Health Systems

Influence of Inputs and Outputs to the Health of a Population

Today healthcare environments present several challenges for individual practitioners, healthcare organizations, patients, families, and the economy. Meeting the diverse healthcare needs of populations in a health system is a complex and challenging issue. The task demands continuous projection of needs into the future, management of various resources, and data assessment to determine the success of the health system in moving towards meeting the needs of the organization. In order to understand and appreciate the several interconnecting parts in healthcare organizations, systems thinking is used to tackle complex health problems, manage, maintain, and improve health outcomes in a particular population. More precisely, systems thinking are used to unveil the underlying characteristics and relationships of health systems. Consistently, viewing healthcare as a large system made up of various intersecting small systems improves efficiency on the evaluation of products and services to achieve the goals and objectives of an organization, with the most obvious goal being the delivery of appropriate services to the target population.  

Systems Thinking in Health

Health systems are open systems, often intertwined with various interacting components to form whole properties beyond the parts. The interacting components typically influence each other to determine the behavior of a health system collectively. In practice, health systems play a critically significant role in improving the health of a population. According to Atun (2012), effective health systems enable the use of available resources for the achievement of good health. Well-functioning systems also facilitate effective mounting of responses to emerging health emergencies and help in addressing the burden of diseases. Ideally, several factors including the capacity of the organizations and individuals, ability to make the right use of opportunities, and economic set up among others influence ways in which health systems achieve good health. Nonetheless, the biggest challenge lies in linking good health with successful health systems, without mixing with other determinants of health. Thus, understanding the interconnectedness and interdependent of elements within a health system and their context in creating the extensive network of action and non-linear relationship collectively results in a dynamic complexity. System thinking is used to organize, understand, and analyze the complexity that prevails in health systems, by enabling testing of system components. Virtually, systems work through components brought from outside to function as inputs that are usually put into smaller subsystems and transformed into products or services. Thus, as Atun notes, systems thinking can be used as a framework to explain the components of a system and the relationship between the components, boundaries of the system, goals, and the ability of the system to adapt and change depending on the demands of the internal and external forces. In health systems, the unifying factor lies in the provision of services necessary to meet the healthcare needs of a population. Inputs, also considered as system components vary greatly but must also be flexible and viable to meet the demands of the external and internal forces within a specific health system. Along with that, some inputs often take several years before their contribution can be realized. For instance, research, development, and testing of new drugs require massive financial investment and time.  Similarly, training healthcare personnel usually takes time for their input as professionals to be experienced and their contribution realized in health systems. Other inputs that determine the health of a population include infrastructure, people, knowledge, materials, medical equipment and supplies, and clients. These other inputs are often considered a part of the delivery of healthcare services, and health systems cannot function without them. Importantly noted, the suitability and standards of the available inputs often determine the quality of outputs in health systems. Additionally, decision-makers in a health system should also be aware of factors beyond control affecting the nature of system inputs such as specific population needs, availability of funds, and distribution of resources among others. 

Managing System Inputs

The goal of health systems is to provide timely and appropriate care to its target population while focusing on improved health outcomes. Successful health systems must consider the significance of raw materials necessary to attain the goals of an organization. Focusing on public health facility, we evaluate the interconnecting subsystems that work independently and resource management to ensure proper and efficient delivery of services to meet the healthcare needs of the target population. Importantly noted, the most visible components of any healthcare system are the human capital, finances, policies, infrastructure, research and development, and education. These components are what determine the quality of care delivered to the target population and if the health care needs are met.

Human Capital

Within the context of health care systems, human capital management receives increased attention due to its significant contribution as a major component of health system inputs. As about health, human resources constitute of clinical and non-clinical staff members who are responsible for the intervention of population health (Kabene, Orchard, & Howard, 2006). Arguably, as one of the most important components of health system inputs, the performance, and benefits of the system largely depends on the knowledge and skills of these individuals. It is therefore important to handle and manage human capital appropriately to ensure the success of the health system. 

Finances

Finances are fundamental to the ability of health systems to maintain and improve health care needs of a population. At the extreme, lack of funds could mean no health workers will be employed, there would be no drugs, and health promotion and prevention would not take place. Nonetheless, financing is broader and goes beyond raising funding. According to WHO (2008), health financing is a function of a health system that involves mobilization, accumulation, allocation of funds to meet the healthcare needs of the people. The purpose is to ensure availability of funding and ensure the right incentives are allotted to providers to ensure that the population receives effective health care. Australia spends huge amounts of money on healthcare through direct payment, insurance premiums, and government taxes (Commonwealth of Australia, 2015). The expenditure is growing, and although Australia’s health care system ranks high by international standards, some parts do not perform as efficiently as expected. Typically, this is manifested in wasteful spending and reduced access to care as well as substandard quality and safety outcomes. 

