Health Systems
Overview, Goals, Functions
Wali Omer
Department of Community Medicine
College of Medicine
Hawler Medical University
www.hmu.edu.iq
2
Best Health System
• Health System performance
• Duties of a medical doctor
• What is the most technologically advanced
medical system?
• What is the best health system?
• How we can improve our health system?
3
Outline
• Introduction and Definitions
• Related Terms
• Goals and Functions
• Health Sector
• Importance
• Health Services
• Organization of Health Services
4
Quality of Health Services
• What is quality?
• Does it matter?
• On a scale of 10, how would rate the Quality
of Health Services in:
• Iraq (Kurdistan)
• UK (or other western countries)
5
Health Services in UK
• Over the past few months, the media image
has been of a service sick to its core, almost
unrivalled in its incompetence and cruelty.
From Mid Staffs to Morecambe Bay, from the
"crisis" in emergency departments to the
Liverpool care pathway, some egregious
failings have certainly been on display.
6
Health Services in UK
• The BMJ would have been remiss if it had not sought to document and interpret these.
In their editorial (doi:10.1136/bmj.f4343), J Nicholl and S Mason seek to get beyond
the "corridors of shame" headlines to the real reasons for sharp rises in numbers
waiting longer than four hours at emergency departments. While the lay press has
scapegoated general practitioners, out of hours services, NHS 111 services, and
immigrants, Nicholl and Mason suggest some less emotive causes. These include the
seasonal norovirus and flu epidemics, and acute hospital trusts taking their eyes off
the ball after the four hour standard was removed as a target in 2011.
• Three of the reviews commissioned in the wake of recent NHS failings see publication
this week. Nigel Hawkes reports on the Neuberger review, which found that the
Liverpool care pathway was well intentioned but poorly implemented and should be
scrapped in favour of personal care plans (doi:10.1136/bmj.f4568). Zosia Kmietowicz
covers the Keogh report into the 14 hospital trusts purported to have the worst death
rates in England, and health secretary Jeremy Hunt’s decision to put 11 of the
hospitals into special measures (doi:10.1136/bmj.f4602). And Jacqui Wise reports on
the Cavendish review—an offshoot of the Francis inquiry into failings at Mid
Staffordshire NHS Foundation Trust—which calls for all healthcare assistants to
receive basic training before they can work unsupervised (doi:10.1136/bmj.f4489).
7
Performance of Health Systems
• WHO has carried out the first
ever analysis and ranking of
the world’s health systems.
• Landmark Publication
• Ranked 191 countries
according to their Health
System Performance:
• Health
• Fairness
• Responsiveness
1. France
8
2. Italy
8. Oman
18. UK
23. Sweden
27. UAE
30. Canada
37. USA
103. Iraq
191. S. Leone Reasons for Failure
• Disregarding private sector.
• Black markets.
• Regulations.
• Moonlighting.
9
Definitions
• Health: state of …
• System: set of related parts that form a
complex whole
• Health System: all the activities whose primary
purpose is to promote, restore or maintain
health (WHO).
10
Related Terms
• Health administration
• Health management
• Healthcare management
• Health systems management
• Health services management
• Health policy and management
11
3 Goals of a Health System
• Better health: DALE
• Fair financial contribution: risks distributed according
to ability to pay rather than to the risk of illness.
• Responsiveness: to people’s expectations in regard to
non-health matters:
• Respect
• Confidentiality
• Autonomy
• Prompt attention
• Amenities: such as cleanliness, space.
• Access to social networks
• Choice of provider
12
4 Functions
• Delivering health services
• Financing: Raising, pooling and allocating
• Creating resources: Investing in people,
buildings and equipment
• Overall stewardship (oversight). Involves
oversight of all the other functions, and has
direct or indirect effects on all the outcomes.
13
Goals and Functions
14
Health Sector Peculiarities
• Compare with other professions: mostly you
see “miserable” people
• Health care can be very costly.
• Mostly unpredictable, so people be protected
from having to choose between financial ruin
and loss of health.
• Illness and medical care can threaten dignity
15
Importance
• Much more can be done with existing resources
• large improvements can be achieved at reasonable
cost
• In poor countries, about 1/3 of the disease burden could be
averted with only $12/person
• Health systems can make fatal mistakes
• in US, medical errors in hospitals cause at least 44,000
deaths/year + 7,000 due to mistakes medication,
• more deadly RTA, breast cancer and AIDS.
16
Organization of our Health System
17
Health Services
Health services have to be (8 As and 3 Cs)
• Available: 24/7
• Adequate: number of physician, beds and centers
• Accessible: financial and geographical
• Affordable: payment mechanism
• Acceptable: doctor-patient relation, social
• Assessable: can be evaluated: proper records
18
Health Services
• Appropriate: right procedure and intervention by
qualified staff
• Accountable: public accountability, public
representation, financial disclosure
• Complete: prevention, early detection, diagnosis,
treatment and follow up.
• Comprehensive: all health problems including dental,
mental and social.
• Continuous: avoid disruption and coordination
between different care providers.
19
Further Readings
• Parks Textbook of Preventive and Social
Medicine
• Lucas, Short Textbook of Public Health
Medicine for the Tropics
• Cassens, Preventive Medicine and Public
Health
• Jekel, Epidemiology, Biostatistcs and
Preventive Medicine
