Financing:
The financing control knob examines how resources are mobilized and allocated for healthcare. Various channels through which the health system can be financed include out-of-pocket payments, taxation, and insurance mechanisms. A single health system can have multiple types of financing channels, each with its own equity implications, sustainability challenges, and incentive structures.

Payment:
The payment knob examines how healthcare providers are remunerated for their services. Payment methods include fee-for-service, capitation, and outcome-based payments. Each method creates financial incentives that can influence the efficiency and quality of healthcare services.

Organization:
The organization control knob assesses how health service delivery is structured and organized for various functions within the system, such as service delivery and regulation. Whether an actor in the health system is public, private, government-run, non-government, or quasi-government affects the incentives that drive them. Understanding these organizational incentives and constraints helps policymakers align these actors to meet the population's needs.

Regulation:
The regulation knob refers to the laws and policies governing the health system. Effective regulation can address market failures, enforce standards of care, and protect consumers. However, overly restrictive regulation can increase costs or limit innovation within the health system.

Behavior:

The behavior control knob emphasizes the importance of health-conscious actions—or the lack thereof—among patients and providers, which impacts health outcomes. It includes issues such as health promotion efforts, patient compliance with medical advice, and behavioral interventions that can promote health within the population.

Access to Healthcare: Access refers to the ability of individuals to obtain necessary health services, both financially and geographically. When the financing, organization, and payment mechanisms are adjusted, the first noticeable change is usually in access to healthcare. For example, reforms that introduce insurance schemes or increase the availability of health facilities can improve people's ability to access services without financial or physical barriers. Some of the metrices to assess access in healthcare include:

1. • • Availability of essential medicines and health services

     • Proportion of the population with insurance coverage

     • Geographic distribution of healthcare facilities and providers

     • Wait times and ability to see a healthcare provider in a timely manner

Quality of Healthcare Services: Quality refers to the effectiveness, safety, and efficiency of healthcare services delivered to patients. Control knobs related to payment, organization, and regulation have a direct impact on the quality of care. For instance, paying providers based on performance or establishing stricter regulatory standards for medical practices can lead to improvements in clinical outcomes and patient satisfaction. Some of the metrices to assess quality of healthcare include:

1. • • Clinical outcomes 

     • Patient safety indicators (e.g., infection rates in hospitals)

     • Adherence to clinical guidelines and standards

     • Provider competency and training levels

Efficiency: Efficiency refers to how well healthcare services utilize resources (such as time, money, and labor) to achieve optimal outcomes. Organizational reforms and changes to the payment system (such as shifting from fee-for-service to capitation or value-based payments) are often designed to improve efficiency. Increased efficiency can reduce costs and improve patient throughput without sacrificing quality. Some of the metrices to assess efficiency in healthcare include:

1. • • Average length of stay in hospitals

     • Number of services delivered per unit of cost or time

     • Resource utilization rates (e.g., bed occupancy, equipment usage)

     • Administrative costs relative to healthcare spending

Health Status: Health status refers to the overall health of the population, including improvements in life expectancy, reductions in mortality and morbidity, and the general well-being of individuals. The ultimate goal of any health system is to improve health outcomes by ensuring access to quality care and preventive services. Some of the metrices to evaluate health status include:

• Life expectancy at birth

• Infant and maternal mortality rates

• Prevalence of diseases (both communicable and non-communicable)

• Disability-adjusted life years (DALYs)

The control knobs influence health status by shaping how healthcare services are delivered, accessed, and financed. For example, better organization and regulation of healthcare services can improve access to essential care, leading to better health outcomes across the population.

Financial Risk Protection: Financial protection ensures that individuals are not exposed to catastrophic or impoverishing health expenditures. A well-functioning health system protects people from the financial burden of healthcare costs by providing adequate coverage through mechanisms like insurance, subsidies, or public healthcare provision. Some of the metrices to evaluate financial protection include:

• Incidence of catastrophic health expenditures (when healthcare costs exceed a substantial portion of household income)

• Levels of out-of-pocket spending

• The proportion of the population covered by health insurance or government health programs

Changes to the financing and payment control knobs can directly affect financial protection. For example, shifting from out-of-pocket payment systems to pre-paid, pooled financing mechanisms (such as social health insurance) can reduce financial risk for households.

Citizen Satisfaction: Citizen Satisfaction refers to how well the health system meets the expectations and needs of the population. This outcome goes beyond just clinical health improvements to include patient experience, the dignity with which care is provided, the timeliness of services, and the ability of the system to meet diverse health needs. Some of the metrices to evaluate Citizen Satisfaction include:

• Patient satisfaction surveys

• Timeliness of services

• Quality of interpersonal interactions (e.g., communication, respect, confidentiality)

• Availability of a choice of providers and services

The organization, regulation, and behavior control knobs play a significant role in determining responsiveness. For instance, regulations that ensure patient rights and provider accountability, combined with efforts to improve the behavior and professionalism of health workers, can lead to higher levels of patient satisfaction.