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

OHE Consulting Report for PhRMA
5 January 2011
typology developed was based on the following criteria: first, what group of people does the
national healthcare system protect, i.e., is it all citizens, the vulnerable or some pre-­‐specified group
of insured individuals? The second is: which sector is the main provider of healthcare, i.e., is it public
or private? The third is: is there state intervention in the financing of healthcare, and if there is, is it
concentrated or dispersed?
Using two main dimensions: (1) financing administration, and (2) provision of healthcare, Lee, et al.
(2008), describe a health system as NHS if financing administration is single or concentrated and if
provision of healthcare is ‘public’. A health system is characterised as NHI if financing administration
is single/concentrated and if there is private provision of healthcare. A health system is
characterised as SHI if financing administration is multiple/dispersed and provision of healthcare is
‘public’. Finally, a health system is characterised as a ‘Liberal model’ if financing administration is
private and there is private provision of healthcare. Lee, et al (2008) use their typology to classify the
healthcare system in Taiwan and South Korea by adding in a fourth criterion of ratio of public to
total healthcare expenditure and the ratio of public hospital beds to total hospital beds.
5.6 Weberian taxonomy of health systems
One other classification system we identified is that by Wendt, et al. (2009). In brief, their approach
is based on what is called the Weberian method of ‘ideal types’, which is a tool used for comparative
research of welfare regimens. The ideal-­‐type ‘is formed by one-­‐sided accentuation of one or more
points of view and by the synthesis of a great many diffuse, discrete, more or less present and
occasionally absent concrete individual phenomena…’ This welfare regimen analyses is meant to
identify the ‘ideal-­‐typical’ case that is, roughly speaking the type of health system that is commonly
observed.
On the basis of this framework, Wendt, et al. (2009) identified 27 types of healthcare systems; there
are three instances of ‘ideal types’ in which there is uniformity in all dimensions (1. finance, 2.
service provision and 3. regulation/governance). These are pure state healthcare systems, societal
healthcare systems and private healthcare systems. For each ideal-­‐type, there are six combinations
of mixed types in which identical features can be seen in two of the three dimensions. In six other
combinations of mixed types, there is no uniformity in any of the dimensions; these are referred to
as pure mixed-­‐types. Their classification is rather complex and over-­‐elaborate and not helpful for our
work.
5.7 WHO’s ‘single’ framework
To the best of our knowledge, the most recent healthcare classification system is what WHO (2007)
calls a ‘single framework with six building blocks’ to promote understanding of what a health system
is and what constitutes health system strengthening. These building blocks highlight the basic
functions of health systems (regardless of how they are organized). The six building blocks shown in
Figure 4, which have some similarity to the features of Figure 2, are:
Service delivery. This captures issues relating to the delivery of effective, safe and quality
personal and non-­‐personal health interventions (with the minimum waste of resources)
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