Health Care Systems

The scope of health systems, as outlined by the World Health Organization (WHO), includes all actors, institutions, and resources that undertake actions where the primary intent is to improve [Page 783]health. The advantage of the WHO approach is that it recognizes that health care is only one route to developing better health. Its disadvantage is that it is not clear what should be included in a health system. For instance, are pedestrian crossings and primary education part of the health system? In practice, though, virtually all analysts, including WHO, focus on the health care system or the delivery of health services, than on all things whose primary intent is to improve health.

There are typically two ways of conceptualizing health care systems. The first way focuses on the actors who are involved in the health care system, and the second way explores the key functions that a health system performs. The actors approach concentrates on the values, interests, and interrelationships among the users of the health system, the payers for the health system, the providers of the health care, and the regulators, which is typically a government body such as the Ministry of Health or other authorized body. The advantage of such an approach is that it highlights the human and political elements of health systems.

The functions approach focuses on the essential activities that must be conducted. Drawing on several models, the following common features are evident:

• Governing the system, also called stewardship—this includes management, planning, administration, and regulation
• Resourcing the system—this consists of both the raising and the pooling of revenue and the production of resources such as trained staff, drugs, equipment, facilities, and knowledge
• Providing/delivering services—this covers both preventive and curative services, services provided at different levels (i.e., primary, secondary, and tertiary) and targeted at certain conditions or population groups, alongside public health interventions. It also includes:
  • Public and private provision (the latter including profit and not-for-profit ownership)
  • Different degrees of organization of delivery (formal vs. nonformal)
  • Alternative medical systems (allopathic vs. ayurvedic)
  • Allocating resources or purchasing services—this includes paying for services from public or private providers. This can be done through a budget and related process or through a contract and negotiations. Criteria for resource allocation are commonly employed.