Health system elements

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The presentation by Professor David Peters was given at the First Complex Adaptive Systems Training Workshop for CNHDRC, which was held in Beijing, China, from 18-19 July. It explains the basic elements of health systems and how they relate to a complex adaptive systems approach.

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Health system elements

  1. 1. 1<br />Health System Elements & ConnectionsJuly 19, 2011David H PetersJohns Hopkins University<br />
  2. 2. 2<br />What Is A System?<br /> An interaction of parts and their interconnections that come together for a purpose<br />
  3. 3. 3<br />Health System Actors, Functions and Outcomes<br />People<br />Financing<br />Revenue Generation<br />Risk Pooling<br />Allocation & Purchasing<br />Health Status<br />Service Delivery<br />Public Health Services<br />Ambulatory Care<br />Inpatient Care<br />Protection from Health <br />Impoverishment<br />Input Management<br />Human Resources Knowledge<br />Pharmaceuticals Technology<br />Consumables Capital <br />Trust/Satisfaction<br />Oversight<br />Policy Setting Information, Disclosure & Advocacy <br />Regulation Strategic Partnerships & Incentives<br />The State<br />Politicians<br />Policy-makers<br />Providers<br />Public/Private<br />Informal<br />
  4. 4. 4<br />Who Produces Health?<br />
  5. 5. The “Control Knobs” of Public Intervention in Health Systems<br />Financing: how to raise money, pool funds, allocate and pay for health care<br />Organization: who delivers services and manages health systems inputs, and how they are delivered<br />Oversight: how do you regulate and use information to change behavior of key actors<br />5<br />
  6. 6. 6<br />Health Financing: Key Functions<br />Raising revenues<br />Pooling resources<br />Allocating and purchasing<br />
  7. 7. 7<br />Changes in Organization (who does what, how)<br />Service delivery point (clinics, hospitals)<br />Government administrative area (district)<br />Management unit<br />Profession<br />Community Organization<br />Priority program/disease<br />
  8. 8. 8<br />Oversight Tools in the Health Sector<br />Policy-making<br />Establish & enforce laws & regulations<br />Public disclosure<br />Professional self-regulation<br />Consumer advocates<br />Independent media<br />Independent monitors<br />
  9. 9. Effective Regulation in the Health Sector<br />Informal and formal “rules of the game” (incentives) can greatly influence performance<br />Local institutions beyond government can be effective: Consumer’s groups, professional organizations, media<br />Co-production-regulation may be more effective than government enforcement of rules<br />Peters & Muraleedharan (2008). Regulating India’s Health Sector: To What End? What Future? Social Sciences & Medicine <br />9<br />
  10. 10. Summary of Health Systems Models: Common Features (1)<br />10<br />
  11. 11. Summary of Health Systems Models: Common Features<br />11<br />
  12. 12. Making Connections: Systems Thinking<br />The process of understanding how things influence each other in a system<br />12<br />
  13. 13. 13<br />Systems Thinking:Key Concepts<br />Parts of a system are interdependent<br />Actions have multiple-order consequences<br />Optimizing one part can lead to poor system performance<br />Organizational structures drive behavior<br />Mental models influence actions<br />
  14. 14. Making Connections<br />Will changes in one part of health system cause changes in other part of health system<br />Other actors<br />Other functions<br />Outcomes<br />14<br />
  15. 15. 15<br />Health System Actors, Functions and Outcomes<br />People<br />Financing<br />Revenue Generation<br />Risk Pooling<br />Allocation & Purchasing<br />Health Status<br />Service Delivery<br />Public Health Services<br />Ambulatory Care<br />Inpatient Care<br />Protection from Health <br />Impoverishment<br />Input Management<br />Human Resources Knowledge<br />Pharmaceuticals Technology<br />Consumables Capital <br />Trust/Satisfaction<br />Oversight<br />Policy Setting Information, Disclosure & Advocacy <br />Regulation Strategic Partnerships & Incentives<br />The State<br />Politicians<br />Policy-makers<br />Providers<br />Public/Private<br />Informal<br />
  16. 16. Making Connections: Where to look<br />Follow people and organizations (actors)<br />Follow the money<br />Follow the information<br />Ask:<br />How will different actors respond?<br />What will happen to health services?<br />What will happen to health system outcomes, for whom?<br />16<br />
  17. 17. Following people<br />Identify “interests”<br />Motivations, Incentives and Accountabilities<br />Identify “influence”<br />Power, Resources<br />Consider how intervention will affect people:<br />Who will benefit, who will lose<br />Who will “own”<br />17<br />
  18. 18. Stakeholder Analysis Matrix (Example)<br />18<br />
  19. 19. Following money and services<br />Will change in financing affect health services?<br />Volume of services<br />Quality of services<br />Who will provide<br />Who will benefit from services<br />19<br />
  20. 20. Following information<br />Will information affect health services?<br />Quality of services<br />Prices for services<br />Who will provide<br />Who will benefit from services<br />20<br />
  21. 21. Incorporating Complexity<br />21<br />
  22. 22. Model for Understanding Health Systems Changes as Complex Adaptive System<br />22<br />
  23. 23. 23<br />Summary<br />Systems thinking in health systems involves:<br />Understand health systems actors, functions, principles, purpose<br />Make changes in financing, organization, oversight<br />Look for responses in actors, health services, money, information<br />Monitor effects on intended and unintended outcomes <br />

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