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Peter C Smith - One of the best experts on this subject based on the ideXlab platform.
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Evolution of Health System Performance assessment: The roles of international comparisons and international institutions
2018Co-Authors: Peter C Smith, Marina Karanikolos, Jonathan CylusAbstract:Health System Performance assessment (HSPA) has become increasingly important nationally and internationally as a way to evaluate whether and to what degree Health Systems achieve their goals and to hold decision-makers to account. A core challenge remains how to best integrate HSPA in policy processes and to use the findings to contribute meaningfully to Health System improvement and Health policy development. In this article we review the evolution of HSPA over the past two decades, discuss some of the conceptual and methodological challenges and consider in particular the roles of international comparisons and international institutions.
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Health System Performance comparison new directions in research and policy
Health Policy, 2013Co-Authors: Irene Papanicolas, Peter C Smith, Niek Klazinga, Dionne S KringosAbstract:The concept of the ‘Health System’ has become central to debates about Health policy since the publication of the World Health Report 2000[1]. In that report, the WHO defined the Health System as “…all the activities whose primary purpose is to promote, restore or maintain Health”. That broad definition is closely aligned to the role of most Health ministries, which includes the promotion of Health and prevention of disease, as well as the organization of Health services. It is therefore not surprising that many policy makers have expressed particular interest in understanding better how their Health System works, and identifying the scope for improvement.
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Health System Performance comparison an agenda for policy information and research
2013Co-Authors: Irene Papanicolas, Peter C SmithAbstract:The 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 reform of Health Systems. Yet, as the demand for transparency and accountability in Health care increases, so too does the need to make comparisons of data from different Health Systems both accurate and meaningful. This timely and authoritative book offers an important summary of the current developments in Health System Performance comparison. It summarizes the current efforts to compare Systems, and identifies and explores the practical and conceptual challenges that arise. It discusses data and methodological challenges, as well as broader issues such as the interface between evidence and practice. The book outlines 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 thus offers a rich source of material for policy-makers, their analytic advisors, international agencies, academics and students of Health Systems.
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An Analysis Of Survey Data From Eleven Countries Finds That ‘Satisfaction’ With Health System Performance Means Many Things
Health affairs (Project Hope), 2013Co-Authors: Irene Papanicolas, Jonathan Cylus, Peter C SmithAbstract:Measures of personal satisfaction with Health Systems play an increasingly important role in national and international Performance assessments. Using data from the 2010 Commonwealth Fund International Health Policy Survey, we analyzed the determinants of personal perceptions of Health System Performance in eleven high-income countries. In most countries there was a clear relationship between overall satisfaction with the Health System and perceptions of affordability and effectiveness of care, as well as ratings of one’s regular doctor. There is some evidence that waiting times for appointments and diagnosis were widely associated with discontent, although respondents’ perceptions of these factors explained relatively little of the observed variation in overall satisfaction across countries. We conclude that “satisfaction” appears to represent something different in each Health System, and that policy makers can nevertheless use this type of analysis to determine priorities for improvement in their own c...
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Risk Pooling in Health Care Financing:The Implications for Health System Performance
2004Co-Authors: Peter C Smith, Sopie N. WitterAbstract:Pooling is the Health System function whereby collected Health revenues are transferred to purchasing organizations. Pooling ensures that the risk related to financing Health interventions is borne by all the members of the pool and not by each contributor individually. Its main purpose is to share the financial risk associated with Health interventions for which there is uncertain need. The arguments in favor of risk pooling in Health care embody equity and efficiency considerations. The equity arguments reflect the view that society does not consider it to be fair that individuals should assume all the risk associated with their Health care expenditure needs. The efficiency arguments arise because pooling can lead to major improvements in population Health, can increase productivity, and reduces uncertainty associated with Health care expenditure. The report considers four classes of risk pooling: no risk pool, under which all expenditure liability lies with the individual; unitary risk pool, under which all expenditure liability is transferred to a single national pool; fragmented risk pools, under which a series of independent risk pools (such as local governments or employer-based pools) are used; and integrated risk pools, under which fragmented risk pools are compensated for the variations in risk to which they are exposed. It notes that small, fragmented risk pools, which are the norm in developing countries, contribute to seriously adverse outcomes for Health System Performance.
Karen Davis - One of the best experts on this subject based on the ideXlab platform.
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Measuring and improving Health System Performance: what can Healthcare management educators do?
