviour. * Tax- and insurance-based approaches can be combined in one system to assure efficiency, equity and quality. | See picture in pages

Question 31

Why is it important to analyse health systems?

Answer 31

* Needed to understand how the public health system functioning * Compares the system to its past performance * Compares the system to those in other countries * Lessons drawing and system improvement

Question 32

Which building blocks is access to essential medicines linked with?

Answer 32

Monitoring access to essential medicines is linked with **service delivery & governance**

Question 33

What is **vertical intervention?**

Answer 33

funding targets specific **interventions & outcomes**

Question 34

What is **horizontal intervention?**

Answer 34

focuses on funding to strengthen health system more broadly