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Models and Systems of Health Services
Organization
PA 574: Health Systems Organization
Session 1 – April 3, 2013
What is a System?
Definition Properties Components
What is a System?
Network of inter-related components Coherence and integration among
parts Standardized Coordinated Common support structures
What is a Health System?
Do we have one in the U.S.?
What are its properties?
What are its components?
What is a Health System? Includes all the activities whose
primary purpose is to promote, restore or maintain health
Formal health services, traditional services, public health, alternatives
Health systems: Improve health of populations Respond to people’s expectations Provide financial protection against costs of
ill health
Functional Components
Financing To obtain health services
Insurance Protection against risks
Delivery Providers of services
Payment Reimbursement
Shi & Singh, Figure 1-1, p. 6
Key Elements in a Complex System
Education & Research Suppliers Insurers Providers Payers Government
Shi & Singh, Table 1-1, p. 3
Tensions in the Health System
Illness <------------------> WellnessSpecialized care <------------------> Primary careInpatient <------------------> AmbulatoryTechnological <------------------> HumanisticCost unaware <------------------> Cost accountableInstitution based <------------------> Community-basedIndividual patient <------------------> Population focusProfessional <------------------> ManagerialCurative care <------------------> Preventive careIndividual provider <------------------> Provider teamsIndependent orgs. <------------------> Integrated systemsService duplication <------------------> Service continuumCurrent regulation <------------------> Re-regulationMarket commodity <------------------> Public good
External Forces Affecting Health Services
Social values and cultures Population characteristics Political climate Economic conditions Physical environment Technology development Global influences
Shi & Singh, Figure 1-2, p. 10
Differentiating Characteristics of the U.S. System
1. No central governance2. Access based on insurance3. Imperfect market conditions 4. Third-party insurers act as intermediaries5. Multiple payers make system cumbersome6. Balance of power prevents dominant single
entity 7. Legal risks affect practice8. New technology creates demand9. Continuum of new service settings10. Quality and value
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