PA 574: Health Systems Organization Session 1 – April 3, 2013

 Definition  Properties  Components

 Network of inter-related components  Coherence and integration among parts  Standardized  Coordinated  Common support structures

 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

 Financing  To obtain health services  Insurance  Protection against risks  Delivery  Providers of services  Payment  Reimbursement Shi & Singh, Figure 1-1, p. 6

 Education & Research  Suppliers  Insurers  Providers  Payers  Government Shi & Singh, Table 1-1, p. 3

Illness Wellness Specialized care Primary care Inpatient Ambulatory Technological Humanistic Cost unaware Cost accountable Institution based Community-based Individual patient Population focus Professional Managerial Curative care Preventive care Individual provider Provider teams Independent orgs. Integrated systems Service duplication Service continuum Current regulation Re-regulation Market commodity Public good

 Social values and cultures  Population characteristics  Political climate  Economic conditions  Physical environment  Technology development  Global influences Shi & Singh, Figure 1-2, p. 10

1. No central governance 2. Access based on insurance 3. Imperfect market conditions 4. Third-party insurers act as intermediaries 5. Multiple payers make system cumbersome 6. Balance of power prevents dominant single entity 7. Legal risks affect practice 8. New technology creates demand 9. Continuum of new service settings 10. Quality and value