Introduction and frameworks - TU Berlin · 2017-11-20 · Introduction and frameworks Reinhard...

Introduction and frameworks

Reinhard Busse, Prof. Dr. med. MPH FFPH

FG Management im Gesundheitswesen, Technische Universität Berlin (WHO Collaborating Centre for Health Systems Research and Management)

& European Observatory on Health Systems and Policies

21 November 2017 1 Introduction and frameworks

Outline of the course- Week 1 Topic Date Lecturer

Introduction and Outline of the course 20.11.2017 15-17 Uhr

Wilm Quentin and Daniel Opoku

Introduction and frameworks 21.11.2017 09-12 Uhr

Reinhard Busse

Financing I: Raising Resources 13.30-17 Uhr Wilm Quentin

Seminar on health system relevant databases and information for term paper

22.11.2017 10-12 Uhr (H8173/74)

Anne Spranger

Financing II: Pooling and re-allocation 13.30-17 Uhr Reinhard Busse

Financing III: Purchasing and payment systems

23.11.2017 09-12 Uhr

Wilm Quentin

Leadership and Governance + Care Delivery

13.30-17 Uhr Reinhard Busse

Workforce 24.11.2017 9-10.30 Uhr

Claudia Maier

Introduction to group exercise 10.30-12 Uhr Anne Spranger

Medical products 13.30-17 Uhr Reinhard Busse 21 November 2017 Introduction and frameworks 2

Outline of the course - Week 2

Introduction and frameworks 3 21 November 2017

Topic Date Lecturer

Preliminary Summary of building blocks 27.11.2017 09-10.30 Uhr

Reinhard Busse

Presentation by GIZ on health system related German development cooperation

10.30-12 Uhr Ursula Bürger, Fachplanerin Kompetenz-Center Gesundheit und Soziale Sicherung, GIZ

Access and Coverage 13.30-17 Uhr Reinhard Busse

Quality and Safety 28.11.2017 09-12 Uhr

Reinhard Busse

Financial and social risk protection 13.30-17 Uhr Wilm Quentin

Improved Health 29.11.2017 13.30-17 Uhr

Wilm Quentin

Efficiency and Responsiveness 30.11.2017 09-12 Uhr

Reinhard Busse

Summary of Health System Performance Assessment

13.30-17 Uhr Reinhard Busse

Group Presentations and Wrap-up 01.12.2017 09-12 Uhr

Reinhard Busse or Wilm Quentin

Organisational matters 13.30 onwards

WHO 2007

WHO building blocks 21 Nov

21 to 23 Nov

24 Nov

24 Nov

23 Nov

23 Nov

Week 8

27 Nov

28 Nov

22 Nov (seminar)

28 Nov

29 Nov

30 Nov

30 Nov

30 Nov/1 Dec

21 November 2017 Introduction and frameworks 4

27 Nov

What is a health system?

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-health through a variety of activities whose primary intent is

to improve health.

European Observatory for Health Systems and Policies (2007)


A starting point: 2000 World Health Report

This report sets out to analyse the role of health systems and suggest how to make them more efficient and, most importantly, more accessible and responsive….

Introduction and frameworks 21 November 2017 6

2000 (WHR)


The first health system framework = strategy behind World Health Report 2000

2000 World Health Report

• First attempt to rank performance of 191 national health systems

• Identifies and measures performance of member states on ‘key health system objectives’

• Examines whether each health system is performing as well as it can, given existing resources

• Based on Murray & Frank framework (2000)


And the winner was…


… but not everyone agreed


Source: World Health Organization (WHO). (2007) Everybody’s business: Strengthening health systems to improve health outcomes. WHO’s framework for action. Geneva: WHO Document Production Services.


Health system frameworks I (an adapted version of the original from 2000)

Roberts et al. 2004

Health system frameworks II

Control Knobs


Health system frameworks III

Atun et al.

Atun 2008


A Q

R

21 November 2017 Introduction and frameworks

14

WHO 2007

Health system framework V (a further WHO development)

WHO building blocks Week 1

Week 14


Week 1

Week 2 + 3

Week 4

Week 6

Week 5

Week 7 (lecture)

Week 8

Week 9

Week 10

Week 7 (seminar)

Week 12

Week 11

Week 13

Week 13

Health system frameworks VI

WHO systems thinking

De Savigny and Adam 2009: Systems thinking for health systems strengthening

“Building blocks do not constitute a system …. It is the multiple relationships and interactions among the blocks …. that convert these blocks into a system”


Overview: frameworks 1. Boundaries of the system 2. Architecture/functions 3. Goals/ objectives + focus on HSPA


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.


Different definitions of boundaries ...

