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1,[object Object],Health System Elements & ConnectionsJuly 19, 2011David H PetersJohns Hopkins University,[object Object]
2,[object Object],What Is A System?,[object Object],	An interaction of parts and their interconnections that come together for a purpose,[object Object]
3,[object Object],Health System Actors, Functions and Outcomes,[object Object],People,[object Object],Financing,[object Object],Revenue Generation,[object Object],Risk Pooling,[object Object],Allocation & Purchasing,[object Object],Health Status,[object Object],Service Delivery,[object Object],Public Health Services,[object Object],Ambulatory Care,[object Object],Inpatient Care,[object Object],Protection from Health ,[object Object],Impoverishment,[object Object],Input Management,[object Object],Human Resources	   Knowledge,[object Object],Pharmaceuticals	     Technology,[object Object],Consumables          Capital       ,[object Object],Trust/Satisfaction,[object Object],Oversight,[object Object],Policy Setting		Information, Disclosure & Advocacy ,[object Object],Regulation 		Strategic Partnerships & Incentives,[object Object],The State,[object Object],Politicians,[object Object],Policy-makers,[object Object],Providers,[object Object],Public/Private,[object Object],Informal,[object Object]
4,[object Object],Who Produces Health?,[object Object]
The “Control Knobs” of Public Intervention in Health Systems,[object Object],Financing: how to raise money, pool funds, allocate and pay for health care,[object Object],Organization: who delivers services and manages health systems inputs, and how they are delivered,[object Object],Oversight: how do you regulate and use information to change behavior of key actors,[object Object],5,[object Object]
6,[object Object],Health Financing: Key Functions,[object Object],Raising revenues,[object Object],Pooling resources,[object Object],Allocating and purchasing,[object Object]
7,[object Object],Changes in Organization (who does what, how),[object Object],Service delivery point (clinics, hospitals),[object Object],Government administrative area (district),[object Object],Management unit,[object Object],Profession,[object Object],Community Organization,[object Object],Priority program/disease,[object Object]
8,[object Object],Oversight Tools in the Health Sector,[object Object],Policy-making,[object Object],Establish & enforce laws & regulations,[object Object],Public disclosure,[object Object],Professional self-regulation,[object Object],Consumer advocates,[object Object],Independent media,[object Object],Independent monitors,[object Object]
Effective Regulation in the Health Sector,[object Object],Informal and formal “rules of the game” (incentives) can greatly influence performance,[object Object],Local institutions beyond government can be effective: Consumer’s groups, professional organizations, media,[object Object],Co-production-regulation may be more effective than government enforcement of rules,[object Object],Peters & Muraleedharan (2008). Regulating India’s Health Sector: To What End? What Future? Social Sciences & Medicine		,[object Object],9,[object Object]
Summary  of Health Systems Models: Common Features (1),[object Object],10,[object Object]
Summary of Health Systems Models: Common Features,[object Object],11,[object Object]
Making Connections: Systems Thinking,[object Object],The process of understanding how things influence each other in a system,[object Object],12,[object Object]
13,[object Object],Systems Thinking:Key Concepts,[object Object],Parts of a system are interdependent,[object Object],Actions have multiple-order consequences,[object Object],Optimizing one part can lead to poor system performance,[object Object],Organizational structures drive behavior,[object Object],Mental models influence actions,[object Object]
Making Connections,[object Object],Will changes in one part of health system cause changes in other part of health system,[object Object],Other actors,[object Object],Other functions,[object Object],Outcomes,[object Object],14,[object Object]
15,[object Object],Health System Actors, Functions and Outcomes,[object Object],People,[object Object],Financing,[object Object],Revenue Generation,[object Object],Risk Pooling,[object Object],Allocation & Purchasing,[object Object],Health Status,[object Object],Service Delivery,[object Object],Public Health Services,[object Object],Ambulatory Care,[object Object],Inpatient Care,[object Object],Protection from Health ,[object Object],Impoverishment,[object Object],Input Management,[object Object],Human Resources	   Knowledge,[object Object],Pharmaceuticals	     Technology,[object Object],Consumables          Capital       ,[object Object],Trust/Satisfaction,[object Object],Oversight,[object Object],Policy Setting		Information, Disclosure & Advocacy ,[object Object],Regulation 		Strategic Partnerships & Incentives,[object Object],The State,[object Object],Politicians,[object Object],Policy-makers,[object Object],Providers,[object Object],Public/Private,[object Object],Informal,[object Object]
Making Connections: Where to look,[object Object],Follow people and organizations (actors),[object Object],Follow the money,[object Object],Follow the information,[object Object],Ask:,[object Object],How will different actors respond?,[object Object],What will happen to health services?,[object Object],What will happen to health system outcomes, for whom?,[object Object],16,[object Object]
Following people,[object Object],Identify “interests”,[object Object],Motivations, Incentives and Accountabilities,[object Object],Identify “influence”,[object Object],Power, Resources,[object Object],Consider how intervention will affect people:,[object Object],Who will benefit, who will lose,[object Object],Who will “own”,[object Object],17,[object Object]
Stakeholder Analysis Matrix (Example),[object Object],18,[object Object]
Following money and services,[object Object],Will change in financing affect health services?,[object Object],Volume of services,[object Object],Quality of services,[object Object],Who will provide,[object Object],Who will benefit from services,[object Object],19,[object Object]
Following information,[object Object],Will information affect health services?,[object Object],Quality of services,[object Object],Prices for services,[object Object],Who will provide,[object Object],Who will benefit from services,[object Object],20,[object Object]
Incorporating Complexity,[object Object],21,[object Object]
Model for Understanding Health Systems Changes as Complex Adaptive System,[object Object],22,[object Object]
23,[object Object],Summary,[object Object],Systems thinking in health systems involves:,[object Object],Understand health systems actors, functions, principles, purpose,[object Object],Make changes in financing, organization, oversight,[object Object],Look for responses in actors, health services, money, information,[object Object],Monitor effects on intended and unintended outcomes ,[object Object]

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