POPLHLTH 301
Strengthening Health Systems
Course coordinator
Dr Laura Wilkinson-Meyers
Lecturer in Health Services Research
Health Systems
School of Population Health
[email protected]
Course description
Relatively rich countries such as New Zealand generally spend a large proportion of their resources on health
care. But does spending more on health care lead to better health outcomes? For individuals, the answer is
generally 'yes', but more resources for health won't necessarily mean that the whole population is healthier.
Whether or not spending on health leads to a healthy population largely depends on the way a country's
health system is organised.
Building on what you learned in POPLHLTH 101, this course provides the opportunity for deeper discussion
about the goals of health systems, how they work and how they perform. Throughout the course you will be
challenged to use a variety of tools and frameworks to consider:
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The importance of access, equity, financing, efficiency and quality goals
How you know if the health system is performing well
How improving one aspect of the health system affects the other aspects
Key course objectives by module
Module 1: Introduction (Dr Laura Wilkinson-Meyers)
What is this module about?
It will have been over a year since you studied about health systems in POPHLTH 101: Health Systems 1.
This module is meant to remind you of some of the key concepts that you explored in that course and to set
the stage for a deeper exploration of health system performance.
What should I know by the end of it? (Learning objectives)
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Understand the main components of a health system, the key stakeolders involved, as well as the
main criteria used internationally to assess the performance of a health system
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Understand why access, equity, quality and efficiency are key criteria used to assess the performance
of health systems
Module 2: Improving Access & Equity (Dr Laura Wilkinson-Meyers)
What is this module about?
This module introduces some of the philosophical foundations for equal access to health care. It defines and
explores different aspects of access to health services and challenges our thinking about evaluating access
and equity. We will also explore health system factors that contribute to equity of access to health services.
What should I know by the end of it? (learning objectives)
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Define equality, equity, access, equity of access, horizontal (in)equity, vertical equity as used in health
services and health systems research
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Gain a deeper understanding of the concept of needs and its relevance to debates about access to
health care and equity
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Identify the factors that contribute to, and the factors that alleviate inequity of access to health
services
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Critically examine access issues to a particular health service
Module 3: Improving Quality (Dr Peter Carswell)
What is this module about?
This module explores mechanisms for improving quality in health services. In doing so it outlines the context
of healthcare that often makes such improvement difficult to either commence or sustain. A number of tools
are presented that can be used in supporting quality improvement. These tools are discussed within a set of
principles designed to support sustainable change.
What should I know by the end of it? (Learning objectives)
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Be able to define quality as it relates to health care and describe key measures of quality
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Be able to describe the quality improvement cycle
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Be able to describe at least two tools for quality improvement
Module 4: Improving Efficiency (Prof. Toni Ashton & Dr Laura Wilkinson-Meyers)
What is this module about?
This module explores different ways of raising and allocating health care funds and the impact of different
financing mechanisms on goals of access, equity, quality and efficiency.
What should I know by the end of it? (learning objectives)
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Be able to debate the strengths and weaknesses of different financing arrangements
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Know the main payments systems for health professionals and hospitals
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Appreciate the types of incentives associated with each form of payment
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Appreciate arguments for and against cost containment as a policy objective
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Describe the main methods of containing costs
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Identify the main strategies that have been used in New Zealand to improve efficiency and contain
costs
Module 5: Case Studies
In the final module of the course you will be asked to present case studies of current initiatives in NZ health
policy and to consider their contributions to improving health system performance against the goals of access,
equity, efficiency, cost containment and quality.
Course structure
There are three basic formats for teaching and learning in this course: lectures, Think Tank workshops and
office hours. The course consists of 24 one-hour lectures (2 per week), 12 one-hour Think Tank workshops
and 12 office hours.
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Lecture, Tutorial & Assessment Schedule
Module
Intro
Lecture
1
Course Intro & Welcome
MODULE 1: Improving Health Systems
2
1
Topic
3
4
Key Health Systems Concepts
Think Tank 1: Introduction to Think Tank & Topics
Key Health Systems Concepts II
Health System Goals: Access, Equity, Efficiency & Quality
Think Tank 2: Getting to know your stakeholders & Relationships between them
MODULE 2: Improving Access & Equity
2
5
6
7
8
Access & Equity: Definitions and Measures
Improving Equity
Think Tank 3: Exploring Access & Equity Issues in your Topic: Relationship to other goals?
Needs and Needs Assessment
Improving Access
Think Tank 4: Addressing Needs & Improving Access in Your initiative
Lecturer
LWM
LWM
LWM
LWM
LWM
RM
LWM
LWM
MODULE 3: Improving Quality
3
9
10
11
12
Assignment 1 Due – Background Paper
Intro to quality
Quality Improvement I
Think Tank 5: Defining quality in your initiative
Quality improvement II
Quality Improvement III
Think Tank 6: Improving quality in your initiative
MODULE 4: Improving Efficiency
13
14
15
16
PC
PC
PC
PC
Mid Semester Break
Intro to concepts of cost containment vs effiicency
Improving efficiency I
Think Tank 7: Assignment 1 Feedback & Assignment 2
Improving efficiency I
Paying Providers
Think Tank 8: How does money matter in your topic: A look at the flow of funds
TA
TA
TA
LWM
MODULE 5: Presentation Prep Week
4
17
18
Assignment 2 Due – Solutions Paper
Presentations with SLS
Presentation Prep Time
Think Tank 9: Presentation Prep Time
MODULE 5: Making Connections
19
20
5
21
22
23
24
All Presentation Slides Due
Workshops – Immunisation Target
Workshops – ED Target
Think Tank 10: Discuss Immunisation & ED Target
Workshops – Elective Surgery Target
Workshops - Cancer Treatment Target
Think Tank 11: Think Tank Workshop: Discuss ES and Cancert Tx Targets
Workshops - Smoking Cessation Target
Workshops – Heart Checks Target
Think Tank 12: Wrap Up & Exam Review
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Students
Students
Students
Students
Students
Students
LW
Course assessment
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Assignment 1 – Background Paper on Special Topic (20%)
Assignment 2 - Special Topic Solution (20%)
Weekly Think Tank Activities - includes weekly workshops during tutorial & take-home activities (10%)
Think Tank Group Presentation (10%)
Final Exam (40%)
Recommending readings
There are no prescribed texts for this course. A list of recommended readings is given for each module.
Students will be expected to have read these prior to the sessions, and to be prepared to discuss the issues
and questions arising from them. This is intended to help students expand their reading on each topic, and is
also designed to assist with assignment work. Students are, however, encouraged to read much more widely.
In preparing assignments, students will be expected to have gone well beyond the references listed.
POPLHLTH 301 course library web page
The course’s web page on the library web site contains links to all your required readings and other useful
research sites.
http://coursepages.library.auckland.ac.nz/poplhlth/301/
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