National healthcare system performance in- dex: methodological approaches and results for Russia

Abstract

The provision of comprehensive and high-quality services is one of the most important aims of the healthcare system. This important task can be accomplished by continuously evaluating and improving the performance of the health care service. The purpose of our study is to propose and to test the methodology for evaluation the performance of the healthcare system in Russia. The methodology is based on the construction of a composite index - an integrated indicator that aggregates four main aspects of the healthcare system (accessibility, financing, responsiveness, outcome), measured by nineteen indicators. The information base of study is not only objective, but also subjective statistical data (data from special surveys). It was established that in general for the period 2000-2017 healthcare system performance improved by 8%. The aspects and indicators contributed to this process were identified. Of the four aspects, improvement has occurred in two. Of the nineteen indicators nine improved, and, accordingly, ten worsened. The main contribution to improving of the healthcare system performance was made by such aspect as “Responsiveness of the healthcare system” (+64%), followed by “Outcome of the healthcare system” (+12%). The worst situation is in the areas of “Financing of the healthcare system” (-26%) and “Accessibility of the healthcare system” (–17%). Despite the difficulties and limitations met by the authors, attempts to build composite indexes are seemed to be a promising approach for assessing the performance of the healthcare system, since they are easier to interpret; make it relatively easy to track progress over time using just one indicator, rather than multiple indicators; identify problem areas that require changes to improve performance; allow to draw public attention to industry problems; can stimulate the search for better analysis methods and statistics of better quality.