A health care system is composed of inter-related and interacting components: health care professionals, processes, programs and institutions. For the purposes of this document the term "health care professional" is used to describe any person specifically trained to participate in the activities of a health care system. As such, health care professionals include planners, managers, clinicians, researchers, technicians, coders and health records professionals. The term "providers" is used to describe those health care professionals who interact directly with persons or populations for the purpose of providing health care.

The purpose of a health care system is:

A system's objectives for moving toward these goals should be determined by the values and priorities of the client population and are, clearly, limited by the resources available to the system. The cycle of activities required to meet the objectives of a health care system is generalized in Figure I-1. An integral component in the cycle is the collection of data and the use of information to formulate decisions. The quality of health care service delivery is predicated on accurate and timely decisions based on information derived from observations made of the health care delivery process and the status of the people affected.

Short term objectives of a health care system must be:

The information used to support these objectives must then be based on data that monitor the health status of both individuals and populations. If one considers this information to be derived from a menu of data items, usually the most prominent item on the menu are vital statistics, that is, the number of births and deaths, but, without census data, rates can not be derived and comparisons can not be made to desired birth and mortality rates. These statistics, however, do not encompass morbidity, the incidence of disease in the population, so that too must be added to the menu.

Although it is desirable to collect data to monitor the health care services and the state of health there must be a mechanism to do so. As such, a health information system is needed. This is not to imply that the system must be computerized although computerization makes data processing simpler. Information systems in health care are 'essentially' complex, that is, their complexity, (which may sometimes be amplified by fictitious needs or wish lists), is based on complex political and social structures and human biological systems. Even in the most technically sophisticated operating environments, the computerized information systems are frequently incompatible, and are considered by various users to be insufficient, narrow in scope, clumsy, error-prone, and inflexible. Manual systems have exactly the same problems but, in addition, they are incapable of processing the data in a timely fashion. Both manual and computerized systems require nurturing, administration, and in-depth understanding of their data structures and information processing methods.

Even though the appropriate data may be collected, there are several other issues to be considered, and, if one is as serious as one should be, monitored and controlled. Data that is inaccurate or processed long after it is useful is nearly as bad as no data whatsoever - at best, it is unreliable and not credible. At worst, it wastes resources and may even lead to destructive decisions.

The availability of census counts is invaluable because they are used nearly everywhere a regional or national health status indicator is derived. It is the use of these indicators that makes comparisons among regions and nations possible. These comparisons are the benchmarks that can be used to evaluate the effectiveness and efficiency of services, programs and policies.

Most countries, regions, and institutions struggle to choose and define indicators and to establish desired standards. To calculate an indicator or to understand its implications requires an understanding of a) the health care system and its institutions that make the observations, b) the data collected, and c) the method used to derive the indicator. An individual who performs this task must have a high level of familiarity with health care services in the appropriate institution or geographical region, the quality of data collected, and the statistical methodology needed to formulate the result.

Levels and Types of Health Care

The health care cycle (figure 1) is applicable to any of the levels and types of activity within a health care system. Levels of health care activity can be generalized as:

Primary Care

Activities executed in the communities and principally intended to promote health and prevent disease: immunization, prenatal and postnatal care, nutritional counseling, etc.

Ambulatory Care

Activities executed in the communities, normally in out-patient health care facilities, and principally intended to manage chronic diseases (e.g., cardiovascular, metabolic, oncological) and treat minor disease on an outpatient basis.

Institutional Care

Activities executed in centrally located, technically sophisticated facilities for the purpose of acute disease treatment or chronic disease management on an inpatient basis. Certain disease prevention and health promotion activities, such as perinatal obstetric care, are also carried out in institutional settings.

Types of health care system activity can be generalized as:

Care

Interaction between health care providers and persons or populations for the purpose of disease treatment and prevention, and health promotion

Management

Interaction between health care managers and programs and facilities for the purpose of maintaining the conditions required for the continued effective and efficient health care activities within those programs and facilities

Planning

Interaction between health care planners (administrators, policy-makers, MOH officials, etc.), the populations they serve and the health care infrastructure for the purpose of distributing available health care resource according to the health care needs of the current population. Health care resources include human resources, supplies, equipment, facilities, etc.Planning is a continuous process because of changes in population distribution, changes in the health profiles of the population, and changes in health care technology and knowledge over time.

Table I-1 provides some examples of the health care system actions produced by each type of activity, the decisions required to execute those actions, the information required to fuel those decisions and the data necessary to produce that information.