Health Systems, Policy & Financing
Syllabus & reading list – key readings highlighted
Lecture 1
• Introduction to the module
• Brainstorming
• Health systems: Definition, elements, functions
• Health system goals and objectives
• Health, financial protection, user satisfaction
• Equity; Efficiency; Effectiveness; Responsiveness and choice
Reading:
Health systems goals and objectives:
• Fogel R. Chapter 2. Why the twentieth century was so remarkable. In: Fogel R (ed.),
The escape from hunger and premature death, 1700-2100. Europe, America and the
Third World. Cambridge University Press: Cambridge, 21-42., 2004
• Hsiao, WC. What is a Health System? Why Should We Care? August, 2003
• Chapter 1: Health systems performance assessment: Goals, framework and
overview. In Murray CJL, Evans D, eds. Health system performance assessment:
debates, new methods and new empiricism. Geneva: World Health Organization
• Chapter 1: Measures of health and disease in populations. In: Merson M, Black R and
Mills A eds. International public health: Diseases, programs, systems, and policies.
Gaithersburg, MD: Aspen Publishers, 2001
• Chapter 2: How well do health systems perform. In World Health Report 2000, World
Health Organization, Geneva, 2000
Equity and efficiency:
• Whitehead M. The concepts and principles of equity and health. International Journal
of Health Services, 1992, 22(3): 429-445
• Wagstaff A, van Doorslaar E, Paci P. Equity in finance and delivery of health care:
Some tentative cross-country comparisons. Oxford Review of Economic Policy, 1989,
5(1): 89-112
• Marmot M. Social determinants of health inequalities. The Lancet, 365(9464), 2005
• Deaton AS. Health, inequality, and economic development. Journal of Economic
Literature, 41(1): 113-158, March 2003
Responsiveness:
• Chapter 43: Health system responsiveness: Concepts, domains and
operationalization. In Murray CJL, Evans D, eds. Health system performance
assessment: debates, new methods and new empiricism. Geneva: World Health
Organization
Choice:
• Chapter 14: Citizen participation and patient choice in health reform. In Saltman RV,
Figueras J, Sakellarides C (eds.) Critical challenges for health care reform in Europe.
Open University Press, Philadelphia, 1998
Lecture 2
• Stewardship
• Group work: Systems thinking
• Health system organisation: Extent of decentralisation, Extent of regulation and
competition
Reading:
Stewardship:
• Chapter 25: Towards better stewardship: Concepts and critical issues. In Murray CJL,
Evans D, eds. Health system performance assessment: debates, new methods and
new empiricism. Geneva: World Health Organization
Health system organisation:
• Chapter 13: Optimal balance of centralized and decentralized management. In
Saltman RV, Figueras J, Sakellarides C (eds.) Critical challenges for health care
reform in Europe. Open University Press, Philadelphia, 1998.
• Londoño JL and J Frenk. Structured pluralism: Towards an innovative model for
health system reform in Latin America. Health Policy, 1997 41(1):1-36
• Le Grand J. Competition, cooperation, or control? Tales from the British National
Health Service. Health Affairs (Millwood) 1999; 18:27 -39
Lecture 3
• Health system financing
• General financing typology
• Tax based financing
• Social insurance
• Voluntary insurance
• Out-of pocket financing including informal payments
• Resource allocation
Reading:
• Chapters 1,2,3,5, 7 in Funding health care: Options for Europe, Mossialos E, Dixon
A, Figueras J and Kutzin J (eds.) European Observatory on Health Systems, 2003.
(Chapter 1 for overview; Chapters 2, 3, 5 & 7 for the different financing systems and
resource allocation)
• Lewis, M. Informal payments and the financing of health care In developing and
transition countries, Health Affairs, 2007, 26,(4):984-997
• King G, Gakidou, E. Imai, K. Lakin, J. Moore, R. Nall, C. Ravishankar, N.Vargas, M.
Téllez-Rojo, M. Hernández, J. Hernández, M. and Hernández, H. Public policy for the
poor? A randomised assessment of the Mexican universal health insurance
programme. The Lancet, 2009 373(9673): 1447-1454.
• Gruber J, Hendren, N. and Townsend, M. 2014. The Great Equalizer: Health care
access and infant mortality in Thailand. American Economic Journal: Applied
Economics, 6(1): 91-107
• Moreno-Serra, R. and Smith, P.C. Does progress towards universal health coverage
improve population health? The Lancet, 2012; 380: 917–923.
Lecture 4 & 5
• Provider payment systems: Typology; Incentives and evidence.
• Service provision
• Health care provision
• Provider organisations
• Key trends in service provision
Readings:
Provider payment systems:
• Health care cost-containment policies in high-income countries: How successful are
monetary incentives? World Health Organization 2002, Department "Health System
Financing, Expenditure and Resource Allocation" (FER), Cluster "Evidence and
Information for Policy" (EIP), Working Paper 2
• Basinga, P, Gertler, P, Binagwaho, A. Soucat, A., Sturdy, J, Vermeersch, C. Effect on
maternal and child health services in Rwanda of payment to primary health-care
providers for performance: an impact evaluation, The Lancet, 2011; 377: 1421–1428.
• Ashraf, N. Bandiera, O. and Jack, K. No margin, no mission? A field experiment on
incentives for public services delivery. Journal of Public Economics, 2014; 120: 1-17
• Miller, G. et al (2012) Effectiveness of provider incentives for anaemia reduction in
rural China: a cluster randomised trial. British Medical Journal 345 pp. 1–10
Equity:
Morris, Stephen, Davlin, Nancy and Parkin, David (2007) Economic Analysis in
Health care, 2nd edition: Chapter 7, particularly section 7.2
Service provision:
• Atun R. What are the advantages and disadvantages of restructuring a health care
system to be more focussed on primary care services? World Health Organisation
Health Evidence Network,. World Health Organisation, Copenhagen, 2004
Lecture 6
• Designing and changing health systems
• Guest speaker, Pam Garside
Reading:
• Commonwealth Fund website re. international comparisons
Lecture 7
Revision and preparation for the assessment (coursework and exam)
Lecture 8
• Restructuring health systems in practice
• Interactive class with guest speaker, Tim Thomas
Lecture 9
• Film: SICKO
• Group discussion
• Coursework
Reading:
• Gruber, J. The impacts of the Affordable Care Act: how reasonable are the
projections? National Tax Journal, 2011; 64 (3), 893-908
• Kaiser Family Foundation website - provides excellent resources about the
Affordable Care Act
Lecture 10 - extended office hours
Coursework support session
