Towards Performance Indicators for the Health Care Sector

The health care sector is a huge industry in many Western countries going through fundamental changes, with increasing needs for new monitoring systems and performance indicators. The aim of this paper is to identify factors that influence the success of external reporting systems, which will ultimately affect the transparency and performance of the sector. We review theory on performance indicators, national care systems, and inter-organizational reporting systems, resulting in formulating several hypotheses. We use a data set and 12 interviews in one case study (the mental health care sector in the Netherlands) to evaluate the hypotheses. Our findings show that the new system is more successful for integrated care organizations than specialized care organizations, and more successful if care organizations have better internal information systems

Measuring health system performance: A new approach to accountability and quality improvement in New Zealand

AbstractIn February 2014, the New Zealand Ministry of Health released a new framework for measuring the performance of the New Zealand health system. The two key aims are to strengthen accountability to taxpayers and to lift the performance of the system's component parts using a ‘whole-of-system’ approach to performance measurement. Development of this new framework – called the Integrated Performance and Incentive Framework (IPIF) – was stimulated by a need for a performance management framework which reflects the health system as a whole, which encourages primary and secondary providers to work towards the same end, and which incorporates the needs and priorities of local communities. Measures within the IPIF will be set at two levels: the system level, where measures are set nationally, and the local district level, where measures which contribute towards the system level indicators will be selected by local health alliances. In the first year, the framework applies only at the system level and only to primary health care services. It will continue to be developed over time and will gradually be extended to cover a wide range of health and disability services. The success of the IPIF in improving health sector performance depends crucially on the willingness of health sector personnel to engage closely with the measurement process

Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions

The Case of South African and Chilean Health Systems: Comparison of Financial, Economic and Health Indicators

The purpose of this study is to identify similarities and differences between healthcare systems of South Africa and Chile. The World Health Report 2000, the Human Development Index, and financial indicators were used for comparison. Chile showed better performance than South Africa in most of the measures used. Significant progress has been made in South Africa, bringing better education, healthcare and housing to the deprived black majority. However, the HIV/AIDS epidemic, weighs heavily on health indicators. Chile decentralized its health services and implemented economic reforms during the 1980\u27s and has had steady improvement in its healthcare indicators. Finally, these counties share: World Bank classification as middle income economies, dual public/private health systems, skewed income distribution and allocation towards the private sector, with relatively high private health expenditures as a percentage of total health expenditures, focus in primary health care in their public health system and implementation of new healthcare reforms

Assessing the efficiency of sub-national units in making progress towards universal health coverage: Evidence from Pakistan

The World Health Report 2010 encourages countries to reduce wastage and increase efficiency to achieve Universal Health Coverage (UHC). This research examines the efficiency of divisions (sub-provincial geographic units) in Pakistan in moving towards UHC using Data Envelop Analysis. We have used data from the Pakistan National Accounts 2011-12 and the Pakistan Social Living and Measurement Survey 2012-13 to measure per capita pooled public health spending in the divisions as inputs, and a set of UHC indicators (health service coverage and financial protection) as outputs. Sensitivity analysis for factors outside the health sector influencing health outcomes was conducted to refine the main model specification. Spider radar graphs were generated to illustrate differences between divisions with similar public spending but different performances for UHC. Pearson product-moment correlation was used to explore the strength and direction of the associations between proxy health systems organization variables and efficiency scores.The results showed a large variation in performance of divisions for selected UHC outputs. The results of the sensitivity analysis were also similar. Overall, divisions in Sindh province were better performing and divisions in Balochistan province were the least performing. Access to health care, the responsiveness of health systems, and patients\u27 satisfaction were found to be correlated with efficiency scores.This research suggests that progress towards UHC is possible even at relatively low levels of public spending. Given the devolution of health system responsibilities to the provinces, this analysis will be a timely reference for provinces to gauge the performance of their divisions and plan the ongoing reforms to achieve UHC

