International Comparative Analyses of Health Care Systems

URL study guide

https://studiegids.vu.nl/en/courses/2024-2025/AM_470820

Course Objective

Students acquire knowledge and insight into:
- Different ways in which health systems in different countries are formed
- To understand and analyze outcomes of health systems with respect to equity, fair financial contribution and health status
- Complex adaptive nature of health systems and their constitution
- To understand the underlying reasons for health system reform and to recognize different health care reform strategies
- Different conceptual frameworks for carrying out a comparative analysis
- To understand different methods in analyzing and comparing health systems: health system performance assessment benchmarking), case study analysis, cost effectiveness analysis
- To apply the acquired knowledge in the context of high, middle and low income countries Students learn the following skills:
- To design, carry out and reflect on a comparative analysis, of high, middle and low income countries, making use of the framework for comparative analysis
- To make a clear and structured presentation in the form of a lecture and present it in a lecture session; and in the form of a poster and present it in a poster presentation session

Course Content

Until recent, the field of global health mainly embraced disease-specific initiatives and focused on the delivery of health services for specific diseases, as well as their lifestyle, environmental and socioeconomic determinants. After decades of such disease-specific initiatives, it is now recognized that programmes that solely target improving prevention or treatment of specific diseases cannot yield the desired outcomes in the context of weak health systems. The Covid-19 pandemic has emphasized the role of health systems in global situations even more. A critical determinant of health, as well as the success of global health initiatives, is the health system as a whole. Recognition of this brought ‘strengthening of health systems’ on the global health agenda and into funding schemes. The global health researchers and professionals of this era need to have a good understanding of health systems and the key skills to analyze and compare them in order; to adapt themselves to the different health systems in which they will work; to analyze different health systems and identify: how they have evolved to this point; and in which areas and how they can be strengthened to improve its outcomes. Serving these purposes, this course aims to equip the students with the knowledge and skills related to concepts, theory and methods on the following key areas:
- What a health system is (and different ways of describing it)
- What goals and functions health systems have
- Why and how health systems and their performance can be analyzed and compared
- Why and how health systems evolve and can be reformed In line with these, the course will cover low, middle income and high-income countries and span across different health system goals (health gain, equity, responsiveness, and effectiveness and efficiency) and functions (stewardship, financing, resource generation, and health services). In terms of methodology, students learn to use the case study approach for carrying out a comparative analysis. Students will be acquainted with the theory of case studies via lectures and reflection sessions and will implement this method on two assignments. both qualitative and quantitative aspects of ‘health systems comparison’ are discussed and critiqued. Furthermore, the complexity and culturally determined nature of health system design and health system reform are presented through a series of lectures form VU-lecturers and experts from a variety of institutions such as the Dutch Royal Tropical Institute (KIT) and OECD. Case examples, such as the Covid-19 pandemic, and what we can learn from this about (strengthening) health systems will also be discussed. Small group work for the assignments provides opportunities to practice relevant skills by analyzing, first, the health system of two selected high-income countries according to a defined theme (e.g. health finance, primary care, and maternal care & family planning). Groups will present their findings with a lecture. Subsequently, health systems of two middle or low income countries with comparable financial resources (e.g. GDP per capita, per capita health expenditure, etc.) but different health outputs and outcomes are analyzed to find out why two countries are performing in such different ways. The findings will be presented in a poster format. By repeating the analysis on the same theme but with different countries, the students are challenged to constantly improve their own analysis process.

Teaching Methods

Teaching methods include lectures by VU teachers and guest lecturers, lectures by other students, workgroups for assignments, problem-driven learning, self-study. The total study time of 160 hours is distributed as follows:
- Lectures ~30hrs
- Lectures and practicals on epidemiology & statistics ~18hrs (for MSc Global Health students only)
- Workgroup meetings with the teachers 4hrs
- Workgroup work on assignments ~50hrs
- Self study ~45hrs
- Student lectures & poster presentation ~12hrs
- Exam 2,25hrs Attendance to the workgroup meetings with the teachers for assignments, as well as the students' lecture presentations and poster presentations, is compulsory.

Method of Assessment

Exam(s) (individual assessment) (50%), Assignment-1 (25%), Assignment-2 (25%). All parts need to be passed (min 5.5). Each assignment is assessed over 100pts, which include 10pts for peer assessment.

Literature

A selection of literature will be made on the basis of lectures and state of the art research. A selection of last year’s literature is below. 1. Murray CJ, Frenk J. A framework for assessing the performance of health systems. B World Health Organ. 2000;78(6):717-31. 2. World Health Report 2000: Health Systems: Improving Performance. (Message form the director, Chapter 1, Chapter 2 and the Statistical Annex) 3. Yin RK. Case Study Research: Design and Methods. Fourth edition, Sage publications 2009, London. (Chapters 1 and 2) 4. Bunders JFG, Broerse JEW. The urgency for change. In: Broerse JEW, Bunders JFG, eds. Transitions in Health Systems: Dealing with Persistent Problems. Amsterdam: VU University Press, 2010. (pages 3-15) 5. Roberts M, Hsiao W, Berman P, Reich M. Getting Health Reform Right: A Guide to Improving Performance and Equity: Oxford University Press; 2004. (Chapter 1) 6. Plsek PE, Greenhalgh T. Complexity science: The challenge of complexity in health care. Brit Med J. 2001;323(7313):625-8. 7. Health System Reviews (HiT reports) of the countries selected for the assignments (European Observatory on Health Systems and Policies), as well as other relevant articles students find.

Target Audience

• Compulsory course within the Master specialization International Public Health
• Compulsory course for 1st year Research Master Global Health students
• Optional course within the Master specialization Infectious Diseases (master programme Biomedical Sciences). In any other circumstances admission should be requested from the course coordinator.

Additional Information

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Recommended background knowledge

It is strongly recommended that students have knowledge on public health and/or public policy in the context of health and/or care.