CHAPTER 1:
WHY DO HEALTH SYSTEMS MATTER?
The changing landscape
What is a health system?
What do health systems do?
Why health systems matter
How modern health systems evolved
Three generations of health system reform
Focusing on performance
CHAPTER 2:
HOW WELL DO HEALTH SYSTEMS PERFORM?
Attainment and performance
Goals and functions
Goodness and fairness:both level and distribution matter
Measuring goal achievement
Overall attainment:goodness and fairness combined
Performance:getting results from resources
Improving performance:four key functions
CHAPTER 3:
HEALTH SERVICES: WELL CHOSEN, WELL ORGANIZED?
Organizational failings
People at the centre of health services
Choosing interventions:getting the most health from resources
Choosing interventions:what else matters?
Choosing interventions:what must be known?
Enforcing priorities by rationing care
After choosing priorities:service organization and provider incentives
Organizational forms
Service delivery configurations
Aligning incentives
Integration of provision
CHAPTER 4:
WHAT RESOURCES ARE NEEDED?
Balancing the mix of resources
Human resources are vital
Adjusting to advances in knowledge and technology
Public and private production of resources
The legacy of past investments
Health care resource profiles
Changing investment patterns
The way forward
CHAPTER 5:
WHO PAYS FOR HEALTH SYSTEMS?
How financing works
Prepayment and collection
Spreading risk and subsidizing the poor:pooling of resources
Strategic purchasing
Organizational forms
Incentives
How financing affects equity and efficiency
CHAPTER 6:
HOW IS THE PUBLIC INTEREST PROTECTED?
Governments as stewards of health resources
What is wrong with stewardship today?
Health policy – vision for the future
Setting the rules,ensuring compliance
Exercising intelligence,sharing knowledge
Strategies,roles and resources:who should do what?
What are the challenges?
How to improve performance
STATISTICAL ANNEX
Explanatory notes
Annex Table 1 Health system attainment and performance in all Member States,
ranked by eight measures,estimates for 1997
Annex Table 2 Basic indicators for all Member States
Annex Table 3 Deaths by cause,sex and mortality stratum in WHO Regions,
estimates for 1999
Annex Table 4 Burden of disease in disability-adjusted life years (DALYs)
by cause,sex and mortality stratum in WHO Regions, estimates for 1999
Annex Table 5 Health attainment,level and distribution in all Member States,
estimates for 1997 and 1999
Annex Table 6 Responsiveness of health systems,level and distribution in
all Member States,WHO indexes,estimates for 1999
Annex Table 7 Fairness of financial contribution to health systems in all
Member States,WHO index,estimates for 1997
Annex Table 8 Selected national health accounts indicators for all Member
States, estimates for 1997
Annex Table 9 Overall health system attainment in all Member States,
WHO index,estimates for 1997
Annex Table 10 Health system performance in all Member States,
WHO indexes, estimates for 1997
LIST OF MEMBER STATES BY WHO REGION
AND MORTALITY STRATUM
ACKNOWLEDGEMENTS
TABLES
Table 3.1 Interventions with a large potential impact on health outcomes
Table 3.2 Examples of organizational incentives for ambulatory care
Table 5.1 Estimated out-of-pocket share in health spending by income level,1997
Table 5.2 Approaches to spreading risk and subsidizing the poor:country cases
Table 5.3 Provider payment mechanisms and provider behaviour
Table 5.4 Exposure of different organizational forms to internal incentives
Table 5.5 Exposure of different organizational forms to external incentives
FIGURES
Figure 1.1 Coverage of population and of interventions under different notions of
primary health care
Figure 2.1 Relations between functions and objectives of a health system
Figure 2.2 Life expectancy and disability-adjusted life expectancy for males
and females,by WHO Region and stratum defined by child
mortality and adult mortality,1999
Figure 2.3 Inequality in life expectancy at birth,by sex,in six countries
Figure 2.4 Relative scores of health system responsiveness elements,
in 13 countries,1999
Figure 2.5 Household contributions to financing health,as percentage of
capacity to pay,in eight countries
Figure 2.6 Performance on level of health (disability-adjusted life expectancy)
relative to health expenditure per capita,191 Member States,1999
Figure 2.7 Overall health system performance (all attainments)relative to
health expenditure per capita,191 Member States,1997
Figure 3.1 The multiple roles of people in health systems
Figure 3.2 Questions to ask in deciding what interventions to finance and provide
Figure 3.3 Different ways of rationing health interventions according to cost and
frequency of need
Figure 3.4 Different internal incentives in three organizational structures
Figure 4.1 Health system inputs:from financial resources to health interventions
Figure 4.2 Health systems input mix:comparison of four high income countries,
around 1997
Figure 4.3 Health systems input mix:comparison of four middle income countries,
around 1997
Figure 5.1 Pooling to redistribute risk,and cross-subsidy for greater equity
Figure 5.2 Structure of health system financing and provision in four countries
BOXES
Box 1.1 Poverty,ill-health and cost-effectiveness
Box 1.2 Health knowledge,not income,explains historical change
in urban –rural health differences
Box 2.1 Summary measures of population health
Box 2.2 How important are the different elements of responsiveness?
Box 2.3 What does fair contribution measure and not measure?
Box 2.4 Weighting the achievements that go into overall attainment
Box 2.5 Estimating the best to be expected and the least to be demanded
Box 4.1 Substitution among human resources
Box 4.2 Human resources problems in service delivery
Box 4.3 A widening gap in technology use?
Box 4.4 The Global Alliance for Vaccines and Immunization (GAVI)
Box 4.5 Investment in hospitals in countries of the former Soviet Union
prior to policy reform
Box 5.1 The importance of donor contributions in revenue collection
and purchasing in developing countries
Box 5.2 The Chilean health insurance market:when stewardship fails
to compensate for pooling competition problems and for
imbalances between internal and external incentives
Box 6.1 Trends in national health policy:from plans to frameworks
Box 6.2 Ghana 's medium-term health policy framework
Box 6.3 SWAPs:are they good for stewardship?
Box 6.4 Stewardship:the Hisba system in Islamic countries
Box 6.5 South Africa:regulating the private insurance market to
increase risk pooling
Box 6.6 Opening up the health insurance system in the Netherlands
Box 6.7 Responsiveness to patients ' rights
Box 6.8 Towards good stewardship – the case of pharmaceuticals
Box 6.9 Thailand:the role of the media in health system stewardship