Performance measurement in the health sector

This paper provides an overview of the development of performance measurement in the Irish health sector, drawing on reported developments in other health systems. Performance measurement has considerable potential in health service management in enabling national priorities for health reform to be translated into organisational and individual objectives, to provide a focus on results, and to enhance accountability. The paper begins by positioning the development of performance measurement within the range of recent policy and legislative changes in the Irish health sector. Drawing on the international literature, four key aspects of performance measurement are identified, which form the framework for the study: developing performance measurement systems; measure definition and data collection; developing the use of performance data; and co-ordinating performance measurement. Performance measurement was also reviewed at the national system level, the organisation level and the individual level. The range of approaches currently in place to measure performance is outlined, and includes: · systems to monitor health outcomes and progress against strategic priorities at the national level, such as the Public Health Information System (PHIS) and strategy indicators used for the National Cancer Register · systems to monitor the performance of programmes/service areas, such as the hospital inpatient enquiry system (HIPE) and datasets being developed for mental health services and intellectual disability services · systems to monitor performance at the health board and agency level, such as integrated management returns (IMRs) and service plan indicators. A comparative review was undertaken of the development of performance measurement systems in Australia, New Zealand, the United Kingdom, the USA and Canada. The report concludes that the focus of performance measurement across these countries is on improving health outcomes, improving the quality of care, achieving national priorities and reducing inequalities in health. The findings also suggest that performance measurement systems are largely evolving around: · developing national frameworks to define standards of expected performance · developing good measures and data collection systems · building managerial capacity to manage performance. The findings highlight the need for strong leadership in promoting the development of performance measurement and developing frameworks to ensure that health care providers comply with good performance standards. Currently, performance measurement tends to be focused around acute health care, but there is increasing interest in extending performance measurement to all parts of the health care system. The report looks at the approach taken across countries to developing performance measures. The concepts of performance measured include health improvement/outcomes, effectiveness and quality, the patient orientation of services, access and financial/resource management. Similar concepts are seen in the range of measures currently being used in the Irish health service, although coverage appears patchy. The area that needs to be developed in particular in the Irish health sector is the patient-orientation of services. The types of measures used across countries include rates; averages; medians or means; proportions; costs; composite measures; and other measures of performance. Similar measures are currently used in the Irish system although composite measures have yet to be developed. In terms of the development of performance measures the findings emphasise the need to move beyond an emphasis on finance and activity towards more balanced sets of measures and to focus on generating information that is useful to decision-makers. The findings also highlight the need to shift the emphasis from compliance with processes to focusing on results, and that performance measures should relate to key objectives in order to drive strategy forward. The report highlights the need to have good quality data available at all levels of the system to support performance measurement. In terms of collecting, aggregating and disseminating data it is reported that data management systems are largely underdeveloped and fragmented. The acute hospital sector is where performance measurement is most developed. The need for a co-ordinated approach to the development of data management systems across the health system is identified. The findings suggest that data currently available on performance is under-utilised and focused mainly on controlling expenditure. A number of points are raised about how the use of data can be improved. The decision-usefulness of data is an important issue. Data must be relevant to users and at the correct level of detail. Data also needs to be timely and easily accessible to those who need it. In addition, the managerial culture needs to be receptive to the importance of basing decisions on performance data, individuals need to feel empowered, and the appropriate skills and expertise are required to be able to interpret data and use the findings constructively. Data must be reliable and individuals need to have confidence in using it. At the individual level it is suggested that performance measurement needs to be developed and linked to performance management and personal development planning. The research found that performance measurement at the individual level is largely underdeveloped. The findings emphasise the need for improved co-operation and collaboration across the health sector in the development of performance measurement. A number of areas must be addressed in this regard, including the need for greater clarity in defining who is responsible for co-ordinating performance measurement across the system. The report concludes that the key issues to be addressed are: · clarifying responsibility for overall co-ordination of performance measurement · extending performance measurement to all areas of the health system · extending performance measurement to the individual level within organisations and linking it with performance managemen

Stayin’ alive: The introduction of municipal in-patient acute care units was associated with reduced mortality and fewer hospital readmissions.

