REORIENTING HEALTH SERVICES Application of a Systems Approach

Transcription

1 REORIENTING HEALTH SERVICES Application of a Systems Approach

2 NATO CONFERENCE SERIES I II III IV V VI Ecology Systems Science Human Factors Marine Sciences Air-Sea Interactions Materials Science II SYSTEMS SCIENCE Recent volumes in this series Volume 5 Volume 6 Volume 7 Applied General Systems Research: Recent Developments and Trends Edited by George J. Klir Evaluating New Telecommunications Services Edited by Martin C. J. Elton, William A. Lucas, and David W. Conrath Manpower Planning and Organization Design Edited by Donald T. Bryant and Richard J. Niehaus VOltih! 8', _1 Volume 9 Volume' 10 Search Theory and Applications, ",Fdited by K. Brian Haley and Lawrence D. Stone \"-{nergy Policy Planning Ed~.9ily 1}, A. Bayraktar, E. A. Cherniavsky, M. A. Laughton, and L. E. Ruff- ; f Applied o~e;a~n;"riilsearch in Fishing Edited by K. Brian f-4lei. _. Volume 11 Volume 12 Volume 13 Volume 14 Volume 15 Volume 16 Work, Organizations, and tecl~l)oiogical Change Edited by Gerhard Mensch and RicHard J. Niehaus "t', Systems Analysis in Urban POlicy-M~kin'g and Planning Edited by Michael Batty and Bruce Hutchinson Homotopy Methods and Global Convergence Edited by B. Curtis Eaves, Floyd J. Gould, Heinz-Otto Peitgen, and Michael J. Todd Efficiency of Manufacturing Systems Edited by B. Wilson, C. C. Berg, and D. French Reorienting Health Services: Application of a Systems Approach Edited by Charles O. Pannenborg, Albert van der Werff, Gary B. Hirsch, and Keith Barnard Adaptive Control of III-Defined Systems Edited by Oliver G. Selfridge, Edwina L. Rissland, and Michael A. Arbib

3 REORIENTING HEALTH SERVICES Application of a Systems Approach Edited by Charles o. Pannenborg Albert van der Werff Department of" Public Health and Environmental Hygiene Leidschendam, The Netherlands Gary B. Hirsch Health Management Consultants Wayland, Massachusetts, USA and Keith Barnard Nuffield Centre for Health Services Studies The University of Leeds Leeds, United Kingdom Published in cooperation with NATO Scientific Affairs Division PLENUM PRESS, NEW YORK AND LONDON

4 Library of Congress Cataloging in Publication Data NATO Advanced Research Institute of Health Services Systems (1982: Hague, Netherlands) Reorienting health services. (NATO conference series. II, Systems science; v. 15) "Proceedings of a NATO Advanced Research Institute on Health Services Systems, held August 29-September 3, 1982, at The Hague, The Netherlands"-T.p. verso. "Published in cooperation with NATO Scientific Affairs Division." 1. Medical care-congresses. 2. System analysis-congresses. I. Pannenborg, Charles O. II. North Atlantic Treaty Organization. Scientific Affairs Division. III. Title. IV. Series. [DNLM:' 1. Health services-organization and administration-congresses. 2. Systems analysis-congresses. W 84.1 N279r 1982) RA394.N ISBN-13: e-isbn-13: DOl: / Proceedings of a NATO Advanced Research Institute on Health Services Systems, held August 29-8eptember 3, 1982, at The Hague, The Netherlands 1984 Plenum Press, New York Softcover reprint of the hardcover 1 st edition 1984 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

5 ACKNOWLEDGEMENTS The realization of a working conference on health services systems, covering such a large field, depends on the support of a large number of people. First of all this NATO-Advanced Research Institute on Health Services Systems owes success to the dedicated members of the Programme Committee, who have given their unsparing support and have so generously contributed their time. They are: Mr. G.B. Hirsch, USA Prof. P.B. Checkland, UK Dr. D.M. Pendreigh, UK Prof. M.I. Roemer, USA Dr. G. Wennstrom, Sweden Dr. B.M. Kleczkowski, Switzerland, WHO, advisor Special recognition is given to our Proceedings Editors: Dr. Ch. O. Pannenborg, The Netherlands Mr.K. Barnard, UK Mr.G. Hirsch, USA Neither the Conference, nor the Proceedings would have been possible without the skill, efforts and support given by the Organizing Committee: Dr. Ch. O. Pannenborg Mr. A.H. Zwennes Mr. P. Kauderer Discussions during the Conference could not have been rendered into text by the conference end without the tireless efforts of the Rapporteurs; they are of the Ministry of Public Health at the Hague: Mrs. H. Emanuel v

