Performance Of National Health Systems Research Articles

Resilience dimensions in health system performance assessments, European Union.

To explore the definition and operationalization of resilience in health system performance assessments in European Union countries. We conducted multiple empirical case study analyses. We identified relevant cases through a literature review from 2014 to 2023 using Google Scholar and through a snowball technique to retrieve additional information. We included only documents that explicitly mentioned resilience in health system performance assessments. We performed a content analysis to identify common patterns in defining resilience. The final sample consisted of six countries: Belgium, Croatia, Czechia, Estonia, Ireland and Italy. Each country adopted a distinct approach to conceptualizing resilience, with countries prioritizing specific aspects based on lessons learnt from the coronavirus disease 2019 (COVID-19) pandemic. Some countries focused on maintaining essential health-care services and protecting vulnerable groups. Other countries prioritized management capacity, staff preparedness, digital health utilization and strengthening of primary health care. Content analysis revealed six resilience definitions derived from the key performance indicators: addressing unmet needs and maintaining outcomes; protecting vulnerable groups; acquiring and using resources; having trained and prepared staff in place; using digital health; and strengthening primary health care. Integration of resilience into the health profiles of European Union countries preceded its inclusion in national health system performance assessments, the latter of which became more prominent after the COVID-19 pandemic. Variations in interpretations within health system performance assessments reflect differences in indicators and policy responses.

EFFECT OF HEALTH SYSTEM PERFORMANCE ON VOLATILITY DURING THE COVID-19 PANDEMIC: A NEURAL NETWORK APPROACH

The study proposes an assessment of the link between the performance of national health systems and volatility during the COVID-19 pandemic. Data from the World Health Organization was accessed regarding the Global Health Security Index of the states considered in the analysis as well as the categories based on which it is determined. To characterise volatility, a representative stock market index was considered for each of the 60 states analysed. Data processing was carried out using an artificial neural network. The main results show that: i) before the pandemic, the link between market volatility and the performance of national health systems was weak; ii) during the pandemic, the connection between the two variables is much stronger; iii) between the six categories that define the Global Health Security Index, norms, health, and prevention had the greatest influence on volatility.

Identifying health inequities using a health system performance assessment: findings from Germany

Abstract Background Reducing health inequities is an important goal of high-performing health systems. Therefore, health inequities need to be assessed systematically, continuously and for all relevant aspects of a health system. The tool “health system performance assessments” (HSPA) aims at monitoring and evaluation the achievement of predefined goals and therefore the overall performance of a national health system. The aim of this study was to identify health inequities using a national HSPA. Methods A pilot study for a national HSPA in Germany was conducted between 2020 and 2023. The underlying framework defined the health system goals (e.g., access, quality, population health) and the respective indicators. Equity analyses (e.g., age, gender, socioeconomic factors, geographical region, type of health insurance) were conducted for each indicator to highlight inequities. Results Inequities were found for all health system goals. For example, unmet needs (“access”) were higher among people in the lowest income quintiles and in suburban areas. Potentially inadequate medication among the elderly (“quality”) was found more often for women and people 85+ years. The prevalence of infectious diseases (“population health”) was higher among men. Conclusions Using a national HSPA to discover health inequities can help identify these in all areas and for all goals of a health system and monitor their development over time. The systematic and continuous assessment within an HSPA is an important prerequisite for identifying and evaluating measures aiming at reducing health inequities. Key messages • A national health system performance assessment is useful for identifying and monitoring health inequities on a system level. • Health inequities (e.g., regarding age, gender, geographic region) were found for every goal of the German health care system.

The African Health Initiative's Role in Advancing the Use of Embedded Implementation Research for Health Systems Strengthening.

<h3>Key Messages</h3> The embedded implementation research (EIR) approach involves engaging policy makers and decision makers at each stage from the design to the dissemination of research and increases the likelihood of the use of research evidence to better inform policy and management decisions. The African Health Initiative is an example of a public enterprise that has demonstrated success in developing domestic research capacity and strengthening health systems in sub-Saharan Africa by integrating the EIR approach into its projects. Further efforts and investments are needed to increase the sustainability and scalability of the EIR approach to improve the performance of national health systems.

