1. 보건의료체계 Health System 김창엽 ( 서울대학교 보건대학원 ) cykim@snu.ac.kr

2. 순서 정의 (Definition) 보건의료체계의 중요성 (Significance and Implication) 구성요소 (Components) 평가 (Evaluation) 유형 (Typology)

3. 체계 (system)? Educational system, administration system, transportation system, subway system, nervous system… Institution, policy, administration, management, governance… Government, public, state…

6. Characteristics of System Organization Interaction Interdependence Integration Central objective

7. Terms and Concepts 건강 (health) 보건 보건의료 의료 의학 Health Health care (healthcare) Medicine Medical care Public health

8. Similarities and Differences Health system Healthcare system Public health system Public health (healthcare) sector

9. Why Health System? - Examples Determinants of individual health and health care utilization Providers’ behaviors: NHS vs. private Health expenses Quality of health care Equity

16. What Is a Health System All the activities whose primary purpose is to promote, restore or maintain health - WHR 2000 -

17. SOCIAL GOALS AND SYSTEMS SOCIAL SYSTEMS SOCIAL GOALS EducationHealth Economic PoliticalCultural Other Education Health Consumption Democratic participation Knowledge Other Responsiveness Fair financing

18. Goals of a Health System Good health Responsiveness to the expectations of the population Fairness of financial contribution

19. HEALTH SYSTEM GOALS Health Responsiveness Fairness in Financial Contribution LEVELDISTRIBUTION QualityEquity * * * * * Efficiency

20. Responsiveness: Conceptual Framework Focus on measuring what happens when health system and person interact Also interested in person’s perception of what happens Differs from patient satisfaction –Reduces role of expectations –Addresses legitimate levels of expectation

21. Components of Responsiveness Respect for persons  Dignity  Confidentiality  Autonomy Communication Client Orientation  Prompt attention  Access to social support networks  Quality of basic amenities  Choice of provider

22. Functions of a Health System Service provision Resource generation Financing Stewardship

23. Structure and Functional Relationship of a National Health System

24. Major Components of a National Health System Infrastructure

25. Relationship between Functions and Objectives of a Health System (WHO, 2000)

26. (WHO, 2007)

27. Health Resources Development Manpower Facilities Equipment and supplies Knowledge

28. Organized Arrangement of Resources National Health Authorities Health Insurance Program Other governmental agencies Private sector

29. Delivery of Health Care Primary, secondary, tertiary Health promotion, prevention, treatment, rehabilitation, social care

30. Economic Support Public sources Employer Organized voluntary agencies Local community effort Foreign aid Private household

31. Management Leadership Decision-making  Planning  Implementation and realization  Monitoring and evaluation  Information support Regulation

32. Limitations of Current Approaches Too technical Closed vs. open systems Whose perspectives? Where is people?

33. Attainment and Performance (Efficiency)  Attainment = achievement of goals single and composite attainment e.g. Human development index  Performance (Efficiency) attainment related to resources available and other non-health system inputs to the production of health system outcomes

34. B M A a b Health system goal inputs attainment = b efficiency = b/(b+c) c L

35. Typology of National Health Systems (1) Health systems Kleczkowski et al. 1984

36. Typology of National Health Systems (2) Financing

37. Typology of National Health Systems (3) Socio-political systems Health as a societal value Collectivism as opposed to individualism Distributional responsibility

38. Typology of National Health Systems (4) Welfare systems (Esping-Andersen) Liberal Corporatist Social democratic

39. Typology of National Health Systems (5) Health systems Market oriented/Liberal Corporatism/Social insurance Universalism