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Defining a healthcare system

In this step, we define a healthcare system.

So far, we’ve defined what we mean by ‘healthcare’ and ‘system’ and examined the common characteristics of the latter. Let’s now bring these together and consider what we mean by a healthcare system.

The two following definitions provide a useful starting point. A healthcare system is:

… all activities whose primary purpose is to promote, restore, and maintain health.
(WHO 2000: 5)
… the combination of resources, organisation, financing, and management that culminate in the delivery of health services to the population.
(World Bank 2007: 173; Roemer 1991)
Therefore, a healthcare system comprises different individuals, organisations, workforces, stakeholders, policies, resources, funding, technology, actions, interactions and reactions, working towards meeting the health needs of a particular patient, user, community or population.
This brings us back to our big question.

Is there a perfect healthcare system?

There are a few international ranking tables comparing healthcare systems across the world and looking at performance between countries. These tables are often used by politicians and journalists to praise or criticise the actions of others.
The World Health Organisation (WHO) produced its first and only ranking in 2000, which placed France at the top. The decision not to repeat the ranking was probably a reflection of the controversy it generated.
The Commonwealth Fund produces a ranking that uses a methodology to rank 11 countries against a set of indicators – and the Economic Intelligence Unit (EUI) analyses the spending and outcomes across 166 countries.
The challenge of comparing healthcare systems is that the ranking is dependent on the indicators used and there is no universally accepted set of metrics for assessing healthcare systems. Additionally, the characteristics of healthcare systems are influenced by the society, culture and practices of the population they service.
The principle of healthcare being available free at the point of use, irrespective of ability to pay, is enshrined in law in the UK (DHSC 2012). In the USA, universal healthcare is a highly political and much-debated topic. President Obama’s Patient Protection and Affordable Care Act of 2010 continues to be subject to repeated repeal attempts by President Trump in 2020.
Britnell (2015) studied the various characteristics of healthcare systems in his book The Perfect Health System. He concluded that there isn’t a perfect health system in the world, but if one could be built, it should consist of the:
  • Values and universal healthcare of the UK
  • Primary care of Israel
  • Community services of Brazil
  • Mental health and wellbeing of Australia
  • Health promotion of the Nordic countries
  • Patient and community empowerment in parts of Africa
  • Research and development of the US
  • Innovation, flair and speed of India
  • Information, communications and technology of Singapore
  • Choice of France
  • Funding of Switzerland
  • Aged care of Japan

Your task

Within a healthcare system you are familiar with, consider its areas of strength and weakness against the elements of a ‘perfect’ health system highlighted by Britnell (2015).
Share your thoughts in the comments area.


Britnell, M. (2015) In Search of the Perfect Health System. Macmillan International Higher Education.

Department of Health and Social Care (2012) NHS Constitution for England [online] available from [21 April 2020]

Roemer, M. I. (1991) National Health Systems of the World. Volume 1: The Countries. Oxford: Oxford University Press.

World Bank (2007) Healthy Development: The World Bank Strategy for Health, Nutrition, and Population Results. World Bank Publications.

World Health Organization (2000) The World Health Report 2000: Health Systems: Improving Performance. London: World Health Organization.

© Coventry University. CC BY-NC 4.0
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Understanding Systems Thinking in Healthcare

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