Essentially, the health system is the health sector categorized (with linkages) according to core functions (financing, provision of inputs and service delivery/coverage), main actors (government and consumers/households) and outcomes (health, fairness in financing and responsiveness.
The WHO Health System Performance Framework defines the goals of health systems as:
- Improving the health of the population they serve
- Responsiveness, i.e., responding to people's legitimate expectations
- Fair financing, i.e., providing financial protection against the costs of ill-health.
Health system performance or efficiency can be examined in terms of the extent to which these goals are attained, given the resources available to the system. Responsiveness is defined as a measure of how well the health system responds to the legitimate expectations of the population (e.g. on waiting times, quality of care). Fair financing suggests every member of society should pay the same share of their disposable income to cover their health costs.
Health service provision is the combination of inputs in a production process that takes place in a particular organizational setting and that leads to the delivery of a series of health interventions. Therefore, the health service is the service that specifically aims to protect or improve health. Whether a health service is effective depends on what services are provided and how they are organized. Issues of equity and equality are particularly relevant here.
It has been suggested that the assessment of effective coverage of a selected group of interventions be incorporated into the assessment of health system performance. Effective coverage is defined as the proportion of the population in need of an intervention who have received an effective intervention. It does not measure the impact of a health intervention, which is often difficult to do, but does represent an intermediate step in achieving a health impact. Its usefulness as an intermediate goal lies in its direct link to the health system and in the fact measuring it can reveal the impact of managerial practices and decision-making processes on the functioning of health service provision at local, regional and national levels.
To link the global and country-specific contexts, it has been suggested that a core set of coverage indicators be selected for global measurement. Each country could add additional interventions, according to their priorities.
There is also the potential for significant enhancement of health systems through the prevention of adverse events, in particular by improving patient safety. There is a recognized need to promote patient safety as a fundamental principle of all health systems, as well as to establish and strengthen science-based systems necessary to improve patients' safety and the quality of health care. This includes the monitoring of drugs, medical equipment and technology. Efforts are currently underway to develop global norms, standards and guidelines for quality of care and patient safety.