EPH 3021 Health Care Systems in the EU Case summary
Summary Case 1: The Building Blocks of a health system: from theory to practice
Learning goals:
1. What is a health system?
2. What are the functions of the building block of WHO?
a. Finance
b. Provision
c. Stewardship
d. Resource generation
3. What are the pro and cons of WHO classification of the building blocks?
4. What are other health system classifications?
5. What are the drawbacks of the classification/ typologies?
6. What are other ways to look at health systems?
1. What is a health system?
Jarvis (2020)
- Public health = ‘multidisciplinary area of practice, concept and set of values that engaged in a larger population health
perspective’
- ‘Public health systems’ = ‘levels of governmental and non-governmental entities which share in the responsibility for
ensuring healthy social and physical environments, and consist of a variety of organisations that contribute to the core
functions of public health to protect and promote health within the community’
WHO definition
- Consists of all organizations, people, and actions whose primary intent is to promote, restore and maintain health
o E.g. a healthcare system includes for example a mother caring for a sick child at home, private providers,
behavior change programmes, health insurance organisations etc.
o Includes efforts to influence determinants of health as well as more direct health-improvement activities
o Health system delivers preventive, promotive, curative and rehabilitative interventions
Combination of public health actions and the pyramid of health care facilities
By both State and non-State actors
o Actions should be: responsive, financially fair, respectably
o Components: staff, funds, information, supplies, transport, communications and overall guidance and direction
to function
1
,EPH 3021 Health Care Systems in the EU Case summary
Another WHO definition (2000)
- Healthcare system the set of activities whose primary purpose is to promote, restore and maintain health
- 4 main functions of a healthcare system
1) Health service provision
2) Generation of health resources (investment and training)
3) Health financing
4) Stewardship
Resources should be fairly distributed
Ferreira
- Existing health care systems are a product of and influenced by, specific political, historical, cultural and
socioeconomic traditions
Ciasullo
- Health system consist of an aggregate of commitments or resources which any national society invests in the health
concern, as distinguished from other concerns
- Health systems are composed of a more or less integrated set of resources that are targeted to the delivery of primary,
secondary and tertiary care and consequently to health protection and promotion
2. What are the functions of the building block of WHO?
- Six core components or ‘building blocks’
o Service delivery
Deliver effective, safe, quality personal and non personal health interventions to those that need
them, when and where needed with minimum waste of resources
o Health workforce
Are responsive, fair and efficient to achieve the best health outcomes possible, given available
resources and circumstances
o Health information systems
Ensures production analysis, dissemination and use of reliable and timely information on health
determinants/health system performance
Data generation, compilation, analysis & synthesis, communication and use
o Access to essential medicines
Ensures equitable access to medical products, vaccines and technologies (quality, safety, efficacy,
cost-effectiveness)
o Financing
Adequate funds which ensure that people can use needed services, protected from financial
catastrophes, provision of incentives for providers/users
o Leadership/ governance
Strategic policy frameworks, combined with effective coalition building, regulation etc.
2
,EPH 3021 Health Care Systems in the EU Case summary
- Cross-cutting components: leadership/ governance & health information systems
o Basis for the overall policy and regulation of all the other health system blocks
- Key-input components: financing and the health workforce
- Immediate outputs of the health system: medical products and technologies and service delivery
- Problems of the framework
o Focuses on health sector actions and underplays the importance of actions in other sectors
o Does not take into account actions that influence peoples’ behaviours
Promoting & protecting health and the use of health-care services
o Does not address the underlying social and economic determinants of health
Gender inequalities or education
o Does not deal with the substantial and dynamic links and interactions that exist across each component
Understanding whole process: outputs, outcome, impact!
3. What are the pros and cons of WHO classification of the building blocks?
- Pro
o Harmonized approach to health systems monitoring and evaluation
o Reduced transaction costs
o Diminished pressures on countries
o Simplicity and ability to provide a common language for researchers
o Allows better monitoring
o Responsiveness, financial risk protection and efficiency as outcomes that, in the pursuit of sustainable
universal health coverage, are essential
- Cons:
o It focuses on health sector actions and underplays the importance of actions in other sectors
o Does not account for actions that influence behavior, such as health (e.g. gender inequalities or education)
o Does not address the substantial and dynamic links and interactions between components
o Community determinant is missing, rarely mentioned, not explicit
3
, EPH 3021 Health Care Systems in the EU Case summary
Community based health services (for communities with limited or no access to national health
services
Health production: outside the medical model of service (e.g. of households and communities)
Criticized the WHO as a very static model, and that healthcare systems are very complex and the
WHO model is too simplified
Community organisations, societal partnerships, household production of health and information
system are often not seen as part of the health system
Sacks et al. : expand on elements from the building block framework
- Limitations with this framework
o Does not answer how a health programme can be operationalised
o ‘block’ are useful to define elements of health systems, but they are limited in the ability to describe functions
of a system
o Adding a block for community organization: does not describe all the ways effective/possible to organize a
community
4. What are other health system classifications?
Böhm et. al framework
- Three core dimensions of the healthcare system
o Regulation
o Financing
o Service provision
Are not entirely independent from each other but follow a clear order
- Three types of actors: state, societal and private actors
o Societal: non-profit, e.g. social health insurance)
27 combinations from which 10 combinations are plausible
4
Summary Case 1: The Building Blocks of a health system: from theory to practice
Learning goals:
