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

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
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