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. 2018 Jun 28:76:32.
doi: 10.1186/s13690-018-0278-0. eCollection 2018.

Headline indicators for monitoring the performance of health systems: findings from the european Health Systems_Indicator (euHS_I) survey

Nataša Perić  1 , Maria M Hofmarcher  2   1 , Judit Simon  1
Affiliations

Headline indicators for monitoring the performance of health systems: findings from the european Health Systems_Indicator (euHS_I) survey

Nataša Perić et al. Arch Public Health. .

Abstract

Background: Cross-country comparisons of health system performance have become increasingly important. Clear evidence is needed on the prioritization of health system performance assessment (HSPA) indicators. Selected "leading" or "headline" HSPA indicators may provide early warnings of policy impacts. The goal of this paper is to propose a set of headline indicators to frame and describe health system performance.

Methods: We identified overlaps and gaps in the availability of reported indicators by looking at HSPA initiatives in Member States (MSs) of the European Union (EU), the European Commission as well as international institutions (e.g. OECD, WHO-EUR). On that basis, we conducted a two-stage online survey, the european Health System_Indicator (euHS_I) survey. The survey sought to elicit preferences from a wide range of HSPA experts on i) the most relevant HSPA domain(s), i.e. access, efficiency, quality of care, equity, for a specific indicator, and ii) the importance of indicators regarding their information content, i.e. headline, operational, explanatory. Frequency analysis was performed.

Results: We identified 2168 health and health system indicators listed in 43 relevant initiatives. After adjusting for overlaps, a total of 361 indicators were assessed by 28 experts in the 1st stage of the survey. In the 2nd stage, a more balanced set of 95 indicators was constructed and assessed by 72 experts from 22 EU MSs and 3 non-EU countries. In the domain access experts assessed share of population covered by health insurance as the top headline indicator. In the domain efficiency, the highest rank was given to Total health care expenditure by all financing agents, and in the domain quality of care to rate of hospital-acquired infections. Percentage of households experiencing high levels/catastrophic of out-of-pocket health expenditures results as the top headline indicator for domain equity.

Conclusions: HSPA indicators from different initiatives largely overlap and public health indicators dominate over health systems aspects. The survey allowed to quantify overlaps and gaps in HSPA indicators, their expert allocation to domain areas and establishment of an informed hierarchy structure. Yet, results show that more multidisciplinary work is needed to ensure the availability of accurate efficiency indicators which are comparable across countries.

Keywords: European Union; Health information; Health system performance assessment; Indicators; International comparisons; Policy making.

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Conflict of interest statement

Nataša Perić (BSc, MSc), Researcher, Department of Health Economics, Centre for Public Health, Medical University of Vienna, Austria. Maria M. Hofmarcher-Holzhacker (MSc, MPH), Director of HealthSystemIntelligence and Research Associate at the Department of Health Economics, Medical University Vienna, Austria. Judit Simon (MD, BA, BSc, MSc, DPhil, FFPH), Professor of Health Economics and Head, Department of Health Economics, Centre for Public Health, Medical University of Vienna, AustriaNot applicableNot applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart with timeline
Fig. 2
Fig. 2
Distribution of stepwise adjustment of indicator inventory for euHS_I survey
See this image and copyright information in PMC

References

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