The Journal of health administration education, 2008Co-Authors: Karen Davis, Kristof StremikisAbstract:Healthcare managers of the future will need to be prepared to accept greater accountability for the quality and efficiency of Healthcare. National and state scorecards on Health System Performance indicate wide variation across the U.S. and across hospitals and Health Systems on key dimensions of Performance including Health outcomes, quality, access, equity, and efficiency. Benchmark data on achievable Performance will be useful to Healthcare managers in identifying best practices, setting priorities for improvement, and closing gaps in Performance. Payment reforms are likely to reward Healthcare organizations that serve as patient-centered medical homes, or assume accountability for total acute care, including hospital readmissions and post-hospital care. Health reforms to extend affordable Health insurance to all, align financial incentives to enhance value and achieve savings, organize the Healthcare System around the patient to ensure that care is accessible and coordinated, assist providers in meeting and raising benchmarks for high-quality, efficient care, and support greater public-private collaboration are needed to set the U.S. Health System on a path to high Performance.
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State Health System Performance And State Health Reform
Health affairs (Project Hope), 2007Co-Authors: Karen Davis, Cathy SchoenAbstract:State policy officials are focusing on improving Health insurance coverage, but other important dimensions of Performance, including quality and cost, are receiving less attention. This paper explores the implications of new data on state personal Health spending, quality, and Health System Performance. Personal Health spending is not related to mortality or quality, but Medicare spending is closely linked to preventable hospitalization. States need to link improved insurance coverage with policy strategies to improve quality and efficiency—such as requiring those covered to designate a medical home and changing payment methods to reward care coordination and more prudent stewardship of resources.
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U.S. Health System Performance: A National Scorecard
Health affairs (Project Hope), 2006Co-Authors: Cathy Schoen, Karen Davis, Sabrina K. H. How, Stephen C. SchoenbaumAbstract:This paper presents the findings of a new scorecard designed to assess and monitor multiple domains of U.S. Health System Performance. The scorecard uses national and international data to identify Performance benchmarks and calculates simple ratio scores comparing U.S averages to benchmarks. Average ratio scores range from 51 to 71 across domains of Health outcomes, quality, access, equity, and efficiency. The overall picture that emerges from the scorecard is one of missed opportunities and room for improvement. The findings underscore the importance of policies that take a coherent, whole-System approach to change and address the interaction of access, quality, and cost.
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U.S. Health System Performance: A National
2006Co-Authors: Cathy Schoen, Karen Davis, C StephenAbstract:This paper presents the findings of a new scorecard designed to assess and monitor multiple domains of U.S. Health System Performance. The scorecard uses national and international data to identify Performance benchmarks and calculates simple ratio scores comparing U.S averages to benchmarks. Average ratio scores range from 51 to 71 across domains of Health outcomes, quality, access, equity, and efficiency. The overall pic- ture that emerges from the scorecard is one of missed opportunities and room for improve- ment. The findings underscore the importance of policies that take a coherent, whole- System approach to change and address the interaction of access, quality, and cost.
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consumer directed Health care will it improve Health System Performance
Health Services Research, 2004Co-Authors: Karen DavisAbstract:The excellent set of papers contained in this issue provides important insight into early experience with consumer-directed Health care plans. While more experience and research are required to reach definitive conclusions, the evidence to date raises major cautions about relying on a consumer-directed Health care movement to address fundamental problems in the Health care System. Longer-term solutions aimed directly at the root causes of higher costs are needed to improve Health System Performance and to achieve better quality, safety, and efficiency of care provision.
Irene Papanicolas - One of the best experts on this subject based on the ideXlab platform.
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Health System Performance comparison new directions in research and policy
Health Policy, 2013Co-Authors: Irene Papanicolas, Peter C Smith, Niek Klazinga, Dionne S KringosAbstract:The concept of the ‘Health System’ has become central to debates about Health policy since the publication of the World Health Report 2000[1]. In that report, the WHO defined the Health System as “…all the activities whose primary purpose is to promote, restore or maintain Health”. That broad definition is closely aligned to the role of most Health ministries, which includes the promotion of Health and prevention of disease, as well as the organization of Health services. It is therefore not surprising that many policy makers have expressed particular interest in understanding better how their Health System works, and identifying the scope for improvement.
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Health System Performance comparison an agenda for policy information and research
2013Co-Authors: Irene Papanicolas, Peter C SmithAbstract:The 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 reform of Health Systems. Yet, as the demand for transparency and accountability in Health care increases, so too does the need to make comparisons of data from different Health Systems both accurate and meaningful. This timely and authoritative book offers an important summary of the current developments in Health System Performance comparison. It summarizes the current efforts to compare Systems, and identifies and explores the practical and conceptual challenges that arise. It discusses data and methodological challenges, as well as broader issues such as the interface between evidence and practice. The book outlines 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 thus offers a rich source of material for policy-makers, their analytic advisors, international agencies, academics and students of Health Systems.
