What is a health care delivery system?

A health care delivery system includes all the people, institutions, and services that assist in care
coordination, patient flows, diagnosis, disease management, and promotion of health maintenance
programs. It covers various service areas such as emergency, primary care, public health, rehabilitation,
hospital care, mental health services, and specialized care. A health care delivery system can be classified
as a single-provider service or a complex health system that meets the care requirements of a specific
population.

Health care organizations – like clinics, hospice care, and ambulatory care centers - comprise health care
delivery systems that include human resources, physical assets, patients, financial organization,
organizational culture, and system structure. Health care delivery systems can be structured as small-
scale local or large hospital systems with their care processes, organizational capacity, financial and
insurance programs, and health priorities. They utilize resources to engender positive health outcomes
for well-defined communities or markets. Care programs are facilitated by specialized medical workers
that deliver services based on internal codes and state regulations.

Health care delivery systems are defined based on the mission statement, non-profit status, and public
or private ownership. Earnings are produced for stakeholders, like for-profit systems, or for the
organization, as in not-for-profit systems, and must meet the healthcare needs of existing populations.
The delivery system, regardless of structure, manages finances in coordination with care processes,
system complexities, and quality maintenance. This ensures the health care organization maintains
quality health outcomes and patient safety.

The following frameworks organize health care delivery systems:

Organizational structure: Operations are conducted based on hierarchy and leadership. All elements that
make up the organization follow the rules based on governance and procedure.

Patients: Patients are based on the type of care they need and how health care organizations make
decisions to deliver available health services.

Finances: The delivery system organizes payments through programs, such as provider payment systems,
to finance operations and allocate resources.

Capacity: This includes all organizational assets – personnel, building conditions, and medical supplies –
that influence service quality and ability to perform care routines.

Service culture: Delivery systems operate on shared values that affect core service competencies, patient
health benefits, and community guidelines.

Care infrastructure: Health care services are evaluated and maintained through health information
systems, standardized practices, performance indicators, quality management, and clinical decision
platforms.
What are the different types of health care delivery systems?

Managed care: These plans are arranged with a predetermined network of care facilities and providers
to offer low-cost health services. Health Maintenance Organizations (HMOs) collect fees to connect
patients with medical care practices.

Concierge services: Patients pay a flat monthly rate to doctors willing to provide full access to their
health services. Health plans can be customized based on demand needs.

Self-directed services: This includes programs like Medicaid and hospice care that allow individuals to
make their own medical decisions. Patients can receive care based on the treatment needed and
manage their services.

Telemedicine: Patients use technology, like phones and mobile apps, to access care based on standard
requirements or emergency needs. Medical care is managed through online platforms and electronic
records, facilitating timely medical assessments.

Health care delivery systems provide the following benefits:

Care for chronic illness: Health care workers provide care under the direction of an organizational
infrastructure to identify health problems and implement protocols. They include self-care, e-mails, and
follow-ups – to create service models that utilize the best methods for clinical oversight of chronic
illness.

Better public health: Health care is managed by frameworks that make access to services – preventative
care, treatment facilities, and insurance coverage – easier. Delivery systems provide oversight of
processes that enable consistent care and preventive services.

Safety-net providers: Health departments and organizations can increase the availability of medical
services for patients without health insurance. State and local governments fund public health initiatives
to help at-risk populations access mental health hospitals, maternal services, and substance abuse
programs.

Advanced health management: Evidence-based planned care is used to deliver health services to
patients with the illness. Health care is organized by patient need and resource attainment, helping
direct clinical expertise to patients who need specialized medical support.

Supportive information systems: Physicians can provide appropriate care with the help of information
systems that organize and analyze data from electronic health records. Health care workers can make
specialized clinical decisions and provide managed care services based on relevant data from patient
history.

Key facts

Between 5.7 and 8.4 million deaths are attributed to poor quality care each year in low- and middle-
income countries (LMICs), which represents up to 15% of overall deaths in these countries (1).

Sixty per cent of deaths in LMICs from conditions requiring health care occur due to poor quality care,
whereas the remaining deaths result from non-utilization of the health system (2).
Four in ten patients living with chronic conditions do not trust their healthcare system. Patients’ trust in
health system goes hand-in-hand with high quality health care and is closely linked to personal
experience of health care (3).

Inadequate quality of care imposes costs of US$ 1.4–1.6 trillion each year in lost productivity in LMICs
(1).

In high-income countries, 1 in 10 patients is harmed while receiving hospital care, and 7 in every 100
hospitalized patients can expect to acquire a health care-associated infection. Four in 100 people die
from unsafe care in the developing world (4).

