UNIT 1

HEALTH SYSTEM
(6 Hours)

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TOPIC 2: GOALS AND FUNCTIONS OF HEALTH SYSTEM

Learning Objectives
At the end of this topic, the students will be able to:
 identify the goals in the health system
 know the functions of health system
 assess the goals and functions of the health system

Presentation of contents

A. HEALTH SYSTEM GOALS

Figure 2.1. The schematic diagram of health system goals and functions.

 The World Health Organization (WHO) institutionalize the three main

goals for health system: 1. Health, 2. Responsiveness and 3. Fairness
in financing. It is considered as the intrinsic goal that every country
should be routinely monitored as basis for the assessment of health
system performance facilitated by WHO. Therefore, the work on
operationalizing the measurement of goal attainment is focused on
measuring these three goals as well as relating goal attainment to
resource use in order to evaluate performance and efficiency.

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  There are also cross-system goals for the health system: how much
does the health system help or hinder education, democratic
participation, economic production etc. These cross-system goals are
potentially very important and should be the subject of ad hoc analysis
and evaluation. One of the more important cross-system goals that
should be emphasized is the contribution of the health system to
economic production. Health and health systems may increase or
decrease economic production.

1. Health.
The defining goal for the health system is to improve the health of the
population. Health of the population should reflect the health of individuals
throughout the life course and include both premature mortality and non-fatal
health outcomes as key components.

2. Responsiveness. The second intrinsic goal is to enhance the

responsiveness of the health system to the legitimate expectations of the
population. Responsiveness expressly excludes the health improvement
expectations of the public, as these are fully reflected in the first goal above.
The term ‘‘legitimate’’ is used to make it clear that although some may have
frivolous expectations for the health system these should play no part in
articulating responsiveness.

Two major components

1. The first can be called ‘‘respect for persons’’, and it captures
aspects of the interaction of individuals with the health system
that often have an important ethical dimension.
a. Respect for dignity. Health systems might be able to achieve
higher levels of health by incarcerating individuals with a
communicable disease or sterilizing individuals with a genetic
disorder, but this would be a violation of basic human rights.
Respect for dignity also includes interactions with providers,
such as courtesy and sensitivity to potentially embarrassing
moments of clinical interrogation or physical exploration.

b. Respect for individual autonomy. The individual should be

able to act autonomously when making choices about his/her
own health. Individuals, when competent, or their agents, should
have the right to choose what interventions they do and do not
receive.

c. Respect confidentiality. When interacting with the health

system, individuals should have the right to preserve the
confidentiality of their personal health information. Respect for
confidentiality serves an instrumental goal of improving the
quality of health care; when individuals have confidence that the

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 confidentiality of their personal health information will be
respected, they are more likely to give important medical history
information to health care providers. In addition, respect for
confidentiality is intrinsically valuable because it upholds a core
notion of privacy and individual control over personal
information.

2. The second can be called “Client orientation” and it includes

several dimensions of consumer satisfaction that are not a
function of health improvement.

Prompt attention to health needs. Surveys of population

satisfaction with health services routinely demonstrate that
prompt attention is a key dimension. Individuals value prompt
attention because it may lead to better health outcomes; this
instrumental value is captured in the defining goal of health.
Individuals may also value prompt attention because it can allay
fears and concerns that come with waiting for diagnosis or
treatment. Both the intrinsic and instrumental value of prompt
attention are critically affected by factors such as physical, social
and financial access.

Basic amenities. The basic amenities of health services, such as

clean waiting rooms or adequate beds and food in hospitals, are
aspects of care that are often highly valued by the population.

Access to social support networks for individuals receiving

care. Even when care is promptly available, if it is provided far
from the individual’s family and community, access to social
support networks during care and recovery may be hampered.
An expectation of access to social support is not only an
instrumental goal, because it may enhance health outcomes, but
it is also an intrinsically valued attribute.

Choice of institution and individual providing care. Patients

may want to select who provides them with health care. This
concern is most often for the individual provider and only
secondarily for the institution providing care. Choice is a
legitimate component of responsiveness and takes on an
increasing importance as other items in this list have been
satisfied.

As with health, we are concerned not only with the average level
of responsiveness, but also with inequalities in its distribution. A
concern for the distribution of responsiveness across individuals
means that we are implicitly interested in differences related to
social, economic, demographic and other factors

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 3. Fair financing. To be fair, financing of the health system should
address two key challenges.

First, households should not become impoverished, or pay an

excessive share of their income in obtaining needed health care. In
other words, fairness in financial contribution requires an important
degree of financial risk pooling.

Second, poor households should pay less towards the health

system than rich households. Not only do poor households have
lower incomes but a larger share of their income goes to basic
needs such as food or shelter. Contribution to the health system
should reflect this difference in disposable income between rich and
poor. These considerations translate into the normative proposition
that every household should pay a fair share towards the costs of
the health system. (In the case of very poor households, ‘‘fair
share’’ might mean no payment at all.) Payment should be based
on income and for the most part should not reflect use of services
or risk. Acceptable notions of a fair share for the poor depend on
the role assigned to the health system in general income
redistribution.

