urgent request in 12 hours time

Running head: HEALTH SYSTEM PERFORMANCE 1

Health System Performance

**** **** ****

HCM 500 -Health Care Systems

Colorado State University-Global Campus & Saudi Electronic University

Dr. *** ***

October 22, 2016

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HEALTH SYSTEM PERFORMANCE 2

Table of Contents

INTRODUCTION 3

WHAT IS THE HEALTH SYSTEM? 3

HEALTH SYSTEM IN SAUDI ARABIA 5

HEALTH SYSTEMS PERFORMANCE ASSESSMENT. 6

CONCLUSION 7

REFERENCES 8

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HEALTH SYSTEM PERFORMANCE 3

Health System Performance

Introduction In the history of development of the health care systems, assessing the health systems

performance has been thought of as a key factor in measuring the overall outcomes for any health

system. Many health indicators have been used currently to rank the different health systems

globally. These indicators, standards and frameworks have been created and mentioned in many

scientific publications and draws highly attention and scientific debates regarding its scientific

evidence, effectiveness and overall purpose.

The major objectives of this article is to explore and define the health system and gives

brief glance about the situation of health system in Saudi Arabia as well as explore and highlight

the main framework and understanding of the concept of assessment of health system performance.

Of course, there have been many publications in regard to health system performance

assessment, but the cornerstone or the main effort it was the World health report 2000. This article

will -in brief- discuss this report and give some critiques to its effectiveness and aim.

What is the Health System? Nowadays it is difficult to state the exact definition for any single issue because of the deferent types of perspectives, challenges or limitation to that issue among countries,

policymakers, researchers or even people in general. In talking about health system or healthcare

system, the World Health Organization has defined a health system as “all the activities whose

primary purpose is to promote, restore or maintain health’’(WHO, 2000). This is currently the

most accepted definition and it is noticeable from this definition that it is widely broad which will

include many sectors and organizations that have the same purpose or aim.

More recent attention has focused on the definition of health system and the traditional

thinking regarding the situation and the boundaries of a health system. According to (Frenk, 2010)

there are four main direction of more comprehensive view expanding our thinking regarding a

health system. First, we should think about health system interrelation as well as its component

elements such as hospital, clinics, technologies, etc. Secondly, we should include the population

because they are essential part of any health system. Patients, consumers, taxpayers, citizens and

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HEALTH SYSTEM PERFORMANCE 4

or co-producers are all among population that we should expand our thinking in regard to a health

system.

Certainly, its clear that in this new information and internet age and the easy access to

information has shifted the health system to what is known nowadays as consumer-driven health

care(Calabretta, 2002). The third expansion regarding our thinking to health systems relate to their

goal. The goal of the health system is not only improving of health, it is also distribution of health,

responsiveness and fair financing of health care.

The final direction is to expand our thinking regard the health system functions. The health

care system should focus on direct provision of services as well as stewardship, financing, and

resource generation and health workforce. This comprehensive view and thinking of health system

is the main idea of the World Health Report 2000 which this article will talk more about it later

on.

The (WHO, 2000) has determined four main objectives of any health systems which is “:

• Improving health outcomes.

• Ensuring financial protection against catastrophic payments.

• Be responsive to population expectations.

• Moving toward universal health coverage.”

First three objectives have been discussed thoroughly in the same report, while the last

objective was the main topic of world health conference in 2013. A lot of research has published

regarding this issue afterward (WHO, 2013).

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HEALTH SYSTEM PERFORMANCE 5

Health System in Saudi Arabia The corner stone in the establishing the health care system in Saudi Arabia started in the

early of the 20th century specifically around 1925 with public health department in Makkah city

which deliver a free health care services to pilgrims and even to the local citizens, while the

systematic organization of Saudi health system started in 1951 as a ministry of health (Salloum,

2014).

In less than a half century there were a dramatically changes and a great development in

delivering health care in the country. The number of hospitals has a considerable grown from 74

in 1970 to 274 in 2015 with total hospital beds of 41,279 and the rate of beds per 10,000-population

was 13.11. The MOH has also operated more than 2282 primary health care centers distributed all

over the vast kingdom (MOH, 2015).

Healthcare services in Saudi Arabia is delivered free of charge to all Saudi citizens, mainly

through the Ministry of Health and other governmental health sectors (Walston, 2008). However,

due to increase health care expenditures and economical situation of the kingdom there are new

strategy and movement to the implementation of a national health insurance and privatization of

some health care facilities (Almalki, 2011). This movement will create many issues related to

universal health coverage. There are another view point some evidence (Hsiao, 2007) claimed that

health insurance and privatization of health services make poor people suffer from lack of health

accessibility and put some barriers to health care and the outcomes of that solutions did not reduce

health care funding and didn’t also improve health care outcomes in the developing or even

developed countries.

According to World Health Organization ranking of health systems in 2000 (WHO, 2000),

Saudi Arabia health care system ranked 26th state among 191 state member of WHO even before

the United State which ranked 31th in this ranking which means that Saudi Arabia health care

system has a good indicators and many strength point in the system. On the other hand, when we

compare Saudi Arabia to the United State health system in regard to health expenditure per capita

we end up with the surprise that the United State health system is the first system rank while Saudi

Arabia health system ranked 63th in regard to health expenditure per capita. This strange ranking

leads to some critics about the validity and effectiveness of the indicators the WHO has been made

to use in measuring health system performance. Later on in this article we will discuss more about

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HEALTH SYSTEM PERFORMANCE 6

these criticisms. Table 1 illustrates some of health systems ranking according to (WHO, 2000).

