Equity Indicators for Health System Performance Assessment

Abstract

Equity in healthcare is included as a key dimension in the most conceptual frameworks for health system performance assessment. Measuring equity is one of the cornerstones by the assessment. The aim of the study is to identify and systematise the primary indicators used to measure equity by the health system performance assessment. A review of reports from international and national organisations as well as scientific publications is completed. The descriptive analysis of the equity concept in healthcare is complemented by a structured synthesis of the indicators used for its assessment - the outlined indicators are grouped, and the most frequently used are analysed. Plenty of equity indicators are used in different frameworks, depending on how this complex concept is interpreted and the definition adopted in the relevant conceptual framework. The literature review identifies 359 indicators, which, after grouping and removing duplicates and similarities are reduced to 157. The most commonly used concern equity in access to health services for different population groups and equity in financing, including financial protection. The largest number of indicators are identified in the groups related to the quality of health services and health status of the population. Different interpretations of equity result in a large number of indicators for its assessment and the lack of consensus for a standard set of such. Measuring equity is still a challenge in health system performance assessment.