Faculty of Medical and Health Sciences


POPLHLTH 301 - Strengthening Health Systems

15 Points

Semester 2

Tāmaki

Description


This course discusses the New Zealand health system in an international context; health system reform, priority setting and rationing; managed care and health integration; and the future of health care in New Zealand.

Requisites


Prerequisite: POPLHLTH 202, 215

Course outline


Relatively rich countries such as New Zealand generally spend a large proportion of their resources on health care. But does spending more on health care lead to better health outcomes? For individuals, the answer is generally 'yes', but more resources for health won't necessarily mean that the whole population is healthier. Whether or not spending on health leads to a healthy population largely depends on the way a country's health system is organised. 

Building on what you learned in POPLHLTH 101, this course provides the opportunity for deeper discussion about the goals of health systems, how they work and how they perform. Throughout the course you will be challenged to use a variety of tools and frameworks to consider: 

  •  The importance of access, equity, financing, efficiency and quality goals
  •  How you know if the health system is performing well
  •  How improving one aspect of the health system affects the other aspects

Key course objectives by module


Module 1: Introduction (Dr Laura Wilkinson-Meyers)

What is this module about?

It will have been over a year since you studied about health systems in POPHLTH 101: Health Systems 1. This module is meant to remind you of some of the key concepts that you explored in that course and to set the stage for a deeper exploration of health system performance.

What should I know by the end of it? (Learning objectives)

  • Understand the main components of a health system, the key stakeolders involved, as well as the main criteria used internationally to assess the performance of a health system
  • Understand why access, equity, quality and efficiency are key criteria used to assess the performance of health systems


Module 2: Improving Access and Equity (Dr Laura Wilkinson-Meyers)

What is this module about?

This module introduces some of the philosophical foundations for equal access to health care. It defines and explores different aspects of access to health services and challenges our thinking about evaluating access and equity. We will also explore health system factors that contribute to equity of access to health services.

What should I know by the end of it? (learning objectives)

  • Define equality, equity, access, equity of access, horizontal (in)equity, vertical equity as used in health services and health systems research
  • Gain a deeper understanding of the concept of needs and its relevance to debates about access to health care and equity
  • Identify the factors that contribute to, and the factors that alleviate inequity of access to health services
  • Critically examine access issues to a particular health service

Module 3: Improving Quality (Dr Peter Carswell)

What is this module about?

This module explores mechanisms for improving quality in health services. In doing so it outlines the context of healthcare that often makes such improvement difficult to either commence or sustain. A number of tools are presented that can be used in supporting quality improvement. These tools are discussed within a set of principles designed to support sustainable change.

What should I know by the end of it? (learning objectives)

  • Be able to define quality as it relates to health care and describe key measures of quality
  • Be able to describe the quality improvement cycle
  • Be able to describe at least two tools for quality improvement


Module 4: Improving Efficiency (Prof. Toni Ashton and Dr Laura Wilkinson-Meyers)

What is this module about?

This module explores different ways of raising and allocating health care funds and the impact of different financing mechanisms on goals of access, equity, quality and efficiency.

What should I know by the end of it? (learning objectives)

  • Be able to debate the strengths and weaknesses of different financing arrangements
  • Know the main payments systems for health professionals and hospitals
  • Appreciate the types of incentives associated with each form of payment
  • Appreciate arguments for and against cost containment as a policy objective
  • Describe the main methods of containing costs
  • Identify the main strategies that have been used in New Zealand to improve efficiency and contain costs


Module 5: Case Studies
In the final module of the course you will be asked to present case studies of current initiatives in New Zealand health policy and to consider their contributions to improving health system performance against the goals of access, equity, efficiency, cost containment and quality.
 

Course structure


There are three basic formats for teaching and learning in this course: lectures, Think Tank workshops and office hours. The course consists of 24 one-hour lectures (2 per week), 12 one-hour Think Tank workshops and 12 office hours.

Lecture, Tutorial & Assessment Schedule


Module

Lecture

Topic

Lecturer

Intro

1

Course Intro & Welcome

LWM

1

MODULE 1:  Improving Health Systems

2

Key Health Systems Concepts 

LWM

 

Tutorial

Think Tank 1: Introduction to Think Tank & Topics

3

Key Health Systems Concepts II

LWM

4

Health System Goals: Access, Equity, Efficiency & Quality

LWM

 

Tutorial

Think Tank 2: Getting to know your stakeholders & Relationships between them

2

MODULE 2: Improving Access & Equity  

5

Access & Equity: Definitions and Measures

LWM

6

Improving Equity

RM

 

Tutorial

Think Tank 3:  Exploring Access & Equity Issues in your Topic: Relationship to other goals?

7

Needs and Needs Assessment

LWM

8

Improving Access 

LWM

 

Tutorial

Think Tank 4:  Addressing Needs & Improving Access in Your initiative

3

MODULE 3: Improving Quality

 

Assignment 1 Due – Background Paper

9

Intro to quality

PC

10

Quality Improvement I

PC

 

Tutorial

Think Tank 5: Defining quality in your initiative

11

Quality improvement II

PC

12

Quality Improvement III

PC

 

Tutorial

Think Tank 6:  Improving quality in your initiative

 

Mid Semester Break

 

MODULE 4:  Improving Efficiency

13

Intro to concepts of cost containment vs effiicency   

TA

14

Improving efficiency I

TA

 

Tutorial

Think Tank 7:  Assignment 1 Feedback & Assignment 2

15

Improving efficiency I

TA

16

Paying Providers

LWM

 

 

Tutorial

Think Tank 8: How does money matter in your topic: A look at the flow of funds

4

MODULE 5:  Presentation Prep Week

 

 

Assignment 2 Due – Solutions Paper

17

Presentations with SLS

 

18

Presentation Prep Time 

 

 

Tutorial

Think Tank 9: Presentation Prep Time

5

MODULE 5:  Making Connections

 

All Presentation Slides Due

19

Workshops – Immunisation Target

Students

20

Workshops – ED Target

Students

 

Tutorial

Think Tank 10: Discuss Immunisation & ED Target

21

Workshops – Elective Surgery Target

Students

22

Workshops  - Cancer Treatment Target

Students

 

Tutorial

Think Tank 11: Think Tank Workshop: Discuss ES and Cancert Tx Targets

23

Workshops  - Smoking Cessation Target

Students

24

Workshops – Heart Checks Target

Students

 

Tutorial

Think Tank 12: Wrap Up & Exam Review

LW

Course assessment


  • Assignment 1 – Background Paper on Special Topic (20%)

  • Assignment 2 - Special Topic Solution (20%) 

  • Weekly Think Tank Activities - includes weekly workshops during tutorial & take-home activities (10%)

  • Think Tank Group Presentation (10%) 

  • Final Exam (40%) 

Recommended readings


There are no prescribed texts for this course. A list of recommended readings is given for each module. Students will be expected to have read these prior to the sessions, and to be prepared to discuss the issues and questions arising from them. This is intended to help students expand their reading on each topic, and is also designed to assist with assignment work. Students are, however, encouraged to read much more widely. In preparing assignments, students will be expected to have gone well beyond the references listed.

POPLHLTH 301 course library web page
The course’s web page on the library web site contains links to all your required readings and other useful research sites.
 

Course Director