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