Health System Performance Assessment

The World Health Report 2000 has generated considerable media attention, controversy in some countries, and debate in academic journals. This volume brings together in one place the substance of many of these key debates and reports, methodological advances, and new empiricism reflecting the evolution of the WHO approach since the year 2000. Specifically, the volume presents many differing regional and technical perspectives on key issues, major new methodological developments, and a quantum increase in the empirical basis for cross-country performance assessment. It also gives the full report of the Scientific Peer Review Group's exhaustive assessment of these new approaches.

Ensuring a robust and resilient health system involves policy actions which need to be implemented based on the best available evidence. This requires health systems to be monitored regularly to build on their strengths and to overcome any apparent shortcomings. In order to assist in that process, this volume, a collaboration between the World Health Organization and the European Observatory on Health Systems and Policies, presents a new framework to support monitoring of health system performance, with a focus on detailed conceptual links between health system functions and overall system goals. This HSPA framework for Universal Health Coverage thus represents a comprehensive attempt to address fundamental questions regarding regular assessment of health systems, including health system boundaries, component elements and outcomes. In this book, each of the health system function chapters outlines the purpose of the function, the sub-functions that enable it to carry out the key activities necessary to fulfil its purpose, as well as the assessment areas and proposed indicative measures to evaluate how well a system performs. The framework will thus assist policy-makers in understanding possible origins or impact of poor performance on a particular health system outcome, triggering more in-depth analysis.

Health systems performance assessment (HSPA) varies across the WHO European Region. This review summarizes HSPA domains and indicators used by Member States in their HSPA or health system-related reports. Thirty Member States published in the English language and from their latest documents, 1485 distinct indicators were extracted. The number of indicators reported per Member State ranged from 9 to 146, with a mean of 50. Among the 14 domains of the WHO 2007 framework, service delivery and improved health were covered by virtually all Member States analysed (30 and 29, respectively), but coverage varied for the other 12 domains, with health workforce and financing having good coverage (25 and 26, respectively) but others, such as safety, efficiency, coverage or responsiveness, covered in only 20-30% of documents. Further refinement of frameworks, both in clarity on scope and function and in the conceptual robustness of domains, is warranted and further standardization of generic sets of indicators should be sought.

This new edition continues to emphasize the use of data envelopment analysis (DEA) to create optimization-based benchmarks within hospitals, physician group practices, health maintenance organizations, nursing homes and other health care delivery organizations. Suitable for graduate students learning DEA applications in health care as well as for practicing administrators, it is divided into two sections covering methods and applications. Section I considers efficiency evaluations using DEA; returns to scale; weight restricted (multiplier) models; non-oriented or slack-based models, including in this edition two versions of non-controllable variable models and categorical variable models; longitudinal (panel) evaluations and the effectiveness dimension of performance evaluation. A new chapter then looks at new and advanced models of DEA, including super-efficiency, congestion DEA, network DEA, and dynamic network models. Mathematical formulations of various DEA models are placed in end-of-chapter appendices. Section II then looks at health care applications within particular settings, chapter-by-chapter, including hospitals, physician practices, nursing homes and health maintenance organizations (HMOs). Other chapters then explore home health care and home health agencies; dialysis centers, community mental health centers, community-based your services, organ procurement organizations, aging agencies and dental providers; DEA models to evaluate provider performance for specific treatments, including stroke, mechanical ventilation and perioperative services. A new chapter then examines international-country-based applications of DEA in health care in 16 different countries, along with OECD and multi-country studies. Most of the existing chapters in this section were expanded with recent applications. Included with the book is online access to a learning version of DEA Solver software, written by Professor Kaoru Tone, which can solve up to 50 DMUs for various DEA models listed in the User’s Guide at the end of the book.

International comparison of health system performance has become increasingly popular, made possible by the rapidly expanding availability of health data. It has become one of the most important levers for prompting health system reform. Yet, as the demand for transparency and accountability in healthcare increases, so too does the need to compare data from different health systems both accurately and meaningfully. This timely and authoritative book offers an important summary of the current developments in health system performance comparison. It summarises the current state of efforts to compare systems, and identifies and explores the practical and conceptual challenges that occur. It discusses data and methodological challenges, as well as broader issues such as the interface between evidence and practice. The book draws out the priorities for future work on performance comparison, in the development of data sources and measurement instruments, analytic methodology, and assessment of evidence on performance. It concludes by presenting the key lessons and future priorities, and in doing so offers a rich source of material for policy-makers, their analytic advisors, international agencies, academics and students of health systems.

In a world where there is increasing demand for the performance of health providers to be measured, there is a need for a more strategic vision of the role that performance measurement can play in securing health system improvement. This volume meets this need by presenting the opportunities and challenges associated with performance measurement in a framework that is clear and easy to understand. It examines the various levels at which health system performance is undertaken, the technical instruments and tools available, and the implications using these may have for those charged with the governance of the health system. Technical material is presented in an accessible way and is illustrated with examples from all over the world. Performance Measurement for Health System Improvement is an authoritative and practical guide for policy makers, regulators, patient groups and researchers.

Increasing health system performance is critical in creating resilient health systems. If health policies are to foster the ability to withstand shocks like the COVID-19 pandemic, they need to focus on the right interventions that strengthen health systems - those that improve performance.1. Assessing the performance of a health system effectively is the first step to improving it. 1.1. This requires a conceptual lens through which to view the health system structures, its inputs and the outputs and outcomes that they feed into.2. The Health System Performance Assessment (HSPA) Framework for Universal Health Coverage (UHC) offers policy-makers a conceptual tool to assess performance effectively. 1.1. It provides a rigorous description of the four health system functions - governance, resource generation, financing and service delivery - and their sub-functions that matter most for the function-level and overall system performance.1.2. It builds on existing tools and frameworks but orients the analysis of health system assessment exercises towards system performance.1.3. It identifies impacts on health system performance and encourages operational focus.3. The HSPA Framework for UHC has real-world applications and helps direct policy action. 1.1. It allows policy-makers to understand how the health system works and how its functions and sub-functions are linked to the "assessment areas" that explain performance.1.2. It provides an explanation of the health system bottlenecks that contribute to specific policy challenges.1.3. This will support efforts to pinpoint the person, group or institution that can and should take responsibility for remedial action and promote accountability.1.4. Its insights into the governance function will help policy-makers to use governance as a lever to achieve health system goals.

This volume presents the work of clinical health care teams and natural work groups, quality improvement teams, committees, and task forces made up of employees in health care settings. It discusses proven multidimensional instruments that measure team performance along with future needs for measuring team performance. It will be a resource for medical instructors and students, public health workers, and health administrators interested in team management.