- In some political settings, it may be easier to redistribute income

by providing free health services to the poor than through direct
redistributive mechanisms. From the perspective of the health
system, however, it should perhaps be assumed that society is
redistributing general income through other mechanisms, such as
direct transfers, when evaluating fairness in financial contribution.
The broad social acceptance

According to Valletta and Gruber, some methods of organizing

health financing, such as some forms of employment-based
insurance, may hinder labour mobility and macro-economic
performance. At the same time, there is increasing evidence that
improvements in health can enhance economic growth.

B. HEALTH SYSTEM FUNCTIONS:

Figure 1.3. The World Health Organization designed four (4) vital health
functions as illustrated below:

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 Health Health
Health
Service Service Stewardship
Financing
Provision Inputs

1. Health service provision is the most visible product of health system

both in private and public. It is any service, not limited to clinical services,
aimed at improving the health of populations. Preventive measures as
well as promotion of a healthy way of living in order to avoid illnesses in
the community.

2. Health service inputs means generating the essential physical resources

for the delivery of health services which include medications, human
resources and medical equipment. Resources such as trained doctors
and medical staff and supply of medications often take time to be
produced; hence, the health system policymakers have to respond and
use the available resources to address short-term population needs.
“Delivering health services is thus an essential part of what the system
does--but it is not what the system is”

3. Stewardship, or the overall system eyesight, is the main responsibility of

the government. This function sets the direction, context, and policy
framework for the overall health systems.
 Core of the Stewardship Function:
 Identify health priorities for allocation of public resources
 Identify the institutional framework
 Coordinating activities with other systems related to external
health care
 Analyzing health priorities and resource generation trends and
their implications
 Identify information needed to ensure effective decision-making
on health matters
 Generating appropriate data for effective decision-making and
policy making on health matters

4. Health financing includes collecting revenues, pooling financial risk, and

allocating revenue.

a. Revenue collection.
Revenue collection is earned from payments for health care services.
The mechanism for revenue include general taxation, direct household
out-of-pocket expenditures, mandatory payroll contributions, mandatory or
voluntary risk-rated contributions, donor financing, and other forms of
personal things.

Each source of health financing is associated with a specific manner of

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 organizing and pooling of funds and purchasing services. Public health
systems rely on general taxation for its financing, while social security
organizations are funded through the mandatory payroll contributions from
workers and employees.

b. Risk pooling.
collection and management of financial resources in a way that spreads
financial risks from an individual to all pool members

Bismark Model (Bismark’s Law on Health Insurance of 1883). This model

uses an insurance system where the sickness fund finances both the
employees and employers through payroll deductions.

Beveridge Model (Beveridge Report or the Social Insurance and Allied

Services). Health care is provided and funded by the government. The
government owns many, but not all, hospitals and clinics in the country.
Doctors may be government or private employees who collect their
professional fees from the government.

c. Strategic purchasing.

Use collected and pooled financial resources to finance or buy health care
services for their members. The purchaser defines the substantial part of
the health provider’s external incentives to develop the provider-user
intersection and the health service delivery modes.

Application

Activity 2A. Compute the health personnel ratio (doctors, dentists, nurse
etc..) versus the total population.
Total number of vs Total number of personnel with
personnel with regular contractual and casual status
item
Tot. no. of Doctors vs Total Population
Tot. no. of Dentists vs Total Population
Tot. no. of Nurses vs Total Population
Tot. no. of Midwives vs Total Population
Tot. no. of Public Health vs Total Population
Workers

Make your own assessment on our health system. Are we on the right track
in achieving the health system goals? Share your insight.

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REFERENCES

1. Health Information System by: Ebuen, Bernard U., et., al.

2. https://www.encyclopedia.com/science/encyclopedias-almanacs-
transcripts-and-maps/healthcare-systems
3. https://www.allianzcare.com/en/support/health-and-wellness/
national-healthcare-systems/healthcare-in-philippines.html
4. .Health Systems in Transition Vol. 8 No. 2 2018).
5. World Health Organization (WHO)
6. Department of Health (DOH)
7. https://www.cdc.gov/publichealthgateway/publichealthservices/
essentialhealthservices.html
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651704/
#:~:text=8%E2%80%9310%5D.-,Acknowledging%20the%20health
%20system%20strengthening%20agenda%2C%20the%20World
%20Health%20Organization,vaccines%20and%20technologies
%2C%20financing%2C%20and
9. Ebuen, B. U. et. al. (2019). HEALTH INFORMATION SYSTEM for
MEDICAL LABORATORY SCIENCE. C & E Publishing, Inc.
Quezon City.
10. Buchmueller T, Valletta R. The effect of health insurance on
married female labour supply. Federal Reserve Bank of San
Francisco, 1996 (paper 96–09).
11. Gruber J, Madrian B. Health insurance and the labour market.
Cambridge MA, National Bureau of Economic Research, 1998
(NBER WP N.6762).
12. Ebuen, B. U. et. al. (2019). HEALTH INFORMATION SYSTEM, C
& E Publishing, Inc. Quezon City.
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651704/
#:~:text=8%E2%80%9310%5D.-,Acknowledging%20the%20health
%20system%20strengthening%20agenda%2C%20the%20World
%20Health%20Organization,vaccines%20and%20technologies
%2C%20financing%2C%20and
14. Ebuen, B. U. et. al. (2019). HEALTH INFORMATION SYSTEM for
MEDICAL LABORATORY SCIENCE. C & E Publishing, Inc.
Quezon City.

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