Illuminating Gender II

Module 4: Health Care Systems and Services

31     In all western nations, public health services are an important economic factor; this applies to an equal degree to investments in health in developing countries. In view of strongly expanding economical and technological developments, and in view of rising expectations concerning medical care, the question increasingly surfaces of how growing health care systems can be constructed taking into consideration economic employment politics and ethical aspects, and remain sufficiently under control. Answering this question represents an urgent task for health policy makers around the globe. In this context, gender aspects are of great importance; however, they have played a subordinate role in relation to the question of developing the macro-level of the systems.

32     The aim of the module is to develop theories of health systems that enable students to analyse and compare differing systems. Knowledge and understanding of the socially determined basic assumptions and prerequisites of a health care system will be conveyed, and students will be enabled to derive possible solutions for specific problem constellations. For this purpose, three dimensions relevant to defining a public health service will be developed and applied:

• Descriptive: A systematics will be developed and conveyed for characterising a health care system which will enable the various givens of the students' respective native countries to be analysed.
• Comparative: The development of indicators that enable a comparative evaluation of the health results and outcomes of a health care system, including aspects of medical effectiveness and economic efficiency.
• Explicative: Explanatory patterns for the various forms of systems with regard to the area of health in cultural contexts will be sought. This is important, for example, in order to arrive at a realistic evaluation of the chances of changing the health care systems in various societies.

33      Problems of various countries that demand a solution at the system level will be presented at the beginning of the module and, together with the students, solutions will be developed and tested to determine their chances of acceptance and their consequences.

34      Subject areas include:

1. Conceptual conditions of a health system:

• Foundation and objectives of health systems, including the aspects of equal health opportunities, solidarity, risk taking behaviour;
• Distribution of the responsibility for health between citizens and state;
• The human dimension, meaning the basic concept of the citizen, the insured, and the patient (e.g. responsible patients versus those needing protection and guidance);
• The position of the public health service in society (e.g. in regard to the extremes of welfare states following the European model of a state public health system, on the one hand, and public health service as a competition-driven economic growth industry on the other).

2. Controlling elements of a public health service:

• Financial coverage for health care costs, health insurance providers
• Placement and financing of the service providers
• Who takes over the health risks? (Health insurance companies, service providers, citizens)
• Professionalisation of the health professions
• Quality of medical care
• Goal-finding processes of health care services
• Participation by citizens, insured people and patients in decision- making on micro-, meso-, and macro-levels of the system.

3. Structures and performance areas of a health care system:

• Levels of care and degree of coverage of the population from primary care to highly technologised inpatient medicine
• Performance areas such as basic care, specialty care, emergency and intensive care
• Health advice, health promotion, prevention, rehabilitation
• Degree of co-operation and networking, integrative care approaches and the respective participating professions

Method session: Health reportage, health system research, health care research