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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

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models and systems of health services organization

Models and Systems of Health Services Organization

PA 574: Health Systems Organization

Session 1 – April 3, 2013

what is a system
What is a System?
  • Definition
  • Properties
  • Components
what is a system1
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?Do we have one in the U.S.?What are its properties?What are its components?
what is a health system
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
Functional Components

Shi & Singh, Figure 1-1, p. 6

  • Financing
    • To obtain health services
  • Insurance
    • Protection against risks
  • Delivery
    • Providers of services
  • Payment
    • Reimbursement
key elements in a complex system
Key Elements in a Complex System

Shi & Singh, Table 1-1, p. 3

  • Education & Research
  • Suppliers
  • Insurers
  • Providers
  • Payers
  • Government
tensions in the health system
Tensions in the Health System

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

external forces affecting health services
External Forces Affecting Health Services

Shi & Singh, Figure 1-2, p. 10

  • Social values and cultures
  • Population characteristics
  • Political climate
  • Economic conditions
  • Physical environment
  • Technology development
  • Global influences
differentiating characteristics of the u s system
Differentiating Characteristics of the U.S. System

No central governance

Access based on insurance

Imperfect market conditions

Third-party insurers act as intermediaries

Multiple payers make system cumbersome

Balance of power prevents dominant single entity

Legal risks affect practice

New technology creates demand

Continuum of new service settings

Quality and value