Infrastructure

The success of healthcare systems relies on several things among them infrastructure. A well-rounded health system requires constant evaluation and maintenance of the infrastructure. Infrastructures, in this case, involve buildings, equipment, supplies, energy, expertise, and materials necessary to ensure effective delivery of care. Hospital equipment plays an integral part in diagnosis, treatment, and management of diseases. An organizational goal to meet the needs of a population comes under threat when facilities intended to provide services are inadequate. In order to understand this better, we take the case of Victoria, where there is a high demand for the latest medical technology for disease diagnosis and treatment. An audit by Doyle (2015) indicates that some of the two most expensive medical equipment; computed tomography (CT) and Magnetic Resonance (MR) scanners are in increasing demand. Unfortunately, there is a great variation in the ways some of the Ct and MR imaging services are operated. A major concern is the fact that in one hospital, patients have to wait for up to 98 days, while in another hospital 10 kilometers away, the wait time is only two days. Similarly, patients from northern and western suburbs Melbourne face double the wait time as compared to those from the South. In particular, in areas where access to scanning services are publicly funded, patients have to travel far or pay out of pocket to receive the services from private facilities. 

Policies

With the growing concern of inequalities in health status, problems of access, and lack of return for investment in health care and the challenge of controlling spiraling medical costs, health reforms have become a necessity. In Australia, the government has put in place several reforms focused on improving the efficiency of the health system to relieve the citizens of the pressure associated with the increasing healthcare expenditure. According to a Commonwealth of Australia report (2015), the government projected to increase healthcare expenditure from 4.2 percent of GDP in 2014 to 2015 to 5.7 percent by 2054 to 2055. Unfortunately, the increase does not guarantee healthcare efficiency. Virtually, the Australian health technology assessment has various weaknesses, and even with government subsidies several health treatments have not been evaluated for clinical and cost-effectiveness. Issues such as poor transparency and duplication in the delivery of care detract efficiency of HTA processes. To the health of the population, these health interventions are irrelevant, with low or no benefits and sometimes cause harm.

Research and development – Use of Evidence-based Practice

A major obstacle in meeting the health needs of a population is the weaknesses of health systems. Several global health initiatives have been created to support available interventions and to strengthen health systems (Remme, Adam, & Becerra-Posada, 2010). The initiatives are accompanied by the growing recognition of the role of research in improving health systems and meeting the needs of a population. Information is essential to avoid wasteful healthcare. It helps intervene in cases where clinicians may not realize they are over-diagnosing patients, providing harmful treatment, or administering valuable treatment in the wrong manner. Such outcomes are particularly possible where clinicians have adopted the use evidence-based practice or where the health cost and benefits vary across patient groups. Research and development provide timely and accessible information and evidence to the clinicians, thus helps promote clinically and cost-effective health care. In Australia, the National Health and Medical Research Council plays a significant role in the development of evidence-based practice by developing clinical guidelines to enhance the quality of care delivered to its population.

Evaluating Outcomes

Health systems have the power to make a difference in the delivery of care and meeting the needs of a population. In most cases, the impact of a particular input on the health of a population can take time to be turned into an input. Case sample is the development of evidence-based research, which involves research and development of clinical guidelines. The policies and practices used in healthcare today are a result of previously collected and researched data to produce evidence-based practice for improved quality care and safety outcomes. Access to appropriate and availability of cost-effective care is a factor in evaluating the impact of health systems regarding inputs such as infrastructure, human capital, and research and development.

Conclusion

Within healthcare settings, system thinking helps in understanding and regulation of the dynamic complexity that inhibits health systems. It provides a framework for inputs (resources) to be transformed into products and services to meet the goals of the organization. As subsystems perform within their designated scope and produce their outputs, the strength and weakness of each input are established in their ability to withstand and adapt to internal and external forces. Human capital, infrastructure, use of the evidence based practice, finances, and policies can significantly influence health outcomes of a population. Pivotal changes to are only possible after thorough research and examination of each input and interaction with the patient group. Importantly noted, when a health system fails to modify the method of organizing and providing care to the dynamic needs of a population then it may be hard to achieve the goal of healthcare delivery. Assessment of the population needs is also necessary as it provides a framework for the management of resources, allows strategic planning, and allocation of funds where necessary. Consequently, data collection is necessary and it should be carefully examined to access the effectiveness of lack of it of the delivery of care and to optimize the needs of the population for positive health outcomes.

References

Atun, R. (2012). Health systems, systems thinking and innovation. Health Policy and Planning, 27(4), iv4-iv8.

Commonwealth of Australia. (2015). Efficiency in health. Retrieved from: https://www.pc.gov.au/research/completed/efficiency-health/efficiency-health.pdf

Doyle, J. (2015). Efficiency and Effectiveness of Hospital Services: High-value Equipment. Victorian Auditor-General Office. Retrieved from: https://www.audit.vic.gov.au/sites/default/files/20150225-Hospital-Equipment.pdf

Kabene, S. M., Orchard, C., Howard, J. M., Soriano, M. A., & Leduc, R. (January 01, 2006). The importance of human resources management in health care: a global context. Human Resources for Health, 4(20), 1-17.

Remme, J. H., Adam, T., Becerra-Posada, F., D’Arcangues, C., Devlin, M., Gardner, C., Ghaffar, A., … Terry, R. F. (2010). Defining research to improve health systems. Plos Medicine, 7(11), 1-7.

WHO. (2008). Health systems financing. Retrieved from: http://www.who.int/healthinfo/statistics/toolkit_hss/EN_PDF_Toolkit_HSS_Financing.pdf