– WHO: “The resources, actors and institutions related to the financing, regulation and provision of health actions. Where health actions are any set of activities whose primary intent is to improve or maintain health”. (Murray & Frenk 2000)

– Commonwealth Fund: “The way in which health care services are financed organized and delivered to meet societal goals for health. It includes the people, institutions, and organizations that interact to meet the goals, as well as the processes and structures that guide these interactions”. (Commonwealth Fund 2006)

– OECD (old!): “The health care system, not including public health activities or other wider issues”. (Hurst & Hughes 2001)

OECD

Commonwealth Fund

WHO


Framework Health System Functions

WHO (2000) • Resource Generation • Financing • Service Provision • Stewardship

WHO (2007) • Service Delivery • Health Workforce • Information • Medical products, vaccines and technologies • Financing • Leadership and Governance

Control Knobs (2003)

• Financing • Payment • Organization • Regulation • Behaviour

Atun (2008) • Financing • Organization and Regulation • Resource Allocation • Provision

What are health system functions?

In summary: 1. Leadership/

governance/ organization/ regulation

2. Resource generation/ financing/payment

3. Human/ technological resources

4. Service provision 21 November 2017 21 Introduction and frameworks

Framework Intermediate Objectives

Ultimate Objectives

WHO (2000; 2007) • Access • Coverage • Quality • Safety

• Level and distribution of health

• Level and distribution of responsiveness

• Fairness in financing

• Efficiency

Commonwealth Fund (2004)

• High quality care • Efficient care • Access • System and workforce innovation and improvement

• Long Healthy and Productive Lives


• Efficiency • Quality • Access

• Health status • Consumer satisfaction • Risk protection

Atun (2008) • Equity • Choice • Efficiency • Effectiveness

• Health • Financial risk protection • Consumer satisfaction

What are health system objectives?

In summary: 1. Health (level and

distribution 2. Responsiveness/

consumer satisfation (level and distribution)

3. Financial protection (level and distribution)

4. Efficiency 21 November 2017 Introduction and frameworks 22

So why bother with a framework?

Health system framework • understand • describe • compare • analyze

Health Systems Performance Assessment framework • Much more contentious


The European Observatory

Activities: • Country-

monitoring (HiTs)

• Studies • Dissemination

(Publications, dialogues, etc.) 21 November 2017 24 Introduction and frameworks


= Health Systems in Transition (HiT)

Describe and analyze a country’s health system and key reform initiatives

Based on a common set of questions and follow the same structure, enabling easy cross-country comparisons ( next slide)

Seek to provide relevant information to support policy-makers and analysts in the development of health systems in Europe and beyond

Observatory‘s approach to country-monitoring

European Observatory 2010

1. Context 2. Organization and governance 3. Financing 4. Physical and human resources 5. Provision of services 6. Principal health reforms 7. Assessement of the health system 8. Conclusions 9. Appendices

Observatory‘s approach to country-monitoring


Chapter 7: Assessment of the health system

WHO goals


Country Monitoring: HSPM


Similar initiative in Africa


… and in Asia


Group Work


Group Work

• 4 Groups of 5 students each

• 30 minutes group work

– Discuss/answer to questions on boundaries of health systems and health system goals

• 25 minutes presentation/discussion of results (5 minutes per group)

• 5 min summary/wrap-up


Questions for group work

Please discuss the following questions

1. Boundaries of health systems:

• What are advantages and disadvantages of different definitions of health systems‘ boundaries?

• Decide as group: How should the boundary of a health system be defined?

2. Goals of health systems:

• What are the most important goals of health systems?

• Please rank health systems‘ goals and add weights to each goal.


Grenzen von Gesundheitssystemen


Framework Intermediate Objectives

Ultimate Objectives

WHO (2000; 2007) • Access • Coverage • Quality • Safety

• Level and distribution of health

• Level and distribution of responsiveness

• Fairness in financing

• Efficiency

Commonwealth Fund (2004)

• High quality care • Efficient care • Access • System and workforce innovation and improvement

• Long Healthy and Productive Lives


• Efficiency • Quality • Access

• Health status • Consumer satisfaction • Risk protection

Atun (2008) • Equity • Choice • Efficiency • Effectiveness

• Health • Financial risk protection • Consumer satisfaction

What are health system objectives?

In summary: 1. Health (level and

distribution 2. Responsiveness/

consumer satisfation (level and distribution)

3. Financial protection (level and distribution)

4. Efficiency 21 November 2017 Introduction and frameworks 35

Ziele von Gesundheitssystemen


Conclusions

• Health systems can be defined with different boundaries and different goals

• Goals usually include (1) Health (level and distribution), (2) Responsiveness/consumer satisfaction (level and distribution), (3) Financial protection (level and distribution), and (4) Efficiency


Introduction and frameworks - TU Berlin · 2017-11-20 · Introduction and frameworks Reinhard...

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