The Evolution of HTA in Emerging Markets Health-Care ... - TREE

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OHE Consulting Report for PhRMA 5 January 2011 budget-‐specification exercises for providers or the development of formulae for the allocation of healthcare funding to lower levels of the system. The term ‘strategic purchasing’ has also been employed to reflect more active purchasing, including decisions made with respect to what is purchased, how it is purchased and from whom it is purchased. This applies to purchasing of medical inputs, the choice of which services to provide, the type of healthcare providers to be used to deliver these services, and how to pay these providers. Figure 2: The four functions of health systems: Murray and Frenk (2000) Provision (of personal and non-‐personal healthcare services) refers to the combination of staff and non-‐staff medical inputs in the production of personal and non-‐personal services that takes place in specified organisation/institutional settings. Personal healthcare services refers to care that will be delivered to an individual; be it preventive, diagnostic, therapeutic or rehabilitative that generate consumption externalities or not. Non-‐personal healthcare services refer to healthcare interventions that are collectively consumed (for instance mass health education programmes) or that which involve non-‐human components of the environment (for instance sanitation, housing, transportation and air pollution). Stewardship: This refers to how healthcare systems are governed. There are six sub-‐functions to stewardship: (1) overall system design (i.e., policy formulation at the macro-‐level) (2) performance assessment (3) priority setting (this includes an element of consensus building and has both technical and political attributes) (4) intersectoral advocacy (5) regulation, and (6) consumer protection. 26
OHE Consulting Report for PhRMA 5 January 2011 Resource generation: This covers skill and technology development, recognising that healthcare providers need medical inputs in terms of skilled trained labour and relevant technologies for the production of medical care. 5.4 Functions and goals of health systems Gottret and Scheiber (2006) report a framework that was put forward by WHO (see also WHO [2000, 2003]) and is consistent with Figure 2 above. That is a categorization of health systems according to the four principal functions of stewardship, resource creation, service delivery and financing and the three principal objectives, i.e., health, fair financial contributions and responsiveness to non-‐medical expectations (Figure 3). Figure 3: Functions and goals of health systems: Gottret and Scheiber (2006) According to these frameworks, the observed variation in the structure and organization of health systems depends on how the various functions and its components (especially financing, provision and stewardship functions) have been integrated or segmented, vertically or horizontally. This level of integration could be partial or complete. In this regard the framework itself is consistent with the paradigm of purchaser provider split. 5.5 A 3-‐model typology of health systems Our conclusions about significant differences in how healthcare systems are categorized was noted by Lee, et al. (2008) work in which they identified a 3-‐model typology (into National Health System [NHS], Social Health Insurance [SHI] and Private Health Insurance [PHI]) as the most common and well known. They document previous typologies dating back to work done in 1973. Lee, et al. (2008), however, develop their own framework for assessing the nature of the healthcare systems. The 27
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