overview of health service
provision and service delivery
This chapter is concerned with the organisation of healthcare systems, healthcare provision and service delivery. In this context, it also explores the different forms of ownership and control of healthcare organisations, and the impact of ownership and control on system design and service delivery.
Healthcare services are often delivered within systems and organisations comprised of three distinct but increasingly overlapping and fluid subsystems – primary, secondary and tertiary care. In this chapter a model of an overall healthcare system and these three components is introduced, and an example of a healthcare organisation from each of these three subsystems is described, though it is recognised that healthcare organisations increasingly cut across the boundaries of primary, secondary and tertiary care and such vertical integration may provide opportunities for improving overall system performance.
The chapter also outlines a range of different models of ownership and control for healthcare organisations – ranging from for-profit commercial companies, through independent not-for-profit entities, to government-funded and controlled agencies. Examples from a range of different healthcare systems are used to explore the effects of ownership and control on healthcare system performance.
The provision of healthcare services within a regional or national healthcare system can be usefully categorised and analysed through the classification of three main subsystems or sectors – primary, secondary and tertiary care (see Figure 4.1). Each of these sectors can be modelled as a subsystem of the whole healthcare system, though in many countries the