Health system performance assessment

Jarle Nyttingnes

The 2009 WHO European Health Report states that improving the performance of national health systems is a priority issue, particularly in the current economic climate where achieving the highest value from existing resources is paramount. In this regard, health system performance assessment (HSPA) is a recognized approach in the WHO European Region. It was given renewed recognition and impetus by the Tallinn Charter of 2008, through which the Member States committed themselves to greater transparency and accountability for health system performance.

Assessing health system performance involves measuring and analysing how well a health system is meeting its ultimate goals (such as better health status for the population, better health system responsiveness, better financial protection, or increased health system efficiency), and how its performance against intermediary objectives (such as access, coverage, quality and safety of health services) contributes to helping serve these goals.

A fully developed HSPA approach has the following attributes:

  • It is regular, systematic and transparent. Reporting mechanisms are defined as a priority and cover the whole assessment. It is not bound in time by a reform agenda or national health plan end-point, though it might be revised at regular intervals to better reflect emerging priorities.
  • It is comprehensive and balanced in scope. It covers the whole health system and is not limited to specific programmes, objectives or levels of care. The performance of the system as a whole is not equivalent to adding up the performance of each of its constituents.
  • It is analytical and uses complementary sources of information to assess performance. Performance indicators are supported in their interpretation by policy analysis, complementary information (qualitative assessments), and reference points (trends over time, local, regional or international comparisons, or comparisons to standards, targets or benchmarks).