6 vi Mrs. L. Gunning Mrs. Dr. J. Hageman Or. J.W. Hartgerink and of the University of Limburg: Mr. A.W.M. Meijer Mrs. Dr. I. Mur ACKNOWLEDGEMENTS I would also like to specifically acknowledge my staff both at the Ministry of Public Health and Environmental Hygiene and at the State University of Limburg who have assiduously dispatched every assignment to make this Conference succeed. A special note of thanks is due to Mrs. M.A. Holtmans Mrs. M.A. Lameree Mrs. F.W.M.A. Jans de Haan for their organizational and secretarial support during the preparation during the Conference itself and especially during the period after the Conference with regard to the typing and editing of the underlying Proceedings. Albert van der Werff Programme and Conference Chairman NATO Advanced Research Institute on Health Services Systems The Hague, 1982

7 PREFACE The Advanced Research Institute on "Health Services Systems" was held under the auspices of the NATO Special Programme Panel on Systems Science as a part of the NATO Science Committee's continuous effort to promote the advancement of science through international cooperation. A special word is said in this respect supra by Professor Checkland, Chairman of the Systems Science Panel. The Advanced Research Institute (ARI) was organized for the purpose of bringing together senior scientists to seek a consensus on the assessment of the present state of knowledge on the specific topic of "health services systems" and to present views and recommendations for future health services research directions, which should be of value to both the scientific community and the people in charge of reorienting health services. The conference was structured so as to permit the assembly of a variety of complementary viewpoints through intensive group discussions to be the basis of this final report. Invitees were selected from allover Europe and North America, including observers from the major international organizations involved in health services research, to provide the experience and expertise necessary to make the issue of "health services systems" val id and significant. The structure of the ARI was designed along the six topics mentioned and highlighted in the introductory address "Health Services Systems in the Western World" (p. 7). The meeting was basically organized in two modes: plenary sessions and parallel workshops on special ized topics. Intensive personal contacts and evening sessions where reports from the day's workshops were presented proved to be very useful for the better understanding of the problems and needs of health services with regard to the systems approach. Rapporteurs wno were assigned to the plenary systems and the chairman and rapporteurs of each workshop prepared summaries which provided the basis for the reports that were ultimately drafted. Special thanks are due for the help and assistance of Dr. B.A. Bayraktar of the Scientific Affairs Division, NATO, which so generousvii

8 vw PREFACE ly provided the ways and means to organize and execute the Advanced Research Institute in such a broad manner. The same holds true for the Ministry of Public Health at the Hague, specifically its Director-General Dr. J. van Donden, who provided the conference equally with both financial and support in natura, for which a special acknowledgement is in order. --- The ultimate success of any conference is based on the activity of the participants and observer~ and they in particular deserve our special thanks, not only for the excellent presentations and ultimate manuscripts which they prepared, but for their devotion to the task of interchanging ideas on a topic which has important implications for the future restructuring of many national and regional health services and ultimately profound consequences for the health and health care of individuals and communities. Because of the intensity and enthusiasm of the participants and observers, who make the ARI a most memorable one, the real success of the conference cannot be determined only by the quality of this volume, but by its impact on future work in this new and important area of health services research. April 1983 The Hague Charles O. Pannenborg Editor

9 CONTENTS Special addresses Opening address of the NATO ARI-HSS Conference M.H.M.F. Gardeniers-Berendsen Adress from the Systems Science Panel.... P.B. Checkland Health Services Systems in the Western World: An International Perspective on Problems and Prospects A. van der Werff SECTION I Re-orienting Health Services-Application of a Systems Approach A Systems view of Health Services and Their Reorientation: Summary of the Conference Proceedings and Background Papers G.B. Hirsch Analysis of Health Services Systems- A General Approach 47 M.I.Roemer "A Systems Approach" and "Health Service Systems": Time to Re-think? P.B. Checkland SECTION II Tools for doing it Introduction A. van der Werff ix

10 x CONTENTS Some Aspects of Alternative Approaches to Planning 69 A.W.H. Meijer Manpower Planning and Health Services Systems G. Wennstrom Financing and Health Services Systems L. Delesie Cost-effectiveness and Health Services Systems - A Systems Approach to the Assessment of Health Care C.O. Pannenborg Health Services Systems and Information Services A.S. Haro Research and Development and the Health Systems Approach D. Affeld SECTION III National Experiences Introduction A. van der Werff The French Health Services System J.F. Lacronique The Dutch Health Services System: Problems and Measures of Interdependencies and Control A.C.J. de Leeuw lom. Mur-Veeman The Italian Health Services System A. Bariletti Health Services in the United States: Groping Toward a "System"? A.R. Somers

11 CONTENTS xi The Health Services Systems in Belgium J.E. Blanpain The Health Services System in Turkey M.R. Dirican The Health Services of Norway: on the Road to a Political System H.T. Skaug The Canadian Health Services System A. Crichton The Health Services System of the United Kingdom K. Barnard D.M. Pendreigh The Changing Health Services System in Greece A. Ritsataki Participants In.dex