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An Analysis Of Survey Data From Eleven Countries Finds That ‘Satisfaction’ With Health System Performance Means Many Things
Health affairs (Project Hope), 2013Co-Authors: Irene Papanicolas, Jonathan Cylus, Peter C SmithAbstract:Measures of personal satisfaction with Health Systems play an increasingly important role in national and international Performance assessments. Using data from the 2010 Commonwealth Fund International Health Policy Survey, we analyzed the determinants of personal perceptions of Health System Performance in eleven high-income countries. In most countries there was a clear relationship between overall satisfaction with the Health System and perceptions of affordability and effectiveness of care, as well as ratings of one’s regular doctor. There is some evidence that waiting times for appointments and diagnosis were widely associated with discontent, although respondents’ perceptions of these factors explained relatively little of the observed variation in overall satisfaction across countries. We conclude that “satisfaction” appears to represent something different in each Health System, and that policy makers can nevertheless use this type of analysis to determine priorities for improvement in their own c...
Emmanuela Gakidou - One of the best experts on this subject based on the ideXlab platform.
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benchmarking Health System Performance across regions in uganda a Systematic analysis of levels and trends in key maternal and child Health interventions 1990 2011
BMC Medicine, 2015Co-Authors: Allen D Roberts, Nancy Fullman, Laura Dwyerlindgren, Gloria Ikilezi, Anne Gasasira, Talemwa Nalugwa, Moses R Kamya, Emmanuela GakidouAbstract:Globally, countries are increasingly prioritizing the reduction of Health inequalities and provision of universal Health coverage. While national benchmarking has become more common, such work at subnational levels is rare. The timely and rigorous measurement of local levels and trends in key Health interventions and outcomes is vital to identifying areas of progress and detecting early signs of stalled or declining Health System Performance. Previous studies have yet to provide a comprehensive assessment of Uganda’s maternal and child Health (MCH) landscape at the subnational level. By triangulating a number of different data sources – population censuses, household surveys, and administrative data – we generated regional estimates of 27 key MCH outcomes, interventions, and socioeconomic indicators from 1990 to 2011. After calculating source-specific estimates of intervention coverage, we used a two-step statistical model involving a mixed-effects linear model as an input to Gaussian process regression to produce regional-level trends. We also generated national-level estimates and constructed an indicator of overall intervention coverage based on the average of 11 high-priority interventions. National estimates often veiled large differences in coverage levels and trends across Uganda’s regions. Under-5 mortality declined dramatically, from 163 deaths per 1,000 live births in 1990 to 85 deaths per 1,000 live births in 2011, but a large gap between Kampala and the rest of the country persisted. Uganda rapidly scaled up a subset of interventions across regions, including household ownership of insecticide-treated nets, receipt of artemisinin-based combination therapies among children under 5, and pentavalent immunization. Conversely, most regions saw minimal increases, if not actual declines, in the coverage of indicators that required multiple contacts with the Health System, such as four or more antenatal care visits, three doses of oral polio vaccine, and two doses of intermittent preventive therapy during pregnancy. Some of the regions with the lowest levels of overall intervention coverage in 1990, such as North and West Nile, saw marked progress by 2011; nonetheless, sizeable disparities remained between Kampala and the rest of the country. Countrywide, overall coverage increased from 40 % in 1990 to 64 % in 2011, but coverage in 2011 ranged from 57 % to 70 % across regions. The MCH landscape in Uganda has, for the most part, improved between 1990 and 2011. Subnational benchmarking quantified the persistence of geographic Health inequalities and identified regions in need of additional Health Systems strengthening. The tracking and analysis of subnational Health trends should be conducted regularly to better guide policy decisions and strengthen responsiveness to local Health needs.
