Biomedical Engineering Reference
In-Depth Information
A health system is composed of interacting elements that include: (1) “financing”
(how the funds are collected and pooled); (2) “resource allocation and provider pay-
ment systems” (how the pooled funds and other available resources, such as human
resources, capital investment or equipment, are allocated, and the mechanisms and
methods used for paying health service providers); (3) “stewardship and organ-
isational arrangements”, which describe the policy- and regulatory-environment,
and the structural arrangements for purchasers, providers and market regulators;
and (4), “service provision”, services the health sector provides as distinct from
the structures within which these services are provided (Atun et al. , 2007a). Pol-
icy makers manage these elements through regulations and incentives to achieve
health system objectives and goals. These elements interact, so that changes in
one element influence the functioning of others, creating a complex dynamic sys-
tem. This interaction affects the way the rules, norms and enforcement mechanisms
are implemented to generate system responses. As with the behaviour of other
complex systems, these responses may not be easy to predict and may indeed be
counterintuitive (Atun et al. , 2005) — sometimes leading to the opposite effect
to the change that was intended. For example, a regulatory intervention aimed at
rationing novel technologies or services to reduce costs and improve efficiency
may adversely affect equity or effectiveness and indeed increase overall cost of the
health system, if a reduction in service- or technology-access in one part of the
system causes increased utilisation of services in other parts. Hence, there is a need
for more holistic approaches to policy making, with careful examination of possi-
ble impact of regulatory interventions on system objectives (Atun and Menabde,
2007).
How Regulation Influences Uptake and Diffusion of Innovations
in Health Systems
The influence of regulation on the uptake and diffusion of innovations can be
explored through a prism of new innovative drugs. In the pharmaceutical sec-
tor, an innovation is defined as a technological advance leading to the creation
of a new drug or one that enhances the therapeutic value of an existing drug
(Wilsdon and Nitsche, 2004). Diffusion occurs when “an innovation is commu-
nicated through certain channels over time among the members of a social system”
(Rogers, 2005).
Earlier reviews which have explored diffusion of innovations in service organ-
isations identified that empirical studies in this area were limited in number and
narrow in scope, focusing on single factors but not taking into account how broad
contextual and health system factors influence the adoption and diffusion process
(Greenhalgh et al. , 2005). This methodological shortcoming is important because
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