Lecture A1 Context: building blocks of health systems · Context: building blocks of health systems ... Definition of “Health systems“ (I) people, institutions and resources,

OBSERVATORY VENICE SUMMER SCHOOL 2010

Reinhard Busse, Prof. Dr. med. MPH FFPHDept. of Health Care Management, Berlin University of Technology

(WHO Collaborating Centre for Health Systems Research and Management)

& European Observatory on Health Systems and Policies

Lecture A1

Context: building blocks of

health systems

EU integration and health systems:

challenges and opportunities for

patients, professionals and policymakers


Definition of “Health systems“ (I)

people, institutions and resources, arranged together in accordance with established policies,to improve the health of the population they serve, while responding to people’s legitimate expectations and protecting them against the cost of ill-healththrough a variety of activities whose primary intent is to improve health.

European Observatory for Health Systems and Policies (2007).Glossary. http://www.euro.who.int/observatory/Glossary/Toppage.


WHO World Health Report 2000


What are the Health system

boundaries?

Source: Murray, CL. and Evans, DB. (2003) Health systems performance assessment: Debates, Methods and

Empiricism. Geneva: World Health Organization.


Commonwealth Fund Framework (2006)

Source: Commonwealth Fund. (2006) Framework for a high performance health system for the United

States, New York: The Commonwealth Fund.


Atun Systems Framework (2008)

Solidarity EquityParticipation

Equity in utilization

and resource

distribution

Quality

Transparency and

accountability

Efficiency

Choice

Equity in finance

Financial protection

Health gain

Equity in health

Responsiveness

Health system goals (WHR2000)

Purchasing

Benefits

Revenue collection

Pooling

Health financing system

How health financing can influence goals

Service delivery

Ste

wa

rds

hip

Resource generation

Health financing within overall system

Core values


… ensemble of all public and private organizations, institutions and resources mandated to improve, maintain or restore health. … encompass both personal and population services, as well as activities to influence the policies and actions of other sectors to address the social, environmental and economic determinants of health.

WHO European Ministerial Conference on Health Systems (2008). Tallinn Charter: Health Systems for Health and Wealth. Resolution EUR/RC58/R4.

Definition of “Health systems“ (II)

Health care outcome:

satisfaction, complications

etc.Structures

and organisation

Patients

Process

Population health status

(need)

Health

gain/

Outcome

Human resources

Technologies

Financial resources Stewardship/ regulation/ incentives

“actions of other sectors to address the determinants of health”

“public and private organizations, institutions

and

resources to improve, maintain or restore health”

Health Production Model forHealth Systems Research

“activities to influence the policies“

Other sectors

Nutrition/ agriculture

Environment



etc.Structures

and organisation

Patients

Process


(need)

Health

gain/

Outcome

Other sectors


Environment

Personnel sufficient

and well qualified?

Institutions of high standards?

Technologies effective?

Human resources

Technologies

Financial resources

Fair and sustainable funding?

Utilization responsive,

appropriate, coordinated …?

Health care system

Needs-based,

equitable

access?

Patients satisfied,

services safe and

of high quality?

Re

so

urc

e c

rea

tio

n

adequate

?

How much?

Is it worth it

(cost-effective)?



etc.Structures

and organisation

Patients

Process


(need)

Health

gain/

Outcome

Other sectors


Environment

Personnel sufficient

and well qualified?

Institutions of high standards?

Technologies effective?

Human resources

Technologies

Financial resources

Fair and sustainable funding?

Utilization responsive,

appropriate, coordinated …?

Health care system

Needs-based,

equitable

access?

Patients satisfied,

services safe and

of high quality?

Re

so

urc

e c

rea

tio

n

adequate

?

How much?

Is it worth it

(cost-effective)?

Art. 152 (5) Community action in the field of public health shall fullyrespect the responsibilities of the Member States for the organisation and delivery of health services and medical care.


(need)

Health

gain/

Outcome

Human resources

Technologies



Other sectors


Environment

Is EU health policy like this imaginable?

Art. 152 (5) Community action in the field of public health shall fullyrespect the responsibilities of the Member States for the organisation and delivery of health services and medical care.


(need)

Health

gain/

Outcome

Human resources

Technologies



Other sectors


Environment

Is EU health policy like this imaginable?


“At European level, health services have to adapt to

market rules, while at national level, health

services are seen as part of a social model.

To overcome this situation and to ensure the social status of health services,

we need – possibly paradoxically – to develop a European health policy.“

2002


The core issue – no matter if persons, goods or services are entitled/ licensed/ authorised to cross borders

Whose regulations are/ should be applied?

• Those of the country of origin?

• Or those of the country of destination?

• Or should common regulations exist?

– If yes, are they applicable also within countries?

– Or only for border-crossing and/or upon choice (de facto

establishing a 28th law within the EU)?


Concretely

• Who does (and who should) determine the necessary

qualifications of a Polish nurse working in Germany?

• Who authorises a UK-made drug sold in Portugal?

Who regulates the price, the reimbursement, the

dispensing rules …?

• Who regulates entitlements, quality, price … of

services available to a Greek tourist in Finland? Are

the regulations the same if the Greek person travels

to Finland to receive the services?

Documents

Lecture A1 Context: building blocks of health systems · Context: building blocks of health systems ... Definition of “Health systems“ (I) people, institutions and resources,