Miller and Murray: A Perfect Union

I appreciated the juxtaposition of Mills et. al.’s (Mills heretofore) Chapter 3 with Murray & Frenk’s (Murray heretofore) “Framework” paper.  Where one was lacking, the other made up.  While Mills’s strength was focusing on specific, tangible factors that contribute to a well functioning health system, Murray seemed to have a better grasp on the health system as both independent and part of a larger social system.  Both strengths, when fused, form a more holistic view on how to assess and bolster health systems.

While Murray discussed abstract concepts, Mills focused in on exact areas of health system functioning.  Within each area, examples of various countries’ weaknesses that were strengthened were provided.  This made the piece more linear and easier to read and conceptualize.  My first thought was how easy it would be to take the paper and form it into a grading scale that could be applied to any country’s system to find strengths and weaknesses.

After further reflection and comparison to Murray, I found Miller to be lacking in two major areas.  In table 3.2, I was concerned to read that financial constraints were attributed primarily, if not completely, to individual households. America is the perfect example of how one’s financial status is not solely the fault of the individual.  Institutional bias creates classes, and any responsible government is aware of this and works to counteract it.  Should the Murray pair ever sit down to discuss their work with the Mills’s entourage, I am certain Murray and Frenk would agree with me.  They were quite clear in their opinion that health systems should be constructed fairly and with equal access for all.  To compare it to an American political party, they are more Democratic in their beliefs.  This oversight by Miller seems to reflect a Republican viewpoint that each individual is responsible for him or herself, and one should simply work harder to gain access to better healthcare.  As both a Democrat and a dual major with the school of social work, I believe that financial constraints should remain in the Community and Household category, but should also be added to the Public Policies Cutting Across Sectors category.

Further, the Murray piece takes the time to explain that a country’s health system does not stand alone.  It impacts other social systems as frequently as they impact it.  The educational system of a country impacts the health system profoundly, and that cannot be overlooked when designing ways to improve a health system.  For example, in the Human Resources section of Mills, a reactive approach is taken.  Mills points out ways that human resources can improve through salaries and benefits, but it does not discuss the fact that proactive options also exist such as improving health professional training programs.

In short, I found Murray to contain an important humanitarian perspective that Mills was lacking.  Combine the two, and you have a well thought out approach to viewing health systems.


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