<?xml version="1.0" encoding="UTF-8"?>
<opml version="2.0">
  <head>
    <title>103-02 Health systems, financing, economics, quality, and resource allocation</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Health systems, financing, and allocation">
      <outline text="System goals and structure">
        <outline text="People, organisations, resources, rules, relationships"/>
        <outline text="Performance not judged by volume alone"/>
        <outline text="Health, responsiveness, financial protection"/>
        <outline text="Fair distribution and resilience"/>
        <outline text="Primary care: first contact, continuity, coordination">
          <outline text="Resolves common problems, manages multimorbidity"/>
        </outline>
        <outline text="Gatekeeping improves coordination">
          <outline text="Harmful if slow or budget-driven"/>
        </outline>
        <outline text="Referral needs clear questions and feedback"/>
        <outline text="Centralisation helps when volume matters">
          <outline text="Travel and separation create burdens"/>
        </outline>
      </outline>
      <outline text="Coverage and financing">
        <outline text="Universal health coverage">
          <outline text="Needed quality services without hardship"/>
        </outline>
        <outline text="Who, which services, how much cost"/>
        <outline text="Entitlement can coexist with informal fees"/>
        <outline text="Promises without workforce create queues"/>
        <outline text="Financing: revenue, pooling, purchasing"/>
        <outline text="Pooling shares uncertain costs"/>
        <outline text="Fragmented pools select low-risk members"/>
        <outline text="Out-of-pocket payment risks catastrophe"/>
      </outline>
      <outline text="Insurance and provider payment">
        <outline text="Adverse selection destabilises voluntary pools"/>
        <outline text="Risk adjustment can be gamed"/>
        <outline text="Moral hazard includes beneficial forgone use"/>
        <outline text="Cost sharing deters poorer, sicker patients"/>
        <outline text="Fee-for-service encourages volume"/>
        <outline text="Salary: predictable, weaker marginal incentive"/>
        <outline text="Capitation promotes prevention">
          <outline text="Risk selection or under-service"/>
        </outline>
        <outline text="Case-based payment invites coding, early discharge"/>
        <outline text="No mechanism aligns every objective"/>
        <outline text="Quality bonuses neglect unmeasured care"/>
        <outline text="Payment can displace other motives"/>
      </outline>
      <outline text="Economic evaluation">
        <outline text="Compares costs and consequences"/>
        <outline text="Cost-effectiveness: cost per extra outcome"/>
        <outline text="Cost-utility: quality-adjusted life years"/>
        <outline text="Cost-benefit: inputs and outcomes in money"/>
        <outline text="Assumptions: whose costs, horizon, discounting"/>
        <outline text="ICER: cost difference over effect difference">
          <outline text="Compare alternatives on efficiency frontier"/>
          <outline text="Cheaper and more effective dominates"/>
          <outline text="Unstable when differences are small"/>
        </outline>
        <outline text="Threshold reflects opportunity cost, not life&#x27;s price"/>
      </outline>
      <outline text="Opportunity cost and equity">
        <outline text="Value forgone from next best alternative"/>
        <outline text="New technology can displace better care"/>
        <outline text="Budget impact differs from cost-effectiveness"/>
        <outline text="Equal gain may carry unequal priority"/>
        <outline text="Distributional weights are ethical choices"/>
        <outline text="Efficiency and equity can improve together"/>
        <outline text="Deliberate trade-offs transparently"/>
      </outline>
      <outline text="Priority setting and waiting">
        <outline text="National, organisational, bedside levels"/>
        <outline text="Relevant reasons, transparency, appeal, enforcement"/>
        <outline text="Wealth or celebrity must not decide access"/>
        <outline text="Waiting list is an allocation system"/>
        <outline text="Waiting rations care without price">
          <outline text="Long waits worsen disease and inequity"/>
        </outline>
        <outline text="Separate referral, assessment, treatment intervals"/>
        <outline text="Moving delay elsewhere is not improvement"/>
      </outline>
      <outline text="Quality and safety">
        <outline text="Safety, effectiveness, timeliness, equity"/>
        <outline text="Structure, process, outcome"/>
        <outline text="Process measures matter if linked to outcomes"/>
        <outline text="Over-adjustment excuses poor care"/>
        <outline text="Patient experience differs from outcome"/>
        <outline text="Adverse events emerge from system conditions"/>
        <outline text="Reporting systems underreport"/>
        <outline text="Root-cause analysis beyond final error"/>
        <outline text="Redesign beats reminders"/>
      </outline>
      <outline text="Workforce, information, resilience">
        <outline text="Numbers, skills, distribution, retention"/>
        <outline text="Training more clinicians takes time"/>
        <outline text="Task sharing needs training and support"/>
        <outline text="Burnout and turnover are system outcomes"/>
        <outline text="Interoperability lets information follow patients"/>
        <outline text="Documentation burden and copied error"/>
        <outline text="Governance balances privacy and public benefit"/>
        <outline text="Resilience: prepare, absorb, adapt, learn"/>
        <outline text="Redundancy looks inefficient until shocks"/>
        <outline text="Protect routine care during crises"/>
      </outline>
      <outline text="Systems as ethical institutions">
        <outline text="Financing decides who bears risk"/>
        <outline text="Payment defines incentives"/>
        <outline text="Queues distribute time"/>
        <outline text="Success is health gained, fairly distributed"/>
      </outline>
    </outline>
  </body>
</opml>
