1. 보건의료체계 Health System 김창엽 ( 서울대학교 보건대학원 ) cykim@snu.ac.kr

2. 체계 (system)? 교육체계, 행정체계, 교통체계, …. 제도, 정책, 행정, 관리 ?? 정부, 공공, 국가 …

3. 보건의료체계의 중요성 개인의 건강과 의료이용의 결정요인 의료제공자 행동의 결정요인 사회체계의 하나 : 다른 체계와의 상호작용

10. What Is a Health System All the activities whose primary purpose is to promote, restore or maintain health - WHR 2000 -

11. SOCIAL GOALS AND SYSTEMS SOCIAL SYSTEMS SOCIAL GOALS EducationHealth Economic PoliticalCultural Other Education Health Consumption Democratic participation Knowledge Other Responsiveness Fair financing

12. Goals of a Health System Good health Responsiveness to the expectations of the population Fairness of financial contribution

13. HEALTH SYSTEM GOALS Health Responsiveness Fairness in Financial Contribution LEVELDISTRIBUTION QualityEquity * * * * * Efficiency

14. Responsiveness: Conceptual Framework Focus on measuring what happens when health system and person interact Also interested in person’s perception of what happens Differs from patient satisfaction –Reduces role of expectations –Addresses legitimate levels of expectation

15. Components of Responsiveness Respect for persons  Dignity  Confidentiality  Autonomy Communication Client Orientation  Prompt attention  Access to social support networks  Quality of basic amenities  Choice of provider

16. Functions of a Health System Service provision Resource generation Financing Stewardship

17. Structure and Functional Relationship of a National Health System

18. Major Components of a National Health System Infrastructure

19. Relationship between Functions and Objectives of a Health System (WHO, 2000)

20. (WHO, 2007)

21. Health Resources Development Manpower Facilities Equipment and supplies Knowledge

22. Organized Arrangement of Resources National Health Authorities Health Insurance Program Other governmental agencies Private sector

23. Delivery of Health Care Primary, secondary, tertiary Health promotion, prevention, treatment, rehabilitation, social care

24. Economic Support Public sources Employer Organized voluntary agencies Local community effort Foreign aid Private household

25. Management Leadership Decision-making  Planning  Implementation and realization  Monitoring and evaluation  Information support Regulation

26. Attainment and Performance (Efficiency)  Attainment = achievement of goals single and composite attainment e.g. Human development index  Performance (Efficiency) attainment related to resources available and other non-health system inputs to the production of health system outcomes

27. B M A a b Health system goal inputs attainment = b efficiency = b/(b+c) c L

28. Typology of National Health Systems(1) Health systems

29. Typology of National Health Systems(2) Financing

30. Typology of National Health Systems(3) Socio-political systems Health as a societal value Collectivism as opposed to individualism Distributional responsibility

31. Typology of National Health Systems(4) Welfare systems (Esping-Andersen) Liberal Corporatist Social democratic

32. Typology of National Health Systems(5) Health systems Market oriented/Liberal Corporatism/Social insurance Universalism

33. Further Readings 김창엽. 건강보장의 이론. 제 4 장. 한울, 2009. Kleczkowski BM, et al. National health systems and their reorientation towards health for all. Geneva: WHO, 1984 ( 번역본 : 서울대학교 의과대 학 의료관리학교실 옮김. 인류 모두의 건강을 위한 국가보건의료체계 의 방향 재설정. 한울, 1993) World Health Organization. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: World Health Organization, 2007.