National Health System a complex organisation

1. ‫جهان‬ ‫و‬ ‫ایران‬ ‫در‬ ‫سالمتی‬ ‫نظامهای‬
‫عمومی‬ ‫بهداشت‬ ‫کارشناسی‬

2. Why study health services?
• 1 Health is of primary importance to most people.
• 2 Health services contribute to maintaining and improving people’s health.
• There is uncertainty as to the effectiveness, humanity, equity and efficiency of
• many interventions.
• 4 There is a need to make health care professionals and services more accountable
• to the public.
• 5 Expenditure on health care represents a large and growing proportion of
• national budgets.
• 6 Health services are a major employer.
• 7 The medical-industrial complex that supplies health services is a major
• power and influence on national governments and international health
• organizations.

3. A systems approach to
health services
Introduction

4. Learning objectives
• After working through this chapter, you will be better able to:
• • identify the basic features of a social system
• • identify inputs, processes and outcomes in health care systems.

5. Key terms
• Inputs The resources needed by a system.
• Outcomes Change in status as a result of the system processes (in the
health services context,
• the change in health status as a result of care).
• Outputs A combination of the processes and outcomes that constitute the
total production of a
• system.
• Processes The use of resources or the activity within a system.
• System A model of a whole entity, reflecting the relationship between its
elements at different
• levels of complexity.

6. What are health services?

7. What is a system?

8. Activity 1.1
Taking the transport system in the town where you live, carry out the
following tasks.
1. Write a brief description of its main constituent parts. Think of the
difference between the notion of a system and the elements it is
made of. You may find it helpful to draw a rough sketch of the
system showing the interrelationships between the parts you
describe.
2. Make a list of the different aspects of transport you can look at, for
example objectives, means and processes.

9. Feedback
• Obviously there is a wide range of possible answers. You may
distinguish, for example, between inputs – cars, boats and aircraft. Or
you may look at the processes related to traffic, for example how a
traffic jam builds up, the financing of public transport, road
maintenance or infrastructure planning; or the objectives of the
transport system, such as increasing mobility or controlling traffic
flows.

10. A system has:
• a purpose or mission
• decision making processes that are themselves systems – these
interact so that
• their effects can be transmitted throughout the system
• resources that can be used by the decision making process
• some guarantee of continuity.

11. Furthermore
• • its performance can be measured
• • it exists in wider systems and/or environments with which it
interacts but from
• which it is separated

12. A systems approach to health care
• There are clearly many different ways of describing a system but, whatever
• approach you choose, you need to put the elements in a coherent and
meaningful
• order. The way health services are presented in this book is intended to
increase
• your awareness of the results of health care and how these are achieved.
Ultimately,
• the objective of any health system is to improve people’s health. Hence a
meaningful
• approach would describe how health care affects health status. The
approach
• followed in this book is:

14. Activity 1.2

15. Feedback
• This way of looking at health care brings together elements that belong to a variety of
• categories.
• Inputs. Examples include resources such as staff, land, buildings, funds, medical knowledge,
• drugs and patients. Did you think of human resources? This is the most important
• input because it is staff who employ (or use) all other resources. You may not have
• thought of ‘patients’ as an input, but without them there would be no processes and, as
• you will see in Chapters 10 and 11, they play key roles in the production of health.
• Processes. Processes are activities within the system, for example investigation and
• treatment of patients or referral of patients between facilities. Did you think of the
• therapeutic process? The patient–staff interaction is one of the essential processes of
• care and you will explore it more in detail later in the book.
• You may also think of organizational processes, for example drug supplies, electronic
• transmission of information, rationing of care, ways of raising money for the health
• sector or paying staff.
• Outcomes. These are the results of care, which can be measured in terms of changes
• in patients’ survival or quality of life. But there are many intermediate measures expressing
• changes in impairment, such as blood sugar levels, body weight or blood pressure,
• and changes in disability or functional ability, such as mobility or memory. You will
• explore the definition and use of outcome measures in Chapter 12.

16. Why outcomes and not outputs?
• You may wonder why you don’t look at outputs as a result of inputs. Economists
use
• the term ‘output’ to describe the production process, for example the number of
• cars produced in an automobile factory. By analogy, health economists apply this
• concept to a combination of processes and outcomes of health services. You will
• explore the relationship between inputs and outputs, and between outputs and
• costs in the health economics books in this series. The systems theory approach
• used here is somewhat different. The focus is on outcomes as a result of inputs
and
• processes, and this concept emphasizes the change in health status as a result of
• care.

17. Summary
• As with other social systems, health services can be seen as a set of
interdependent elements that constitute a purposeful whole. In order
to describe how health care affects health status, this book will
consider the inputs, processes and outcomes of health services.
Before you move on to study inputs, however, Chapter 2 will provide
you with a brief introduction to the challenges that the planners and
managers of health services face.

18. Challenges facing health
services
Introduction

19. Formal and lay care
Introduction

20. Diseases and medical knowledge
Inputs to health care:

21. Medical paradigms
Inputs to health care:

22. Staff: the challenge of
professionalism
Inputs to health care:

23. Funding health care
Inputs to health care:

24. The need and demand for
health care
Processes of health care

25. The relationship between
need and use
Processes of health care

26. Staff–patient interactions
Processes of health care

27. Public as consumers and
policy makers
Processes of health care

28. Outcomes
Outcome of health care

29. Analysing health systems
Organization of services

30. Why are health systems as
they are?
Organization of services

31. Low and middle income
countries: from colonial
inheritance to primary care
Organization of services

32. Low and middle income
countries: from
comprehensive primary care
to global initiatives
Organization of services

33. Health services in high
income countries
Organization of services

34. Defining good quality health
services
Quality improvement

35. Performance assessment
Quality improvement

36. Improving quality of care
Quality improvement