Background: Integrated care is seen as integral in combating the current and projected resource scarcity in the healthcare systems of developed economies. Previous research finds positive effects from implementing intermediate care but there is a lack of research on how this shift towards care integration has affected traditional quality indicators within healthcare, indicators such as mortality rates and hospital readmissions. We seek to contribute to the discourse by studying how the introduction of intermediate care in the form of municipal acute units (MAUs) in Norway has affected age adjusted mortality rates and hospital readmissions. Data and methods: In this retrospective cohort study we utilize yearly population-based registry data from 2010 to 2016, analysed with fixed-effects regressions. Data on the implementation, characteristics and localization of the MAUs were gathered by telephone during the implementation period. Data on mortality rates and hospital readmissions were collected from Statistics Norway and the Norwegian patient registry. Results: Our analyses finds that the introduction of MAU was associated with a statistically significant reduction in both aggregated mortality rates and hospital readmission rates. In depth analyses finds that our results are contingent upon the age of the patients treated at the MAUs and the clinical characteristics of the medical units themselves. Conclusion: Our findings indicate that the shift towards intermediate care through the introduction of MAUs has increased performance within the public healthcare sector in Norway. Our findings indicate that the introduction of MAU have had a positive public health impact by lowering the mortality and readmission rates for the oldest population cohort in Norway. Our findings suggests that countries with comparatively similar healthcare systems as Norway could achieve similar benefits from implementing intermediate care in the form of somatic medical institutions in the local communities.publishedVersio

Libya’s Pharmaceutical Situation: A Professional Opinion

Abstract: To improve the countries’ pharmaceutical situation and to monitor the progress, the World Health Organization (WHO) and member states developed a system of indicators to measure the respective important aspects as a prerequisite step. Level I indicators to assess the country’s pharmaceutical situation include the national drug policy; legislation and regulations; drug accessibility and affordability; essential drug list; quality control; pharmacovigilance; storage and distribution; information and rational use. This study is aimed to document the professional opinion of 20 pharmacy practice professionals on Libya’s current pharmaceutical situation, utilizing WHO indicator-based approach. The core indicators measure the most important information needed to understand the pharmaceutical situation in a country. A closed-end questionnaire was distributed to ten practicing pharmacists and ten pharmacy teaching staff members who practice pharmacy. The questionnaires were handed over personally and collected on the same day. The responses were analyzed using simple statistics. The results were argued in the light of the first author’s observation and view, being expert in this field, with reference to the other experts’ views, relevant publications’ findings and WHO reports’ conclusions on these indicators. Suggestions and recommendations for a proper situation assessment, planning and action taking are presented. Primarily, government’s commitment towards appropriate restructuring, management and monitoring of the pharmaceutical sector is crucial. That is to enhance the country’s pharmaceutical situation, to provide and sustain efficient pharmaceutical services and to improve the overall health care system’s performance

Report of the 6th Tanzania Joint Annual Health Sector Review 4th-6th April 2005 Kunduchi Beach Hotel,Dar es Salaam

The 6th Annual Joint Health Sector Review was concluded successfully at Kunduchi Beach hotel,between 4th and 6th April 2005. It was preceded by a Technical preparatory meeting, held at Belinda Hotel. This year’s was the largest review yet, with over 200 participants. As well as government and donor representatives, the meeting was attended by a variety of civil society and NGO representatives. The Honourable Minister of Health opened the meeting. Judged by the milestones, performance over the last year has been mixed. The advent of the Joint Rehabilitation Fund, the successful integration of Health into MKUKUTA, the scaling up of AIDS Care and Treatment and a steep budget increase (FY2004/5) were all registered as achievements. However, little if any progress was achieved in tackling the Human Resources crisis. The meeting resolved to address the issue with renewed commitment and urgency. A good deal of quantitative data was presented at the meeting, including the State of Health report, the updated health sector performance profile, and the ten-district study. In most respects these reports point to improvement in health service delivery between 2000 and 2003. The major areas of concern were maternal health services and child malnutrition – neither of which seem to have made any improvement over the last 2 decades. Weaknesses in the routine information system mean that data for 2004 is still patchy. Public Private Partnership was the theme of the technical review this year. The clearest message emerging in plenary was the need to replace the current government subsidy to faith-based providers by a service agreement, linked to outputs. Another resonating theme was the need to expand the opportunity for NGOs (including FBOs) to participate in health planning and management at district level. More generally, there was a commitment by both public and private stakeholders to deepen their collaboration. The recommendations of the Technical Review extended well beyond these two themes. However, lack of time in plenary precluded reaching consensus on most of the recommendations in the report. A good start has been made with the rehabilitation of district health infrastructure. This is expected to accelerate in the year ahead. Participants called for a holistic approach towards prioritisation and effective monitoring of implementation. The Honourable Minister called for a new approach and renewed urgency in tackling the human resources crisis. The challenges and the priorities are clear enough. But the shared commitment of MOF, PO-PSM, PORALG and MOH will be needed in order to move forward. A cabinet paper was seen as one way to secure this joint commitment. The financing situation for Health has improved markedly. The PER demonstrates a 33% nominal rise in health budget between 2003/4 and this budget year. FY2005/6 will witness a further steep increase. This good news is tempered by the fact that payroll expenditure is not keeping up with “other charges”, and central government expenditure is expanding much faster than local government. Even these increases are not sufficient to cover the requirements of the health sector. A 167 billion resource gap was documented by the MOH. New financial commitments continue to come on stream, often initiated by short-term donor funding. Moreover, a substantial portion of new money coming into the sector is tightly earmarked. Flexible, discretionary resources remain highly constrained and tough choices on resource allocation will have to be made. Detailed discussion of health financing in general, and user charges / CHF in particular, was deferred to the Health Financing Workshop due in early May.\u

