In the early part of the lecture, we analyzed what we meant by comparative analysis. In this part of the lecture, I want to focus on in particular what we mean when we refer to health systems. This is crucial because health systems are internally complex. Any system even a microsystem is an extremely complex set of relationships between people, managers, providers, and patients. The level of complexity on the macro system scale is immense. It is possible to engage in an unending catalog of all of those relationships in the ways that are neither helpful nor particularly useful. This is particularly relevant and pertinent when engaging comparative analysis. However, a systems analysis does provide us with a point of focus for engaging in comparative analysis. A system can be described as a set of elements or parts and is coherently organized and interconnected in a pattern or structure that produce characteristics that have behaviors often classified as its function or purpose. Now, this definition may appear to be very basic. It simply refers to a set of interactions between its parts. But it is very useful because it defines the relationship between the parts and their functional purpose. And so when we comparing health systems, we're going to be comparing how those health systems achieved their purposes or goals. One of the questions that we can ask ourselves is what is the health care system and what is its functional purpose? A healthcare system consists of all organizations, people, and actions whose primary intent is to promote or restore health. Again, this definition appears to be circular because the health system is defined with reference to health. But when we think more clearly about what we mean by promoting health, it reveals some important goals. The goals of a healthcare system as defined by the World Health Organization. Be this can be described as improving health and health equity in ways that are responsive, financially fair, and make the best or most efficient use of available resources. Every element of this statement of goals or purposes is relevant to our analysis because within this statement are a composite set of goals. And we can imagine the capacity of a healthcare system to achieve this multiple set of goals. What are the composite set of goals? The first is the most open-ended, improving health. Improving health, in this context, includes improving the health of individuals. That's the way in which we normally think about health care because it's improving our individual health. But it's also about improving the health of populations. So we're going to be analyzing healthcare systems with their reference to the capacity to improve individual health, but also the health of populations. In subsequent parts of the lecture, we'll analyze how we understand population health and how we measure it. The goal of improving population health includes the goal of improving health equity. This involves assessing the capacity of health systems to ensure that all parts of the population can have access to healthcare. This means addressing the question of whether health systems provide access to health in ways that are responsive to disadvantages that arise out of socioeconomic status, race, gender, or class. This is important and useful because we'll know later in the lecture. We will analyze healthcare system by reference to their inputs. That is what are the inputs needed in a healthcare system to produce a given set of outcomes. When were analyzing interactions between health inputs in health systems, one of the outcomes that we'll focus on is whether the system is responsive to the populations of people that it serves. That is whether the outcomes produced by each health care systems are equitable ones. This involves assessing whether health systems are responsive to the needs of populations in particular places or with reference to particular conditions or diseases. The capacity for a healthcare system to be responsive to the needs of population is going to be directly relevant as to whether or not achieves the outcome of improving the health of a population. Financially fair, here, we shift dimensions altogether because we're not just concerned about improving health and health equity or about whether or not the healthcare system is responsive. We're talking about financially fair and here we are concerned with reducing the amount of the out-of-pocket payments for any individual to obtain healthcare services. This is significant because for most of the population, a system based upon out-of-pocket payments will ensure that the bulk of the population will not have adequate or equitable access to health care. As we will see later when we analyze the health system in China. Access to health care is concerned with ensuring the population has access to quality healthcare services as and when they are needed. Access to healthcare is also facilitated by ensuring that reductions in the level of out-of-pocket payments. It's also important that the health care system make best use of its resources. Here, we will refer to the quality of care. We're referring to whether or not the population receives recommended care that is whether the particular populations receive care that is effective. This involves assessing whether particular populations of people receive unnecessary care, which may increase the risk of harm, wut which also certainly increase the cost of healthcare. Finally, it involves assessing whether care is safe that is where the care is itself a course of harm. This is sometimes referred to as iatrogenic harm. And even in high income countries, healthcare is productive of significant amounts of iatrogenic harm. Efficiency, it's important that a healthcare system be efficient. The cost of health care provided by that system will affect its capacity to provide access to health care for the population as a whole. Health systems that provide access to a broad range of services for the entire population consume large amounts of resources. There is a constant tension between providing access to care for the whole population and the range of services that are made available to the population as a whole. In health systems which provide universal health coverage, there is a constant tension between strategies to provide access to care for the population as a whole. Strategy is to provide particular populations with particular needs and strategies that aim to ensure the health care services are both safe and effective. Indeed, in the United States the question of whether to provide universal health coverage is so troublesome because it revolves around the cost of providing high-quality health care for the population as a whole. So when we're thinking then about the purposes of goals of the healthcare system, we're thinking about a composite set of purposes of health, health equity, financial effect, fairness, quality of care, and access and cost of care.
