Health system responsiveness

Health System Responsiveness Dr. Ahmed-Refat AG Refat
www.SlideShare.Net/AhmedRefat 18-12-2012

Health System
Responsiveness
‫االستجابة كمؤشر اداء النظام الصحي‬
"‫"اإلعزاز و اإلحسان‬
Dr.
Ahmed-Refat AG Refat
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Contents
 Dimension and objectives of health system
 Definition of responsiveness
 Legitimate expectation
 Patients vs customer
 Elements of responsiveness
 Dignity
 Autonomy
 Confidentiality
 Prompt attention
 Quality of amnesties
 Access to social support
 Choice of Care Provider

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The World Health Organisation’s new
framework for health system
performance assessment has
health improvement, responsiveness
and fairness of financing

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as the three goals of the health
system

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Functional Form for Overall Health
System Attainment
The general form of the overall
measure of health system attainment
is simply:
Composite = f (H,HI,R, RI,FF)

Health system attainment is simply:

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Composite = f (H,HI,R, RI,FF)
Where
H is the level of health,
HI is health inequality,
R is responsiveness,
RI is responsiveness inequality
and FF is fairness of financial contribution.

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What is
Responsiveness
Response to individuals’ legitimate
expectations regarding the non-health
enhancing aspects of the health
system.
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Why Responsiveness
Patient satisfaction with non-medical
aspects of care, is often associated
with better compliance with
treatment instructions, prompt
seeking of care and a better
understanding and retention of
medical information .
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WHAT IS Health System
RESPONSIVENESS?
Responsiveness in the context of a system can be
defined as:

the outcome that can be achieved when
institutions and institutional relationships are
designed in such a way that they are respond
appropriately to the universally legitimate
expectations of individuals.
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Responsiveness can be viewed from two angles.
Firstly
The user of the health care system is often
portrayed as a consumer, with greater
responsiveness being perceived as a means of
attracting consumers.

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Secondly,
Responsiveness is related to the safeguarding of
rights of patients to adequate and timely
care.
“treat those who use health services as
consumers within a market
based and people centred system”.

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Patient
or
Client /Customer/Consumer ???
Patient Vs Customer

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The use of the word patients is considered to
underrate the status of the individual, as it crates
a hierarchy.

The patient should be defined as a consumer, a
rationale that originates from the emphasis on
the market mechanism.

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Patient Vs Customer

The term consumer dignifies the
professional/patient relationship in a way that the
traditional term patient with its association of
powerlessness against the medical
establishment does not.

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Patient Vs Customer

Using the word client, customer or service user
similarly moves away from the idea of the user of
medical services being passive and dependent.

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Patient Vs Customer
The seven principles should relate to consumers:
1. access,
2. choice,
3. information,
4. redress,
5. safety,
6. value for money
7. and equity
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Responsiveness Vs SATISFACTION
(1) Scope: patient satisfaction focuses on clinical
interaction in specific health care settings whereas
responsiveness evaluates the health system as a whole;
(2) Range: patient satisfaction generally covers both
medical and non-medical aspects of care while responsiveness
focuses only on the non-health enhancing aspects of the health
system;
(3) Rationale: patient satisfaction represents a
complex mixture of perceived need, individually determined
expectations and experience of care.
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Legitimate EXPECTATIONS
a- Expectations
Expectations are often simply defined
as individual’s beliefs regarding
desired outcomes.

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Four types of expectations:
- Ideal:
similar to aspirations, desires or preferred
outcomes
- Predicted
realistic, practical or anticipated outcomes that
result from personal experiences, reported
experiences of others and sources
of knowledge such as the media
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Four types of expectations:
- Normative
expectations that are based on what should or ought to happen
- Unformed
– the situation that occurs when individuals are unable or
unwilling for various reasons to articulate their expectations,
which may either be because they do not have expectations,
have difficulty expressing their expectations or do not wish to
reveal their expectations due to fear, anxiety or conforming to
social norms.

