Health systems

Health Systems Strengthening Glossary


Capital expenditure: the cost for resources that last more than one year, such as building, vehicles, computers, pre-service training. Sometime a price ceiling is also defined (usually $US 100), below which costs are considered as recurrent. The cost of capital equipment is net of depreciation. Also called investment or non-recurrent cost/expenditure. 1

Care Maps: plans for the management of patient care that set goals for patients and provide the sequence of interventions that physicians, nurses and other professionals should carry out in order to reach the desired goals in a given time period. 2

Case Management: provision of continuous care across different services through the integration and coordination of needs and resources around the patient. The fundamental difference with disease management is that it focuses more on individual patients and their families than on the population of patients with a certain disease. This type of management is targeted at people with a high level of risk requiring expensive care, people who are vulnerable, or have complex social and health needs. The case manager coordinates patient care throughout the entire continuum of care. 3

Certification: a process by which an authorized body, either a governmental or non-governmental organization, evaluates and recognizes either an individual or an organization as meeting pre-determined requirements or criteria. Although the terms accreditation and certification are often used interchangeably, accreditation usually applies only to organizations, while certification may apply to individuals, as well as to organizations. When applied to individual practitioners, certification usually implies that the individual has received additional education and training, and demonstrated competence in a specialty area beyond the minimum requirements set for licensure. An example of such a certification process is a physician who receives certification by a professional specialty board in the practice of obstetrics. When applied to an organization, or part of an organization, such as the laboratory, certification usually implies that the organization has additional services, technology, or capacity beyond those found in similar organizations. 4

Clinical Integration: the extent to which patient care is coordinated across the system’s different functions, activities and operating units. The degree of coordination of care depends primarily on the patient’s condition and the decisions made by his or her health team. Clinical integration includes horizontal and vertical integration. 5

Clinical Practice Guidelines: systematic recommendations, based on the best available scientific knowledge, to guide the decisions of both professionals and patients regarding the most appropriate, efficient health interventions for addressing a specific health-related problem given specific circumstances. 6

Clinical Service Lines: organizational arrangements based on outputs (versus inputs). Organizing around outputs creates a service line structure consisting of people, in different disciplines and professions, who have a common purpose of producing a comprehensive set of clinical services. 7

Coherence (of a national health policy/strategy/plan): (i) the extent to which proposed strategies are aligned with the priorities identified in the situation analysis; (ii) the extent to which programme plans are aligned with the national health strategy and plan; (iii) the extent to which the different programmatic strategies in the national health policy/strategy/plan are coherent among each other.

Commitment:"in accounting usage, commitments refer to a stage in the expenditure process at which contracts or other forms of agreement are entered into, generally for future delivery of goods or services. A liability will not be recognized until delivery of the item, but the government is contractually committed to meeting the obligation once delivery is made. The term is also used in a more general, noncontractual sense to mean firm promises of the government made in policy statements." 8

Commodity: "an economic good ready to be exchanged or exploited within a market." 9

Community:a unit of population, often generally geographically defined, that is the locus of basic political and social responsibility and in which everyday social interactions involving all or most of the spectrum of life activities of the people within it takes place. 10

Comprehensive Health Services: health services that are managed so as to ensure that people receive a continuum of health promotion, disease prevention, diagnosis, treatment and management, rehabilitation and palliative care services, through the different levels and sites of care within the health system, and according to their needs throughout the life course. 11

Comprehensiveness (of a national health policy/strategy/plan): the extent to which a national health policy/strategy/plan addresses the full range of health problems and health system problems and challenges.

Comprehensiveness of care: the extent to which the spectrum of care and range of resources made available responds to the full range of health problems in a given community. Comprehensive care encompasses health promotion and prevention interventions as well as diagnosis and treatment or referral and palliation. It includes chronic or long-term home care, and, in some models, social services. 12

Consensus building: the process by which different stakeholders reach an overall agreement on a policy concern.

Continuity of care: a term used to indicate one or more of the following attributes of care: (i) the provision of services that are coordinated across levels of care - primary care and referral facilities, across settings and providers; (ii) the provision of care throughout the life cycle; (iii) care that continues uninterrupted until the resolution of an episode of disease or risk; (iv) the degree to which a series of discrete health care events are experienced by people as coherent and interconnected over time, and are consistent with their health needs and preferences. 13

Contracting-out: "the practice of the public sector or private firms of employing and financing an outside agent to perform some specific task rather than managing it themselves." 14

Cost benefit analysis: a comparison of costs and achieved benefits, where both costs and benefits are expressed in monetary terms. The usual rule in cost benefit analysis is for the benefit-cost ratio (B/C) to exceed unit or for (B-C) > 0. > 0. 15

Cost effectiveness analysis: a form of economic evaluation where costs are expressed in money terms but consequences are expressed in physical units. It is used to compare different ways of achieving the same objective. 16

Costing: (i) the estimation of a specific strategy or intervention, or of an overall national policy, strategy or plan. (ii) the estimation of the cost of different scenarios, corresponding to different priorities or strategies, in the short, medium or long term.

Cost-recovery: "receipt, by a health provider, of income from individuals or the community in exchange for health services. It may be expressed as a percentage of expenditure." 17

Coverage: the extent of interaction between the service and the people for whom it is intended. Coverage is not to be limited to a particular aspect of service provision, but ranges from resource allocation to the achievement of the desired objective. 18


  • A glossary of technical terms on the economics and finance of health services. World Health Organization, Regional Office for Europe. 1998. Available at:
  • Longest BB, Young GJ. Coordination and communication. In: Shortell SM, Kaluzny AD, DD. Health care management. New York, Delmar, 2000:210-43.
  • Smith JE. Case management: a literature review. Canadian Journal of Nursing Administration, 1998; May-June: 11(2):93-109.
  • Rooney AL, van Ostenberg PR. Licensure, accreditation, and certification: approaches to health services quality. Bethesda, MD. USAID, 1999. Available at:
  • Modified from Shortell SM; Anderson DA; Gillies RR; Mitchell JB; Morgan KL. Building integrated systems: the holographic organization. Healthcare Forum Journal 1993; 36(2):20-6.
  • Field MJ, Lohr KN, editors. Clinical Practice Guidelines: directions for a new program. Washington, DC; National Academy Press, 1990.
  • Charns M, Tewksbury L. Collaborative management in health care: implementing the integrative organization. San Francisco: Jossey-Bass, 1993.
  • Manual on fiscal transparency. Washington, DC. International Monetary Fund, 2007.
  • Merriam-Webster’s online dictionary.
  • Starfield B. Basic concepts in population health and health care. Journal of Epidemiology and Community Health 2001;55:452-454. doi:10.1136/jech.55.7.452.
  • Modified from WHO. Integrated health services-what and why? Technical Brief No. 1, May 2008
  • The world health report 2008: primary health care - now more than ever. Geneva, World Health Organization, 2008. Available at:
  • Modified from Haggerty JL, Reid RJ, Freeman GK, Starfield B, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. British Medical Journal 2003; 327(7425):1219-21.
  • WHO Task Force on Health Economics (1995). Glossary.
  • Health Systems Observatory. Glossary for Health System. World Health Organization, Eastern Mediterranean Regional Office.
  • Strategy of health care financing for countries of the Western Pacific and South East Asia Regions (2006-2010). World Health Organization, 2005. Available at:
  • WHO Task Force on Health Economics (1995). Glossary.
  • Tanahashi T. Health service coverage and its evaluation. Bulletin of the World Health Organization, 1978;56(2):295-303. Available at: