Healthcare System

The complexity of health systems and the delivery of healthcare has resulted in the growing field of health systems science, which has now joined basic and clinical sciences as the 3rd pillar of medical education. Health systems science allows for an understanding of the framework in which care providers practice, and in comprehension of the interconnected components of care delivery. Effective communication and collaboration within this context are essential for providing quality healthcare. The patient is at the center of a nested model of healthcare and is surrounded by the care team, the supporting organizational infrastructure, and the political environment. Models of health systems are defined by the ways in which healthcare is paid for, financed, and delivered. Healthcare delivery systems are further defined by a network of providers, affiliated organizations, and financial structures.

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Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Table of Contents

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  • Health systems science provides a framework to understand all interconnected components of the health system.
  • Communication, collaboration, and context are essential for quality healthcare.
  • Models for health systems are based on the way in which healthcare is paid for, financed, and delivered: Beveridge, Bismarck, single-payer, and out-of-pocket models
  • Healthcare delivery systems are defined by the network of organizations and providers of care within a given financial structure, such as Health Maintenance Organization (HMO) and Integrated Delivery System (IDS).

Health Systems Science

  • Defined as “the principles, methods, and practice of healthcare delivery”
  • A framework for how care is delivered to meet the needs of patients or populations
  • The manner in which professionals work together to improve patient care
  • The 3rd pillar of medical education along with basic and clinical sciences
  • Domains of health systems science:
    • Healthcare structure and process:
      • Organization of individuals, resources, and processes for care delivery
      • Coordination and collaboration of care
    • Healthcare policy and economics:
      • Decisions, plans, and actions taken to meet community healthcare goals
      • Efficiency and effectiveness
    • Clinical informatics and health technology:
      • Electronic health records, documentation, and decision support
      • Analysis of data for healthcare improvement
    • Population, public, and social determinants of health:
      • Strategies to improve population health
      • Consideration of social determinants of health
      • Measuring and monitoring key health metrics
    • Value in healthcare:
      • Delivery of quality of care divided by the cost of care over time
      • Health economics outcomes research (HEOR) is an emerging branch of health science.
    • Health system improvement:
      • Measuring and analyzing the quality of care delivery
      • Setting goals for improvement, implementing interventions, evaluating effectiveness, and continual improvement
    • Leadership:
      • Motivating others to pursue a common goal
      • Emerging key opinion leaders (KOLs) among medical and surgical subspecialties:
        • Development of consensus guidelines
        • Development of standardized quality measures
    • Teaming:
      • Collaboration to achieve shared goals
      • Development of coordinated care teams
      • Development of clinically integrated networks (CINs)
    • Change agency, management, and advocacy:
      • Knowledge and skills required to act as a change agent
      • Patient advocacy to improve healthcare services for patients
      • Deliver the best quality of care
    • Ethics Ethics Medical ethics are a set of moral values that guide the decision-making of health care professionals in their daily practice. A sense of ethical responsibility has accompanied the profession of medicine since antiquity, and the Hippocratic oath was the 1st document to codify its core ethical principles. Basics of Medical Ethics and legal:
      • Ethical and legal issues involved in healthcare delivery
      • Administrative codes set by the state medical boards
      • Medicolegal review committees integral to pharmaceutical, biotechnology, and medical device industries
    • Systems thinking:
      • An understanding of how these domains interact
      • Emerging system of integrations, checks, and balances
Health systems science domains

Health systems science domains

Image by Lecturio.

Models of Health Systems

  • Beveridge model:
    • Paid for by healthcare and provided by the government
    • Financed by taxation
    • Examples:
      • UK National Health System
      • US Veterans Administration (VA)
      • New Zealand
      • Spain
  • Bismarck model:
    • Healthcare paid for by nonprofit insurance
    • Financed by employee, employer contributions, and general tax revenue
    • Service provided by private and public sectors
    • Examples:
      • Netherlands
      • Switzerland
      • France
      • Germany
      • Japan
  • National health insurance or single-payer model:
    • Healthcare paid for by government-run insurance programs
    • Financed by taxation
    • Service provided in private and public sectors
    • Examples:
      • Canada
      • US Medicare
      • South Korea
  • Out-of-pocket model:
    • Healthcare paid for by the consumer
    • Service provided by private and public sectors
    • No insurance coverage
    • Low- and middle-income countries
    • Examples:
      • Rwanda
      • India
      • Chad

Healthcare Structure and Process

  • Nested model of healthcare structure:
    • Patient:
      • At the center of care
      • The patient is empowered to be a key player in healthcare decision making.
    • Care team:
      • Professional care providers (physicians, nurses, pharmacists, others)
      • Patient self-care
      • Family members
    • Organization:
      • Hospitals, ambulatory surgical centers, doctor’s offices, nursing homes
      • Infrastructure that supports the work of the care team
    • Political environment:
      • Conditions under which the care team and organization operate
      • Legal and regulatory entities oversee and administer the delivery of healthcare.
  • Healthcare processes:
    • Evaluation, testing, treatment, surgery, medication administration
    • Transfer to alternative facilities (i.e., more advanced resources, higher level of care)
    • Admission/discharge
A four level conceptual health model (1)

A 4-level conceptual health model

Image by Lecturio.

Healthcare Delivery Systems

  • HMO:
    • Provides designated services for a prepaid premium
    • Serves a geographic area known as a jurisdiction
    • Primary care provider ( PCP PCP Pneumocystis jiroveci is a yeast-like fungus causing pneumocystis pneumonia (PCP) in immunocompromised patients. Pneumocystis pneumonia is spread through airborne transmission and classically affects patients with AIDS, functioning as an AIDS-defining illness. Patients may present with insidious onset of fever, chills, dry cough, chest pain, and shortness of breath. Pneumocystis jiroveci/Pneumocystis Pneumonia (PCP)) evaluates and treats.
    • Referral initiated by PCP PCP Pneumocystis jiroveci is a yeast-like fungus causing pneumocystis pneumonia (PCP) in immunocompromised patients. Pneumocystis pneumonia is spread through airborne transmission and classically affects patients with AIDS, functioning as an AIDS-defining illness. Patients may present with insidious onset of fever, chills, dry cough, chest pain, and shortness of breath. Pneumocystis jiroveci/Pneumocystis Pneumonia (PCP), as needed, to specialist providers within the network
  • Exclusive provider organization (EPO):
    • Managed care plan
    • Providers only within a specific network
  • IDS:
    • A single or group of organizations
    • Ambulatory and tertiary-care services
  • Preferred provider organization (PPO):
    • Services rendered by preferred provider network
    • Referral not required
    • Services outside of the network have additional out-of-pocket costs.
  • Point-of-service (POS) plan:
    • Hybrid of HMO and PPO
    • Services rendered from participating and nonparticipating providers
    • Higher cost premiums, deductibles, and coinsurance
  • Telemedicine services:
    • Video technology used to increase ease and access to care
    • Care delivery based exclusively on televisits
    • Services limited to conditions not requiring in-person visits
    • Organizations, individuals, and health plans finance these benefits.
  • Concierge services:
    • Individual or group of providers
    • Flat monthly payment in exchange for medical services


  1. American Medical Association. Health Systems Science. Retrieved December 15, 2021, from: https://www.ama-assn.og/topics/health-systems-science
  2. Reid, P.P., Compton, W.D., Grossman, J.H., et. al.; Editors (2005). A Framework for a Systems Approach to Health Care Delivery. National Academy of Engineering (US) and Institute of Medicine (US) Committee on Engineering and the Health Care System; Washington (DC): National Academies Press (US).
  3. Types of Health Systems. Columbia Comparative Health Policy Library. Last Updated: Sep 30, 2021. Retrieved December 15, 2021, from
  4. Medicare Supplement. 7 Common Health Care Delivery Models Explained. Retrieved December 15, 2021, from

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