Health system performance

The Observatory has been asked by its partners to initiate a programme of work on health system performance comparison. The objectives are “to help governments, regulators, citizens and other commentators gain a better understanding of the comparative performance of their health systems, to improve approaches to measurement and analysis, and to demonstrate how comparative metrics can help in the design and evaluation of initiatives intended to strengthen health systems.” The initiative is undertaken with the close collaboration of the WHO European Region, the EC, the OECD and other organizations. It is being led by Professor Peter Smith at Imperial College London, who coordinates a team at the Observatory’s other academic partners.

The first substantive product of the initiative will be a book on performance information for health system comparison. It will “clear the ground” for the initiative, identifying data and methodological issues and exploring the current interface between evidence and practice. It is informing the future priorities and content of the entire programme. In parallel, the programme is developing a series of reports on metrics, methodology and performance comparison. The domains of performance under scrutiny are as follows:

  • Population health status (including risk factors)
  • Health services outcomes
  • Responsiveness
  • Equity (in health and access to services)
  • Financial protection
  • Efficiency

Methodological studies are under development, but will examine important methodological advances needed to enhance comparison. The intention is to produce approximately three methodological papers per year. Each will address the following issues:

  1. Statement of the problem
  2. What is the current approach and state of knowledge, and why is it important?
  3. What is the proposed methodological development, including an example?
  4. Implementation, including the benefits from a policy perspective?
  5. Recommendations for future comparison

In addition, the programme will produce a biennial comparative report for the European Region on one of the domains of performance. The intention is that the first report in 2012 will be on population health. It will include summary data and narrative, commentaries from acknowledged experts, and a guide for policy-makers on further analysis and data sources.