Strategies for health services

Martin McKee, Ellen Nolte and Josep Figueras

in Oxford Textbook of Public Health

Fifth edition

Published on behalf of Oxford University Press

Published in print September 2009 | ISBN: 9780199218707
Published online March 2011 | e-ISBN: 9780199609673 | DOI:

Series: Oxford Textbooks

Strategies for health services

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This chapter starts from the premise that a health system should, fundamentally, seek to improve population health. It first reviews the evidence that modern healthcare can impact positively on population health. Employing the concept of avoidable mortality, which identifies deaths that should not occur in the presence of timely and effective care, it shows that modern healthcare does make an important contribution to health but it also notes that some care provided is either ineffective or even harmful. It continues by examining the many factors that are acting on health systems and to which they must respond. One factor is the changing economic situation, with increasing evidence that investment in health promotes economic growth. Another is the evolving burden of disease, characterized in particular by the growing number of people with multiple complex disorders. Others include changing beliefs about the relationship between the individual and the state, and greater knowledge and expectations among actual and potential users. It then examines what public health professionals can do to maximize the amount of effective care provided to those in need while minimizing what is ineffective or harmful. It identifies a series of strategies. One is priority setting, which should be based on evidence and underpinned by explicit values, including the pursuit of equity in healthcare funding and delivery. Another is optimal allocation of resources, based on the quest to maximize health gain, which includes assessment of need and intelligence-led purchasing of appropriate care. Another is defining models of service delivery, ensuring that care is provided in the most appropriate setting and in ways that achieve optimal outcomes. Finally, the chapter examines some of the ways in which health systems can provide a setting for prevention and health promotion. It concludes by arguing that public health professionals must engage in the debate about how healthcare is funded and delivered if they are to maximize population health.

Chapter.  14140 words.  Illustrated.

Subjects: Public Health and Epidemiology ; Public Health

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