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Legitimate EXPECTATIONS
b- Legitimate
can be defined as conforming to
recognised principles or accepted
rules and standards.
Ethical norms can be set in most instances without
much debate
as to the optimal desired behavioural process

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Elements of
Responsiveness

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1 Dignity
The right of a care seeker to be
treated as a person in their own right
rather than merely as a patient

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Dignity includes:
♦ the safeguarding of human rights
such as the liberty to free movement
even for individuals who have
leprosy, tuberculosis or are HIV+
♦ treatment with respect by health
care staff;

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♦ the right to ask questions and
provide information during
consultations and treatment;
♦ privacy during examination and
treatment
Patients satisfaction levels are increased by doctors
taking time to make conversation with the patient, such
as make comments that are not related to health or
crack a joke.

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Assessment of dignity

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2-Autonomy

Autonomy is self-directing freedom.

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The Four rights of individual
♦ The right of an individual to
information on his/her disease and
alternative treatment options (this
facilitates informed choice)

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♦ The right to be consulted about
treatment

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♦ Informed consent in the context of
testing and treatment

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♦ The right of patients of sound mind
to refuse treatment

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Models of Autonomy.
1- The first the paternalistic model
has the health care provider making
all
decisions on behalf of the patient,
since the provider is considered to be
better informed this is considered to
be optimal.

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2- The second model termed the
informed decision making model,
imposes the need for information
dissemination on the
provider and the responsibility of
decision making on the patient.

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3- The professional agent model,
has the patient willingly foregoing
the right to decision making, though
well informed, through voluntarily
and explicitly transferring the
decision making
task to the provider.

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4- The final model termed the shared
decision making model
focuses on the sharing of both
information and decision making
between the patient

and the provider, including the
determination of preferences.

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Assessment of Autonomy

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3- Confidentiality
Information relating to the patient
and his illness should not be divulged
during the course of care, except in
specific contexts, without the prior
permission of the patient.

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Assessment of Confidentiality

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4- Prompt
Attention
Prompt attention is consist of three
characteristics:
♦ Patients should be entitled to rapid
care in emergencies, and

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♦ Patients should be entitled to care
within reasonable time periods
even in the case of non-emergency
health care problems or surgery..
♦ Patients seeking care at healthcare
units should not face long
waiting times for consultations and
treatment.

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Assessment of Prompt attention

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5- Qualities of
clean amenities
This aspect relates to the provision of
physical infrastructure and a
conducive care environment. The
study defines basic amenities in the
following manner:

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♦ clean surroundings
♦ regular procedures for cleaning and
maintenance of hospital buildings .
♦ adequate furniture
♦ sufficient ventilation
♦ clean water
♦ clean toilets
♦ clean linen
♦ healthy and edible food

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Assessment of the qualities of clean amenities

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6 -Access to social
support networks
during care
The patient welfare is best served if
the individual has access to support
networks during care.

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The procedures in the provision of
inpatient health care should allow
♦ regular visits by relatives and friends
♦ provision of food and other consumables
by relatives and friends, if not provided by
the hospital
♦ religious practices that do not prove a
hindrance to hospital activities or hurt the
sensibilities of other individuals

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Assessment of Social Support Network

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7- Choice of Care
Provider
The ability to choose between care
providers .

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Assessment

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Cited References
Amala de Silva. A FRAMEWORK FOR MEASURING RESPONSIVENESS .GPE Discussion Paper Series: No. 32
EIP/GPE/EBD. World Health Organization

Christopher JL Murray,Jeremy Lauer,Ajay Tandon,Julio Frenk. OVERALL HEALTH SYSTEM
ACHIEVEMENT FOR 191 COUNTRIES Discussion Paper Series: No. 28 EIP/GPE
World Health Organization

Ana-Lucia Ristea1, Ion Steg_roiu2, Valeriu Ioan-Franc3 and Vasile Dinu4 Responsiveness of Health Systems: a
Barometer of the Quality of Health Services. Amfiteatru Economic Vol XI • Nr. 26 • June 2009

WHO- World Health report 2000. http://www.who.int/whr/2000/en/whr00_en.pdf

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Health system responsiveness

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