Chapter 12: Understanding and organizing health care systems
What is a health care system?
-Within the health sector, the element that most affect health are public health
activities such as water supply and sanitation, food inspection, vector insect
control, disease surveillance, reduction of industrial pollution, and regulation of
pharmaceuticals. But many don’t take these into account.
-The organization of the health care system in each country is a reflection of its
political trajectory and societal ideas/values. It is also influenced by the
international political and economic order.
-Roemer says: A health care system is the “a combination of resources,
organization, financing, and management that culminate in the delivery of
health services to the pop”.
oHealth care systems tend to focus on medicalized care, at the expense of
community-based, integrative services. Closely related to this is the fact
that HC systems tend to privilege biomedical and behavioural models over
the other ones.
-W/in every country, there is an entity, usually a ministry of health. They may be
the dominant provider of medical care, or its main function may be to supervise
and regulate the work of other organization.
-Health policy is usually focused on curative, medicalized care and
underemphasizes community, preventive, and integrated services.
-A bona fide health policy would focus on a range of societal determinants of
health, many of which are outside of the direct influence of ministries of health
-**An important characteristic of health care systems according to Donald Light
is their relation to a society’s cultural and political values:
o1) mutual aid values; underlying aim of health system is to help fellow
members of society and their families when they are ill
o2) societal/state values; main goal of health system is to strengthen the
nation through a vigorous, healthy population
o3) professional values; purpose of the health system is to provide the best
possible care to every sick patient
o4) Corporatist values: the role of the health care system is to join buyers
and sellers, providers and patients, who then decide on the range and cost
of services to be provided.
-Health care systems are further shaped by the extent to which health is viewed as
a public good & human right as opposed to a commodity or privilege
Table 12-1:Public vs Private Financing & delivery
-no health systems that are privately financed & publicly delivered
-Korea, Canada, New Zealand, Thailand largely publicly financed, mix of
private/ public delivery