introduction and frameworks - tu berlin · 2017-11-20 · introduction and frameworks reinhard...
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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)
21 November 2017 5 Introduction and frameworks
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)
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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)
21 November 2017 Introduction and frameworks 8
And the winner was…
Introduction and frameworks 9 21 November 2017
… but not everyone agreed
21 November 2017 Introduction and frameworks 10
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.
21 November 2017 Introduction and frameworks 11
Health system frameworks I (an adapted version of the original from 2000)
Roberts et al. 2004
Health system frameworks II
Control Knobs
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Health system frameworks III
Atun et al.
Atun 2008
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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
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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”
21 November 2017 Introduction and frameworks 16
Overview: frameworks 1. Boundaries of the system 2. Architecture/functions 3. Goals/ objectives + focus on HSPA
21 November 2017 Introduction and frameworks 17
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.
21 November 2017 Introduction and frameworks 18
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
21 November 2017 Introduction and frameworks 19
Introduction and frameworks 20 21 November 2017
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
Control Knobs (2003)
• 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
21 November 2017 Introduction and frameworks 23
The European Observatory
Activities: • Country-
monitoring (HiTs)
• Studies • Dissemination
(Publications, dialogues, etc.) 21 November 2017 24 Introduction and frameworks
21 November 2017 Introduction and frameworks 25
= 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
21 November 2017 Introduction and frameworks 26
Chapter 7: Assessment of the health system
WHO goals
21 November 2017 Introduction and frameworks 27
Country Monitoring: HSPM
21 November 2017 28 Introduction and frameworks
Similar initiative in Africa
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… and in Asia
Introduction and frameworks 30 21 November 2017
Group Work
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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
Introduction and frameworks 32 21 November 2017
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.
Introduction and frameworks 33 21 November 2017
Grenzen von Gesundheitssystemen
Introduction and frameworks 34 21 November 2017
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
Control Knobs (2003)
• 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
Introduction and frameworks 36 21 November 2017
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 37 21 November 2017