Report of the 6th Tanzania Joint Annual Health Sector Review

\ud The 6th Annual Joint Health Sector Review was concluded successfully at Kunduchi Beach hotel, between 4th and 6th April 2005. It was preceded by a Technical preparatory meeting, held at Belinda Hotel. This year’s was the largest Review yet, with over 200 participants. As well as government and donor representatives, the meeting was attended by a variety of civil society and NGO representatives. The Honourable Minister of Health opened the meeting. Judged by the milestones, performance over the last year has been mixed. The advent of the Joint\ud Rehabilitation Fund, the successful integration of Health into MKUKUTA, the scaling up of AIDS Care and Treatment and a steep budget increase (FY2004/5) were all registered as achievements. However, little if any progress was achieved in tackling the Human Resources crisis. The meeting resolved to address the issue with renewed commitment and urgency. A good deal of quantitative data was presented at the meeting, including the State of Health report, the updated health sector performance profile, and the ten-district study. In most respects these reports point to improvement in health service delivery between 2000 and 2003. The major areas of concern were maternal health services and child malnutrition – neither of which seem to have made any improvement over the last 2 decades. Weaknesses in the routine information system mean that data for 2004 is still patchy. Public Private Partnership was the theme of the technical review this year. The clearest message emerging in plenary was the need to replace the current government subsidy to faith-based providers by a service agreement, linked to outputs. Another resonating theme was the need to expand the opportunity for NGOs (including FBOs) to participate in health planning and management at district level. More generally, there was a commitment by both public and private stakeholders to deepen their collaboration. The recommendations of the Technical Review extended well beyond these themes. A good start has been made with the rehabilitation of district health infrastructure. This is expected to accelerate in the year ahead. Participants called for a holistic approach towards prioritisation and effective monitoring of implementation. The Honourable Minister called for a new approach and renewed urgency in tackling the human resources crisis. The challenges and the priorities are clear enough. But the shared commitment of MOF, PO-PSM, PORALG and MOH will be needed in order to move forward. A cabinet paper was seen as one way to secure this joint commitment. The financing situation for Health has improved markedly. The PER demonstrates a 33% nominal rise in health budget between 2003/4 and this budget year. FY2005/6 will witness a further steep increase. This good news is tempered by the fact that payroll expenditure is not keeping up with “other charges”, and central government expenditure is expanding much faster than local government. Even these increases are not sufficient to cover the requirements of the health sector. A T. Shilling 167 billion resource gap was documented by the MOH. New financial commitments continue to come on stream, often initiated by short-term donor funding. Moreover, a substantial portion of new money coming into the sector is tightly earmarked. Flexible, discretionary resources remain highly constrained and tough choices on resource allocation will have to be made. Detailed discussion of health financing in general, and user charges / CHF in particular, was deferred to the Health Financing Workshop due in early May. A new set of Milestones, some of them carried over from last year, was debated and concluded after the meeting. These are reproduced in Table 7.\u