Health System

Lore & Background

There is a wide variety of health systems around the world, with as many histories and organizational structures as there are countries. Implicitly, countries must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures. In certain countries, the orchestration of health system planning is decentralized, with various stakeholders in the market assuming responsibilities.

In contrast, in other regions, a collaborative endeavor exists among governmental entities, labor unions, philanthropic organizations, religious institutions, or other organized bodies, aimed at the meticulous provision of healthcare services tailored to the specific needs of their respective populations. Nevertheless, it is noteworthy that the process of healthcare planning is frequently characterized as an evolutionary progression rather than a revolutionary transformation.

As with other social institutional structures, health systems are likely to reflect the history, culture and economics of the states in which they evolve. These peculiarities bedevil and complicate international comparisons and preclude any universal standard of performance.

Reader's Guide

According to the World Health Organization (WHO), the directing and coordinating authority for health within the United Nations system, healthcare systems' goals are good health for the citizens, responsiveness to the expectations of the population, and fair means of funding operations. Progress towards them depends on how systems carry out four vital functions: provision of health care services, resource generation, financing, and stewardship. Other dimensions for the evaluation of health systems include quality, efficiency, acceptability, and equity.

They have also been described in the United States as 'the five C's': Cost, Coverage, Consistency, Complexity, and Chronic Illness. Also, continuity of health care is a major goal. The World Health Organization defines health systems as follows: Some authors have developed arguments to expand the concept of health systems, indicating additional dimensions that should be considered: Health systems should not be expressed in terms of their components only, but also of their interrelationships.

Health systems should include not only the institutional or supply side of the health system but also the population. Health systems must be seen in terms of their goals, which include not only health improvement, but also equity, responsiveness to legitimate expectations, respect of dignity, and fair financing, among others. Health systems must also be defined in terms of their functions, including the direct provision of services, whether they are medical or public health services, but also 'other enabling functions, such as stewardship, financing, and resource generation, including what is probably the most complex of all challenges, the health workforce.'

There are many ways to understand health systems. All of them are key to help understand their functions and elements, as well as the relationships between them. These frameworks, besides, can serve as guides to analyze and study specific health systems and their performance, in all their complexity. In 2000, the World Health Organization proposed a clear health system framework in the annual World Health Report.

It featured 4 functions (stewardship, creating resources, financing, and delivering services), together with three objectives (responsiveness, fair financial contribution, and health).

Did You Know?

• The six building blocks of a health system are service delivery, health workforce, health information system, medicines/supplies/vaccines, health financing, and governance/leadership.
• There are generally five primary methods of funding health systems: general taxation, national health insurance, voluntary or private health insurance, out-of-pocket payments, and donations to charities.