A health system encompasses the collective structures and efforts aimed at delivering health services to cater to the health needs of particular populations. Often termed as a health care system or healthcare system, it fundamentally revolves around the effective and efficient organization of resources, institutions, and individuals dedicated to providing health care services.
Around the world, health systems exhibit a wide array of structures and histories, as varied and unique as the nations they serve. The organizational structures of these systems can be centralized or distributed, influenced by market forces or by deliberate planning. While some nations lean on market participants for health system planning, others witness the collective involvement of various entities such as governments, trade unions, charities, religious institutions, and other coordinated bodies to strategically provide health services. One key observation in the evolution of health care systems is their tendency to evolve incrementally rather than undergoing sudden, radical changes.
Goals of Health Systems
The World Health Organization provides clear goals for health care systems, which encompass:
- Ensuring good health for its citizens.
- Being responsive to the expectations of the population.
- Adopting a fair approach to funding operations.
The achievement of these goals hinges upon how effectively a health system performs four essential functions:
- Provision of health care services
- Generation of resources
Moreover, health systems are also evaluated on dimensions such as quality, efficiency, acceptability, and equity. Other evaluation criteria in the United States include the "five C's": Cost, Coverage, Consistency, Complexity, and Chronic Illness. A continuous continuity of health care is also a prime objective of a robust health system.
It's crucial to differentiate between the broader concept of a health system and the narrower perspective of a health care system. While the two terms are often used interchangeably in literature, some authors have highlighted the need to embrace a more comprehensive view of health systems. This expansive view emphasizes:
- Viewing health systems in terms of both their components and the interrelationships between them.
- Incorporating the population into health systems, not just institutional or supply side elements.
- Defining health systems based on their goals - this includes health improvement, equity, and more.
- Understanding health systems in terms of their multiple functions, which span beyond just service provision to encompass stewardship, financing, and resource generation.
World Health Organization Definition
The World Health Organization provides a holistic definition of health systems:
- "A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services."
Providers within Health Systems
Health care providers play a pivotal role in the realm of health systems. These can be institutions or individuals that deliver health care services. The spectrum of providers includes, but is not limited to, health professionals, allied health professions, government health departments, private entities, medical laboratories, and health training institutions.
Examples of health workers, integral to the system, include doctors, nurses, dietitians, paramedics, dentists, therapists, psychologists, pharmacists, chiropractors, optometrists, community health workers, and traditional medicine practitioners.
Health systems are primarily funded through several avenues:
- General taxation
- Social health insurance
- Voluntary or private health insurance
- Direct out-of-pocket payments
- Donations to charities
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- "Health care system". Liverpool-ha.org.uk. Retrieved 2011-08-06.
- New Yorker magazine article: "Getting there from here." 26 Jan 2009
- World Health Organization. (2000). World Health Report 2000 – Health systems: improving performance. Geneva, WHO http://www.who.int/whr/2000/en/index.html
- Remarks by Johns Hopkins University President William Brody: "Health Care '08: What's Promised/What's Possible?" 7 Sept 2007
- Frenk J, The Global Health System : strengthening national health systems as the next step for global progress, Plos Medicine, January 2010, Vol 7, issue 1, 3pp., available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797599/
- "Regional Overview of Social Health Insurance in South-East Asia, World Health Organization. And Overview of Health Care Financing". Retrieved August 18, 2006.
Contributors: Prab R. Tumpati, MD