RANKING COUNTRY EXPENDITURE PER CAPITA

1 France 4

8 Oman 62

18 United Kingdom 26

26 Saudi Arabia 63

27 United Arab

Emirates 35

30 Canada 10

31 United States 1

Table 1: World Health Organization ranking of health systems in 2000.

Health systems performance assessment. In most of the countries, improving healthcare systems’ outcomes is a major challenging

even to the high-income countries. In order to accomplish this broad aim many research and

scientific articles has published started with Evans framework in 1981 to World Health Report

2000 which was entitled with “Health systems: improving performance” (Fried, 2012). Moreover,

the World Health Report 2010 was on the health systems financing (WHO, 2010), while the World

Health Report 2013 was basically on the concept of universal health coverage (WHO, 2013).

The World Health Report 2000 is the main framework in the field of health systems

performance assessment. This framework has three main goals which is improving health, fair

finance and responsiveness to population expectations (Fried, 2012).

Since its publication, it draws a great attention and more debate and arguments regarding

its scientific evidence and the overall purpose of the ranking. Vicente Navarro in his critics

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HEALTH SYSTEM PERFORMANCE 7

(Navarro, 2000) to the World Health Report 2000 in regards to the effectiveness which they

measured as levels of health including mortality and morbidity and he stated that there is no

scientific evidence to support their assumption. Therefore, ranking the countries based on the level

of health should not be used as an indicator for the effectiveness of health care.

In addition, what is the point to compare 191 countries as a one group and in fact, there are

many differences in the financing, technologies and abilities between these countries. Dose it make

sense to compare Zimbabwe and Papua New Guinea to the US or Canada as stated by (Pedersen,

2002). This answers why United States has ranked 31th and many low-income countries with

relative low health systems has ranked better than US health system.

In 2007, the WHO has published the WHO’s Framework for Action (WHO, 2007). The

major system building blocks with an overall goals or outcomes has been specified in this

framework. The main sex building blocks are: service delivery, health workforce, information,

medical products and technologies, financing and finally leadership or governance.

Conclusion This essay article has discussed the main concept of assessing the health system

performance. It is clear now that the world health report 2000 was a great step towards evidence-

based health policy as stated by (Murray, 2001) despite of the controversy issues regarding its

effectiveness. The following world health repots also provided a guide to the international health

systems to measure their overall health outcomes.

Further researches in this field would be of great help for the international health systems

and health policymakers around the globe. It is obvious to say that every health system and every

country has its own capacities, challenges and expectations. Therefore, it is highly recommended

to use the international standards and frameworks wisely and specifically.

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HEALTH SYSTEM PERFORMANCE 8

References Almalki, M., Fitzgerald, G., & Clark, M. (2011). Health care system in Saudi Arabia: an overview.

Eastern Mediterranean Health Journal, 17(10), 784–793. Calabretta, N. (2002). Consumer-driven, patient-centered health care in the age of electronic

information. Journal of the Medical Library Association, 90(1), 32–37. Frenk, J. (2010). The global health system: Strengthening national health systems as the next step

for global progress. PLoS Medicine. http://doi.org/10.1371/journal.pmed.1000089 Fried, B. J., & Gaydos, L. M. (2012). World health systems : challenges and perspectives.

(Second). Chicago, Illinois: AUPHA. Hsiao, W. C. (2007). Why is a systemic view of health financing necessary? Health Affairs.

http://doi.org/10.1377/hlthaff.26.4.950 MOH. (2015). Saudi Arabia Health Statistical Annual Book. Murray, C., & Frenk, J. (2001). World Health Report 2000 World Health Report 2000 : a step

towards evidence-based health policy. The Lancet, 357, 1698–1700. http://doi.org/16/S0140- 6736(00)04826-1

Navarro, V. C. N.-C. (2000). Assessment of the World Health Report 2000. The Lancet, 356, 1598–1601. http://doi.org/10.1016/S0140-6736(00)03139-1

Pedersen, K. M. (2002). The World Health Report 2000: Dialogue of the deaf? Health Economics, 11(2), 93–101. http://doi.org/10.1002/hec.691

Salloum, N. A., Cooper, M., & Glew, S. (2014). The development of primary care in Saudi Arabia. InnovAiT: Education and Inspiration for General Practice, 8(5), 316–318. http://doi.org/10.1177/1755738014523575

Walston, S., Al-Harbi, Y., & Al-Omar, B. (2008). The changing face of healthcare in Saudi Arabia. Annals of Saudi Medicine, 28(4), 243–250. http://doi.org/10.1016/0041-0101(63)90051-5

WHO. (2000). The world health report - Health systems: improving performance. WHO. (2007). Everybody’s business: strengthening health systems to improve health outcomes:

WHO’s framework for action. Production, 1–56. http://doi.org/10 July 2012 WHO. (2010). The World Health Report 2010: HEALTH SYSTEMS FINANCING, The path to

iniversal coverage. The World Health Report, 1–128. http://doi.org/17 July 2012 WHO. (2013). The world health report 2013: Research for universal health coverage. World

Health Organization Press, 146. http://doi.org/10.1126/scitranslmed.3006971

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