It has been estimated that high quality health systems could prevent 2.5 million deaths from
cardiovascular disease, 900 000 deaths from tuberculosis, 1 million newborn deaths and half of all
maternal deaths each year (2).

Overview

Quality of care is the degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with evidence-based professional knowledge.
This definition of quality of care spans promotion, prevention, treatment, rehabilitation and palliation,
and implies that quality of care can be measured and continuously improved through the provision of
evidence-based care that takes into consideration the needs and preferences of health service users –
patients, families and communities.

Quality health services should be:

effective by providing evidence-based health care services to those who need them;

safe by avoiding harm to the people for whom the care is intended;

people-centred by providing care that responds to individual preferences, needs and values, within
health services that are organized around the needs of people;

timely by reducing waiting times and sometimes harmful delays for both those who receive and those
who give care;

equitable by providing the same quality of care regardless of age, sex, gender, race, ethnicity, geographic
location, religion, socio-economic status, linguistic or political affiliation;

integrated by providing care that is coordinated across levels and providers and makes available the full
range of health services throughout the life course; and

efficient by maximizing the benefit of available resources and avoiding waste.

Universal health coverage and quality: a global commitment

Taking action for enhancing quality of care

Quality health services are a product of the health system’s environment and the actions of health care
providers and individuals working within the system. To achieve the goal of access to high quality health
services for all, governments should take an integrated approach and work with different key actors
within the health system and beyond, including individuals and communities. The success and
sustainability of efforts to improve quality of care is dependent on effective integration of health actions
and programmes across different levels of the health system.

National strategic direction on quality: National policies and strategies aimed at improving quality of care
are essential to ensure action across the health system and need to be closely aligned with broader
national health policy and planning. The national quality policy and strategy identifies a pragmatic
package of interventions to strengthen the system environment, reduce harm, improve clinical care, and
engage patients, families and communities. An illustrative list of interventions for each of these areas is
available for countries to consider.

Quality across the health system: In addition to an enabling policy environment, the provision of quality
health services requires good governance; skilled and competent health workforce that is supported and
motivated; financing mechanisms that enable and encourage quality care; information systems that
continuously monitor and learn to drive better care; medicines, medical devices and technologies that
are available, safe and appropriately regulated; and accessible and well-equipped health care facilities.

Quality-driven primary health care approach: Primary health care (PHC) is pivotal for building a high
quality health system and achieving universal health coverage. Careful consideration is needed to ensure
PHC-oriented health systems deliver effective, safe and user-centred health services. PHC can not only
improve quality from the perspective of people but also enhance their trust in the health system.

Monitoring and evaluation: Quality of care needs to be continually measured to monitor progress
towards improvement goals. This requires context-specific indicators and accurate, timely and actionable
data. The integration of global and national measurement efforts is critical to ensuring that countries
collect data that matters and use that data to transform and improve their service delivery systems. The
role, for instance, of adverse event reporting and learning systems is critical in this context.
Data-driven response and learning systems: It is critical to document and share on-the-ground
experiences related to quality of care efforts. This is key to understand the realities of the health system,
what works and what doesn’t work. Such knowledge, emerging from implementation experiences must
be shared globally and within the countries.

Engaging users and communities: To improve quality of care, health systems need to listen to and learn
from the population they serve. Understanding people’s views can provide valuable insights on what is
important for them. Robust and regular dialogue between governments and their population fosters
trust as people feel that the policy-makers listen to their needs and interests and consider their
perspectives (6).

WHO’s response

WHO works with Member States and partners to ensure that quality of health services is addressed at
the national level and operational plans are in place to improve quality of care at national, sub-national
and facility level.

Specifically, WHO:

supports countries in the development, review and implementation of national policies and strategies
for quality of care and patient safety;

works with countries and partners to enhance, sustain and scale up quality of care efforts from global to
local level;

promotes patient safety initiatives to reduce harm to patients in the delivery of quality health services;

strengthens infection prevention and control capacity alongside efforts on water, sanitation and hygiene
(WASH), as pivotal to quality health services;

strengthens use of quality of care measurement frameworks and indicators in the countries, and
develops countries capacities in this regard;

provides support to countries in their work on community engagement for quality health services;

builds capacities of training institutions and health and care workers to develop a safe and supporting
quality improvement environment and patient safety culture;

facilitates global collaboration and learning within and between countries through communities of
practice hosted on the WHO Integrated Health Services Hub;

reports on progress.