International Comparative Analysis of Health Systems


Course Objective

Students acquire knowledge and insight into:
- Different ways in which health systems in different countries are
- Complex adaptive nature of health systems and their constitution
- Underlying reasons for reforming systems and different models for
reforming health systems
- The relationship between system innovation and transdisciplinary
- Different conceptual frameworks for carrying out a comparative
- Benchmarking the cost effectiveness of different health systems

The student learns:
- To design and carry out a comparative analysis and to reflect on the
scope of application, to make use of the framework for comparative
- To make a clear and structured presentation in the form of a lecture
and present it in a lecture session; and in the form of a poster and
present it in a poster presentation session

Course Content

Until recent, the field of global health mainly embraced
disease-specific initiatives and focused on the delivery of health
services for specific diseases, as well as their lifestyle,
environmental and socioeconomic determinants. After decades of such
disease-specific initiatives, it is now recognized that programmes that
solely target improving prevention or treatment of specific diseases
cannot yield the desired outcomes in the context of weak health systems.
A critical determinant of health, as well as the success of global
health initiatives, is the health system as a whole. Recognition of this
brought ‘strengthening of health systems’ on the global health agenda
and into funding schemes.

The global health researchers and professionals of this era need to have
a good understanding of health systems and the key skills to analyze and
compare them in order; to adapt themselves to the different health
systems in which they will work; to analyze different health systems and
identify: how they have evolved to this point; and in which areas and
how they can be strengthened to improve its outcomes.

Serving these purposes, this course aims to equip the students with the
knowledge and skills related to concepts, theory and methods on the
following key areas:
- What a health system is (and different ways of describing it)
- What goals and functions health systems have
- Why and how health systems and their performance can be analyzed and
- Why and how health systems evolve and can be reformed

In line with these, the course will cover low, middle income and
high-income countries and span across different health system goals
(health gain, equity, responsiveness, and effectiveness and efficiency)
and functions (stewardship, financing, resource generation, and health

In terms of methodology, students learn to use the case study approach
for carrying out a comparative analysis. Students will be acquainted
with the theory of case studies via lectures and reflection sessions and
will implement this method on two assignments. both qualitative and
quantitative aspects of ‘health systems comparison’ are discussed and
critiqued. Furthermore, the complexity and culturally determined nature
of health system design and health system reform are presented through a
series of lectures form VU-lecturers and experts from a variety of
institutions such as the Royal Tropical Institute and OECD.

Small group work for the assignments provides opportunities to practice
relevant skills by analyzing, first, the health system of two selected
high-income countries according to a defined theme (health finance,
primary care, and maternal care & family planning). Groups will present
their findings with a lecture. Subsequently, health systems of two
middle or low income countries with comparable financial resources (e.g.
GDP per capita, per capita health expenditure, etc.) but different
health outputs and outcomes are analyzed to find out why two countries
are performing in such different ways. The findings will be presented in
a poster format. By repeating the analysis on the same theme but with
different countries, the students are challenged to constantly improve
their own analysis process.

Teaching Methods

Teaching methods include lectures by VU teachers and guest lecturers,
lectures by other students, workgroups for assignments, problem-driven
learning, self-study. The total study time of 160 hours is distributed
as follows:
- Lectures 36hrs
- Practicals (epidemiology & statistics) 5hrs
- Workgroup meetings with the teachers 4hrs
- Workgroup work on assignments ~55hrs
- Self study ~45hrs
- Student lectures & poster presentation 12hrs
- Exam 2,5hrs

Attendance to the workgroup meetings with the teachers for assignments,
as well as the students' lecture presentations and poster presentations,
is compulsory.

Method of Assessment

Written exam (50%), Assignment-1 (25%), Assignment-2 (25%). All parts
need to be passed (min 5.5).
Each assignment is assessed over 100pts, which include 10pts for peer


A selection of literature will be made on the basis of lectures and
state of the art research. A selection of last year’s literature is
1. Murray CJ, Frenk J. A framework for assessing the performance of
health systems. B World Health Organ. 2000;78(6):717-31.
2. World Health Report 2000: Health Systems: Improving Performance.
(Message form the director, Chapter 1, Chapter 2 and the Statistical
3. Yin RK. Case Study Research: Design and Methods. Fourth edition, Sage
publications 2009, London. (Chapters 1 and 2)
4. Bunders JFG, Broerse JEW. The urgency for change. In: Broerse JEW,
Bunders JFG, eds. Transitions in Health Systems: Dealing with Persistent
Problems. Amsterdam: VU University Press, 2010. (pages 3-15)
5. Roberts M, Hsiao W, Berman P, Reich M. Getting Health Reform Right: A
Guide to Improving Performance and Equity: Oxford University Press;
2004. (Chapter 1)
6. Plsek PE, Greenhalgh T. Complexity science: The challenge of
complexity in health care. Brit Med J. 2001;323(7313):625-8.
7. Health System Reviews (HiT reports) of the countries selected for the
assignments (European Observatory on Health Systems and Policies), as
well as other relevant articles students find.

Target Audience

First-year students MSc Global Health

Additional Information

Compulsory course for Research Master Global Health students

Recommended background knowledge

It is recommended that students have knowledge on public health and/or
public policy in the context of health and/or care.

General Information

Course Code AM_1025
Credits 6 EC
Period P2
Course Level 500
Language of Tuition English
Faculty Faculty of Science
Course Coordinator dr. T. Cesuroglu
Examiner dr. T. Cesuroglu
Teaching Staff dr. T. Cesuroglu

Practical Information

You need to register for this course yourself

Last-minute registration is available for this course.

Teaching Methods Study Group*, Lecture

*You cannot select a group yourself for this teaching method, you will be placed in a group.

Target audiences

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