PA 574: Health Systems Organization Session 2 January 13,
2011
Slide 2
Includes all the activities whose primary purpose is to
promote, restore or maintain health Formal health services,
traditional services, public health, alternatives Health systems:
Improve health of populations Respond to peoples expectations
Provide financial protection against costs of ill health
Slide 3
Financing To obtain health services Insurance Protection
against risks Delivery Providers of services Payment Reimbursement
Shi & Singh, Figure 1-1, p. 6
Slide 4
Social values and cultures Population characteristics Political
climate Economic conditions Physical environment Technology
development Global influences Shi & Singh, Figure 1-2, p.
10
Slide 5
Six Aims Safe Effective Patient-centered Timely Efficient
Equitable Ten Rules for System Redesign
Slide 6
1. Care is based on continuous healing relationships; 2. Care
is customized according to patient needs/values; 3. The patient is
the source of control; 4. Knowledge is shared and information flows
freely; 5. Decision making is evidence-based; 6. Safety is a system
property; 7. Transparency is necessary; 8. Needs are anticipated;
9. Waste is continuously decreased; and, 10. Cooperation among
clinicians is a priority.
Slide 7
Level 1: Patient and Community Experience of patients Level 2:
Microsystem Functioning of small units of care delivery Level 3:
Organization Functioning of organizations that house microsystems
Level 4: Environment Policy, payment, regulation, accreditation
Shapes behavior, interests and opportunities of Level 3
organizations
Slide 8
Brainstorm: What has transformed health services delivery over
past few decades?
Slide 9
Professional sovereignty Urbanization Science and technology
Growth of institutions Dependency Cohesion among medical
professionals Licensing and regulation Health professions
education
Slide 10
Growth in public health Consumer advocacy Increase in chronic
conditions and longevity Services to special interest groups
(veterans, disease, racial/ethnic) New forms of coverage
Slide 11
Science & Technology Mid 18 th to late 19 th Late 19 th to
late 20 th Late 20 th to 21 st Consumer Professional Corporate
Sovereignty Dominance Dominance Beliefs and Values Social, Economic
& Political Constraints Shi & Singh: Figure 3.1; p.
113
Slide 12
Please be back in 10 minutes
Slide 13
Market Commodity or Public Good?
Slide 14
Market justice and social justice (Table 2-4; p. 59) Belief in
advancement of science Capitalist orientation leads to health care
viewed as a market commodity, not as public resource Culture of
capitalism consistent with entrepreneurial spirit,
self-determination and personal responsibility Some concern for
underprivileged based on underlying values of equity and fairness
Principles of free enterprise dominate
Slide 15
Consideration of critical human concerns Protection of society
Application to health care delivery Health insurance Health
services organization Equality/inequality Distributional
(in)efficiency
Slide 16
Attempt to integrate medical care, preventive services, health
promotion, health education in community (see Fig. 2-5, p. 65)
Healthy People 2010 (see Fig. 2-6, p. 66) Improve systems Increase
quality and years of healthy life Eliminate health disparities 28
focus areas (Ex. 2-1, p. 67)
Slide 17
Shift in Health System Reform Preferences
Slide 18
New developments in health care reform -- political forces,
alliances, federal/state roles Emphasis on accessibility Proposed
Healthy Americans Act Guarantees market-driven choices
Administrative savings Feasibility?
Slide 19
Scorecard using national and international data to identify
performance benchmarks Ratio scores of US average to benchmark
Healthy lives score: 75/72 / 100 Quality score: 72/71 /100 Access
score: 67/58 /100 Equity score: 70/71 /100 Efficiency score: 52/53
/100 Overall score: 67/65 /100 Importance of policies to take
coherent, whole-system approach to change and address interaction
of access, quality, and cost
Slide 20
Affordable coverage for all Align incentives with value and
effective cost control Accountable, accessible, patient-centered
and coordinated care Aim high to improve quality, health outcomes,
and efficiency Accountable leadership and collaboration to set and
achieve national goals
Slide 21
Extent to which health services are consumed Critical
assessment necessary to assess capacity Types of Measures: Access
to primary care Utilization of primary care Utilization of targeted
services Average daily census Occupancy rate Average length of
stay
Slide 22
Self-perception of health and well-being Life expectancy -
longevity Morbidity disease Disability dysfunction Mortality -
death rates Demographic population Other kinds of health
status
Slide 23
How do you untangle this mess of ideas and proposals?
Implications for first paper vis a vis how to improve the
system
Slide 24
Health system resources Redesign of primary care to enhance
health services delivery Group presentation #1: Lewis, Ch.1 Shi
& Singh, Ch. 5 World Health Report 2008, Ch. 4 Review Oregon
Health Information website Friedberg et al. (2010): Primary Care
Kilo and Wasson (2010): Practice Redesign Margolius and Bodenheimer
(2010): Transforming Primary Care Bodenheimer and Pham (2010):
Primary Care: Current Problems Grundy et al. (2010):
Multi-Stakeholder Movement for Primary Care Renewal Lewis, Chapter
1
