Abstract
Background:Health system performance assessment (HSPA) is a major tool for evidence-based governance in health systems and patient/population-orientation is increasingly considered as an important aspect. The IPHA study aims (1) to undertake a comprehensive performance assessment of the German health system from a population perspective based on the intermediate and final dimensions defined by the World Health Organization (WHO) and (2) to identify differences in HSPA between (a) common user characteristics and (b) user types, which differ in their interactions and patterns of action within the health system.Methods and Analysis: A cross-sectional survey was conducted between October and December 2018 with statutorily and privately health insured to assess the German health system from a population perspective related to the past 12 months. The random sample consists of 32 000 persons insured by AOK Nordost and 20 000 persons insured by Debeka. Data from the survey will subsequently be linked with health insurance claims data at the individual level for each respondent who has given consent for data linkage. Claims data covers the time period January 1, 2017 to June 30, 2018. The combination of the 2 data sources allows to identify associations between insured patient characteristics and differences in the assessment of health system performance. The survey consists of 71 items measuring all final and intermediate health system goals defined by the WHO and user characteristics like health literacy, self-efficacy, the attention an individual pays to his or her health or disease, the personal network, autonomy, compliance and sociodemographics. The claims data contains information on morbidity, care delivery, service utilization, (co)payments and sociodemography. Discussion: The study represents a promising attempt to perform a holistic HSPA using a population perspective. For this purpose, a questionnaire was designed that contains both validated and new items in order to collect data on all relevant health system dimensions. In particular, linking survey data on HSPA with claims data is of high potential for assessing and analysing determinants of health system performance from the population perspective.
Highlights
Health system performance assessment (HSPA) is increasingly becoming a major tool for evidence-based governance in modern health systems
Several countries and international organizations, eg, Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO), have implemented initiatives and programs to investigate the performance of single sectors or the overall health system based on different frameworks.[2,3,4]
The study aims (1) to undertake a comprehensive performance assessment of the German health system from a population perspective based on the intermediate and final dimensions defined by the WHO and (2) to identify differences in HSPA between (a) common user characteristics and (b) user types, which differ in their interactions and patterns of action within the health system
Summary
Health system performance assessment (HSPA) is increasingly becoming a major tool for evidence-based governance in modern health systems. HSPA is defined as the process of monitoring, evaluating, communicating and reviewing the extent to which different aspects of a healthcare system can achieve previously defined goals.[1] Several countries and international organizations, eg, Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO), have implemented initiatives and programs to investigate the performance of single sectors or the overall health system based on different frameworks.[2,3,4]. The Framework takes into account both the ultimate goals of a health system, such as population health, social and financial risk protection, efficiency, health system responsiveness and inequality in healthcare, and intermediate objectives, ie, access, coverage, quality and safety.[5,6]. This, in turn, comprises the following 4 dimensions: (i) population coverage, (ii) service coverage (ie, services included in the benefit basket), (iii) cost coverage, ie, affordability/cost sharing, and (iv) availability of services (with possible access barriers being distance, waiting times, and lack of choice of providers).[7]
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