Optimizing existing health systems: an argument for integrating functioning information

Abstract

Background Health systems are being challenged, in meeting the needs of growing numbers of people living with chronic health conditions, where cure of the disease is not the primary outcome of care but rather maintaining or improving functioning over a person’s life span. Functioning is an umbrella term; it encompasses body structures and body functions, as well as people’s capacity and actual performance to conduct activities of daily living and to participate in society. It is a multi-dimensional and interactive concept, which describes not merely the consequences of health, but constitutes a fundamental component for understanding health and how it plays out in everyday life. Health information constitutes the foundation for any evidence-based decision making related to finances, service delivery, policy and governance in health systems. Though, there is agreement that disease-specific and functioning information are conceptually complimentary, health systems could be further optimized by accounting for health and how it plays out in everyday life on an operational level. If not, current health systems will continue to fail in predicting e.g. length of stay, discharge destination, and service costs of people with chronic health conditions. Ultimately, they will be limited in providing optimal care for this growing sub-population. The aim of this paper is to describe how functioning information can be integrated systematically in health systems.