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benchmarking Health System Performance across states in nigeria a Systematic analysis of levels and trends in key maternal and child Health interventions and outcomes 2000 2013
BMC Medicine, 2015Co-Authors: Alexandra Wollum, Roy Burstein, Nancy Fullman, Laura Dwyerlindgren, Emmanuela GakidouAbstract:Nigeria has made notable gains in improving childhood survival but the country still accounts for a large portion of the world’s overall disease burden, particularly among women and children. To date, no Systematic analyses have comprehensively assessed trends for Health outcomes and interventions across states in Nigeria. We extracted data from 19 surveys to generate estimates for 20 key maternal and child Health (MCH) interventions and outcomes for 36 states and the Federal Capital Territory from 2000 to 2013. Source-specific estimates were generated for each indicator, after which a two-step statistical model was applied using a mixed-effects model followed by Gaussian process regression to produce state-level trends. National estimates were calculated by population-weighting state values. Under-5 mortality decreased in all states from 2000 to 2013, but a large gap remained across them. Malaria intervention coverage stayed low despite increases between 2009 and 2013, largely driven by rising rates of insecticide-treated net ownership. Overall, vaccination coverage improved, with notable increases in the coverage of three-dose oral polio vaccine. Nevertheless, immunization coverage remained low for most vaccines, including measles. Coverage of other MCH interventions, such as antenatal care and skilled birth attendance, generally stagnated and even declined in many states, and the range between the lowest- and highest-performing states remained wide in 2013. Countrywide, a measure of overall intervention coverage increased from 33% in 2000 to 47% in 2013 with considerable variation across states, ranging from 21% in Sokoto to 66% in Ekiti. We found that Nigeria made notable gains for a subset of MCH indicators between 2000 and 2013, but also experienced stalled progress and even declines for others. Despite progress for a subset of indicators, Nigeria’s absolute levels of intervention coverage remained quite low. As Nigeria rolls out its National Health Bill and seeks to strengthen its delivery of Health services, continued monitoring of local Health trends will help policymakers track successes and promptly address challenges as they arise. Subnational benchmarking ought to occur regularly in Nigeria and throughout sub-Saharan Africa to inform local decision-making and bolster Health System Performance.
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China's Health System Performance
Lancet (London England), 2008Co-Authors: Yuanli Liu, Keqin Rao, Emmanuela GakidouAbstract:We created a comprehensive set of Health-System Performance measurements for China nationally and regionally, with Health-System coverage and catastrophic medical spending as major indicators. With respect to Performance of Health-care delivery, China has done well in provision of maternal and child Health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to Performance of Health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing Health care. Although Health-System coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in Health-System coverage and Health-care affordability measures exist. People with low income not only receive lower Health-System coverage than those with high income, but also have an increased probability of either not seeking Health care when ill or undergoing catastrophic medical spending. China's current Health-System reform efforts need to be assessed for their effect on Performance indicators, for which substantial data gaps exist.
Kenneth Grech - One of the best experts on this subject based on the ideXlab platform.
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The development of Health System Performance assessment frameworks in Malta and beyond and their impact upon policy making
2018Co-Authors: Kenneth GrechAbstract:Introduction and aims: Following the 2008 financial crisis, Performance monitoring and evaluation in the form of Health System Performance Assessment (HSPA) received heightened attention and is now used by policy makers and Health service leaders for decision taking. However, despite its increased importance and relevance, there is, as yet, no common internationally recognised standardised methodology for its development and implementation. Moreover, whilst there is ample evidence linking HSPA with service improvement, the literature on the impact of HSPA upon Health policy-making is limited. The research questions aim at addressing these two research gaps, looking into the most appropriate method for developing a Health System Performance assessment framework for Malta and examining the role, if any, that national Health System Performance assessment frameworks play in the development of national Health policy. These two facets of HSPA are the focus of this research, where a methodology for implementing HSPA in a small state (Malta) is developed and the relationship between HSPA and policy development at national and European level is thoroughly investigated. Methods: The study consisted of three phases. A comprehensive document analysis was first carried out. This was followed by the development and implementation of a HSPA framework and Performance assessment report for Malta. The final phase consisted of a three-year ethnographic study across Europe’s capitals, resulting in the collection and analysis of data on the relationship between HSPA and Health policy development in the European region. Results: HSPA methodology must combine scientific robustness with policy constraints to take into account the political exigencies of the Health System it is purported to assess. This is deemed both important and appropriate for HSPA, especially for small states like Malta. The research also reveals the unique role HSPA plays in policy development, as one of the many variables that influences Health policy. However, the study also goes on to highlight the mismatch between the evidence generated by HSPA and a more evidence-based approach to policy making. Conclusions: The study concludes by proposing a new model for policy making, incorporating HSPA as a central tenet of this process. Several options are then suggested to better align the disparate agendas of policy makers and researchers, such as matching the research and policy priorities closely at the start of the research and policy process.
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The challenges of developing and implementing a Health System Performance Assessment Framework in small states – the experience of Malta and Estonia
European Journal of Public Health, 2014Co-Authors: Kenneth Grech, Taavi LaiAbstract:The development and implementation of a national Health System Performance assessment (HSPA) framework is an important tool to assess Health outcomes. This is more so for small states since small changes can have profound effects upon population Health. Drawing upon the experience of Malta and Estonia, the presentation will highlight some of the particular challenges …
