Health systems, public health, and resource stewardship
Domain 9 - Health systems, public health, and resource stewardship
This domain tests how care is organized, financed, and prioritized, including prevention, screening, and efficient use of limited resources.
Core rules
- Levels of prevention: primordial, primary, secondary, tertiary, and quaternary.
- Screening requires a common and treatable disease, an acceptable test with good sensitivity and specificity, evidence that early treatment improves outcomes, and acceptable cost.
- Stewardship: use essential medicines, avoid low-value tests, choose generic equivalents, and consider opportunity cost.
- In the Palestinian context, pluralistic financing and providers, referral pathways, out-of-pocket spending, and donor support shape access and equity.
Worked example
A clinic considers PSA screening for all men over 50. Apply Wilson–Jungner criteria: prostate cancer is common and the test is acceptable, but evidence that early treatment reduces mortality is contested because of overdiagnosis. Shared decision-making for high-risk men is more defensible than universal screening.
Traps
- Screening without evidence that early treatment changes outcome.
- Ignoring overdiagnosis and false positives.
- Choosing a costly intervention when a cheaper equivalent exists.
- Neglecting equity and access in resource allocation.