1. What is a health system?
2. What are the functions of the building block of WHO?
a. Finance
b. Provision
c. Stewardship
d. Resource generation
3. What are the pro and cons of WHO classification of the building blocks?
4. What are other health system classifications?
5. What are the drawbacks of the classification/ typologies?
6. What are other ways to look at health systems?
1. What is a health system?
Jarvis (2020)
- Public health = ‘multidisciplinary area of practice, concept and set of values that engaged in a larger population health
perspective’
- ‘Public health systems’ = ‘levels of governmental and non-governmental entities which share in the responsibility for
ensuring healthy social and physical environments, and consist of a variety of organisations that contribute to the core
functions of public health to protect and promote health within the community’
WHO definition
- Consists of all organizations, people, and actions whose primary intent is to promote, restore and maintain health
o E.g. a healthcare system includes for example a mother caring for a sick child at home, private providers,
behavior change programmes, health insurance organisations etc.
o Includes efforts to influence determinants of health as well as more direct health-improvement activities
o Health system delivers preventive, promotive, curative and rehabilitative interventions
Combination of public health actions and the pyramid of health care facilities
By both State and non-State actors
o Actions should be: responsive, financially fair, respectably
o Components: staff, funds, information, supplies, transport, communications and overall guidance and direction
to function
1
,EPH 3021 Health Care Systems in the EU Case summary
Another WHO definition (2000)
- Healthcare system the set of activities whose primary purpose is to promote, restore and maintain health
- 4 main functions of a healthcare system
1) Health service provision
2) Generation of health resources (investment and training)
3) Health financing
4) Stewardship
Resources should be fairly distributed
Ferreira
- Existing health care systems are a product of and influenced by, specific political, historical, cultural and
socioeconomic traditions
Ciasullo
- Health system consist of an aggregate of commitments or resources which any national society invests in the health
concern, as distinguished from other concerns
- Health systems are composed of a more or less integrated set of resources that are targeted to the delivery of primary,
secondary and tertiary care and consequently to health protection and promotion
2. What are the functions of the building block of WHO?
- Six core components or ‘building blocks’
o Service delivery
Deliver effective, safe, quality personal and non personal health interventions to those that need
them, when and where needed with minimum waste of resources
o Health workforce
Are responsive, fair and efficient to achieve the best health outcomes possible, given available
resources and circumstances
o Health information systems
Ensures production analysis, dissemination and use of reliable and timely information on health
determinants/health system performance
Data generation, compilation, analysis & synthesis, communication and use
o Access to essential medicines
Ensures equitable access to medical products, vaccines and technologies (quality, safety, efficacy,
cost-effectiveness)
o Financing
Adequate funds which ensure that people can use needed services, protected from financial
catastrophes, provision of incentives for providers/users
o Leadership/ governance
Strategic policy frameworks, combined with effective coalition building, regulation etc.
2
,EPH 3021 Health Care Systems in the EU Case summary
- Cross-cutting components: leadership/ governance & health information systems
o Basis for the overall policy and regulation of all the other health system blocks
- Key-input components: financing and the health workforce
- Immediate outputs of the health system: medical products and technologies and service delivery
- Problems of the framework
o Focuses on health sector actions and underplays the importance of actions in other sectors
o Does not take into account actions that influence peoples’ behaviours
Promoting & protecting health and the use of health-care services
o Does not address the underlying social and economic determinants of health
Gender inequalities or education
o Does not deal with the substantial and dynamic links and interactions that exist across each component
Understanding whole process: outputs, outcome, impact!
3. What are the pros and cons of WHO classification of the building blocks?
- Pro
o Harmonized approach to health systems monitoring and evaluation
o Reduced transaction costs
o Diminished pressures on countries
o Simplicity and ability to provide a common language for researchers
o Allows better monitoring
o Responsiveness, financial risk protection and efficiency as outcomes that, in the pursuit of sustainable
universal health coverage, are essential
- Cons:
o It focuses on health sector actions and underplays the importance of actions in other sectors
o Does not account for actions that influence behavior, such as health (e.g. gender inequalities or education)
o Does not address the substantial and dynamic links and interactions between components
o Community determinant is missing, rarely mentioned, not explicit
3
, EPH 3021 Health Care Systems in the EU Case summary
Community based health services (for communities with limited or no access to national health
services
Health production: outside the medical model of service (e.g. of households and communities)
Criticized the WHO as a very static model, and that healthcare systems are very complex and the
WHO model is too simplified
Community organisations, societal partnerships, household production of health and information
system are often not seen as part of the health system
Sacks et al. : expand on elements from the building block framework
- Limitations with this framework
o Does not answer how a health programme can be operationalised
o ‘block’ are useful to define elements of health systems, but they are limited in the ability to describe functions
of a system
o Adding a block for community organization: does not describe all the ways effective/possible to organize a
community
4. What are other health system classifications?
Böhm et. al framework
- Three core dimensions of the healthcare system
o Regulation
o Financing
o Service provision
Are not entirely independent from each other but follow a clear order
- Three types of actors: state, societal and private actors
o Societal: non-profit, e.g. social health insurance)
27 combinations from which 10 combinations are plausible
4
