Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Front Public Health. 2022 Aug 15;10:956487. doi: 10.3389/fpubh.2022.956487. eCollection 2022.
Defining the health system, as a multidimensional and complex structure, is challenging, and the existing definitions often fail to incorporate the various levels and functions involved in a single system definition. An ideal framework should be easy to evaluate, allow for comparison, and be divisible into smaller sub-systems for easier interpretation. This paper concisely explores a novel framework to perceive health systems. As in any system, it is important to accurately define the health system's input, process, and output, as the cornerstone of evaluating any system is to assess outputs with regard to inputs besides analyzing outcomes, impact, objectives, and values. Since the raison d'être of the health system is to improve health in society, it is proposed that the input can be considered as the population subject to the system's process, and the output as the population with improved health status. This paper also proposes defining support systems, whose input and output are needs and parts of the process in the main system, respectively. Example support systems include the health evidence production or education and development of human resources systems. Instead of considering all functions as part of the main system, this concept allows implementation and assessment of policies in various levels of health systems to be simplified, as each support system can be separately evaluated with clear functions.
定义医疗体系作为一个多维且复杂的结构极具挑战性,现有的定义往往无法将单一系统定义中涉及的各个层面和功能纳入其中。一个理想的框架应该易于评估、便于比较,并可细分为更小的子系统,以便更易于解读。本文简要探讨了一种新颖的医疗体系认知框架。在任何系统中,准确界定医疗体系的投入、流程和产出都至关重要,因为评估任何体系的基础都是在分析结果、影响、目标和价值的基础上,根据投入来评估产出。鉴于医疗体系存在的根本原因是提高社会整体的健康水平,因此可以将投入界定为受该体系流程影响的人群,将产出界定为健康状况得到改善的人群。本文还建议将支持体系界定为投入和产出分别为主要体系流程中的需求和部分。例如,支持体系包括卫生证据生产或人力资源教育和发展系统。通过这种方式,我们无须将所有功能都视为主要体系的一部分,从而简化了在不同层面的医疗体系中实施和评估政策的工作,因为每个支持体系都可以通过明确的功能来进行单独评估。