Health Services Administration and Management
Core concepts
Know health system building blocks (service delivery, workforce, information, medicines, financing, leadership/governance) and the WHO framework for health system goals (access, quality, equity, efficiency, responsiveness). Understand financing models (tax-based, social insurance, private insurance, out-of-pocket), provider payment methods (fee-for-service, capitation, DRG, salary) and their incentive effects. Master planning cycle, priority setting, resource allocation, leadership styles, and quality improvement (PDSA, accreditation). Familiarity with cost concepts-cost-effectiveness, cost-benefit, cost-utility-and basic health economics is essential.
Traps
- Assuming fee-for-service controls cost-it incentivises volume.
- Confusing cost-effectiveness (cost per health outcome) with cost-benefit (monetary outcomes).
- Mixing equity (fairness of distribution) with equality (sameness).
- Forgetting that capitation incentivises under-provision while FFS incentivises over-provision.
Worked example / rule of thumb
Incremental cost-effectiveness ratio (ICER) = (Cost_new − Cost_old)/(Effect_new − Effect_old). If a new programme costs $500,000 and yields 100 extra QALYs versus $200,000 for 50 QALYs with the old one, ICER = (500,000−200,000)/(100−50) = $6,000 per QALY. Rule of thumb: compare ICER to a willingness-to-pay threshold; lower is better value.