Health System Performance Comparison: New Directions in Research and Policy

A special issue of Health Policy that is published in collaboration with the European Observatory on Health Systems and Policy, draws attention to the growing field of international comparison and performance assessment of health systems.

International comparison of health system performance has become a powerful influence on health policy-makers worldwide. Important initiatives such as the World Health Report 2000, the annual surveys undertaken by the Commonwealth Fund, and the Health Care Quality Indicators prepared by the OECD have in different ways contributed to the debate. Without question, quantitative comparisons can constitute a rich source of evidence when properly conducted. However, it is also sometimes the case that gaps in the data or poor analytic methodological can lead to unwarranted policy interpretations that may in turn have seriously adverse policy and political consequences.

The articles in this special issue highlight the strengths of current performance comparisons and outline future potential. Thematically the issue covers 4 broad areas related to methodological issues associated with analysis and interpretation of comparative data.

  • A subset of the papers considers key developments in determining the scope and study of performance comparison, highlighting how existing theoretical frameworks and methodologies can assist in this endeavour.
  • A second group of papers highlight the progress made in developing existing performance metrics across a range of performance dimensions including financial protection, affordability, waiting times and satisfaction.
  • A number of papers examine to what extent analytic methodologies such as Data Envelopment Analysis and time-series methodology, can be used to conduct performance comparisons, given the data constraints inherent in this pursuit.
  • Finally, a set of articles consider what policy inferences can be drawn from existing comparisons.
This Health Policy issue aims to contribute to the debate, promote best practice and support the development of a common methodology of health system performance assessment.