Taking Systems Thinking to the Global Level: Using the WHO Building Blocks to Describe and Appraise the Global Health System in Relation to COVID-19.

Adequately preparing for and containing global shocks, such as COVID‐19, is a key challenge facing health systems globally. COVID‐19 highlights that health systems are multilevel systems, a continuum from local to global. Goals and monitoring indicators have been key to strengthening national health systems but are missing at the supranational level. A framework to strengthen the global system—the global health actors and the governance, finance, and delivery arrangements within which they operate—is urgently needed. In this article, we illustrate how the World Health Organization Building Blocks framework, which has been used to monitor the performance of national health systems, can be applied to describe and appraise the global health system and its response to COVID‐19, and identify potential reforms. Key weaknesses in the global response included: fragmented and voluntary financing; non‐transparent pricing of medicines and supplies, poor quality standards, and inequities in procurement and distribution; and weak leadership and governance. We also identify positive achievements and identify potential reforms of the global health system for greater resilience to future shocks. We discuss the limitations of the Building Blocks framework and future research directions and reflect on political economy challenges to reform.

Validation and application of a needs-based segmentation tool for cross-country comparisons.

ObjectiveTo compare countries' health care needs by segmenting populations into a set of needs‐based health states.Data sourcesWe used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data.Study designWe developed the Cross‐Country Simple Segmentation Tool (CCSST), a validated clinician‐administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self‐reported physician diagnosis of chronic disease, and performance‐based tests conducted during the survey interview, individuals were assigned to 1–5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross‐sectionally to assess cross‐country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death.Data collection/extraction methodsWe segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories.Principal findingsThe CCSST is a valid tool for segmenting populations into needs‐based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country‐specific areas for analysis of ecological and cultural risk factors.ConclusionsThe CCSST is an innovative tool for aggregate cross‐country comparisons of both health needs and transitions between them. A cross‐country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high‐need, high‐cost patients.

Spatial and temporal variations of spatial population accessibility to public hospitals: a case study of rural–urban comparison

Quantification and assessment of nationwide population access to health-care services is a critical undertaking for improving population health and optimizing the performance of national health systems. Rural–urban unbalance of population access to health-care services is widely involved in most of the nations. This unbalance is also potentially affected by varied weather and road conditions. This study investigates the rural and urban performances of public health system by quantifying the spatiotemporal variations of accessibility and assessing the impacts of potential factors. Australian health-care system is used as a case study for the rural–urban comparison of population accessibility. A nationwide travel time-based modified kernel density two-step floating catchment area (MKD2SFCA) model is utilized to compute accessibility of travel time within 30, 60, 120, and 240 min to all public hospitals, hospitals that provide emergency care, and hospitals that provide surgery service, respectively. Results show that accessibility is varied both temporally and spatially, and the rural–urban unbalance is distinct for different types of hospitals. In Australia, from the perspective of spatial distributions of health-care resources, spatial accessibility to all public hospitals in remote and very remote areas is not lower (and may even higher) than that in major cities, but the accessibility to hospitals that provide emergency and surgery services is much higher in major cities than other areas. From the angle of temporal variation of accessibility to public hospitals, reduction of traffic speed is 1.00–3.57% due to precipitation and heavy rain, but it leads to 18–23% and 31–50% of reduction of accessibility in hot-spot and cold-spot regions, respectively, and the impact is severe in New South Wales, Queensland, and Northern Territory during wet seasons. Spatiotemporal analysis for the variations of accessibility can provide quantitative and accurate evidence for geographically local and dynamic strategies of allocation decision-making of medical resources and optimizing health-care systems both locally and nationally.

Badalona Story: integrating the integration initiatives

Introduction: The STOPandGO Project [1] developed an approach [2] to the procurement activities in a local initiative of integrated care in the framework of a multi-annual process of innovation of the managerial, administrative, clinical, and social aspects [3], accompanied by a meaningful use of technology. The paper applies the approach to analyse the journey of Badalona Serveis Assistencials (BSA), a Reference Site for EIPonAHA [4], with a unique long-term experience of effective integration [5, 6]. Methods: The paper systematically describes how the sequence of local initiatives in BSA were complementary or overlapping according to the earmarked combination of two perspectives [1, 2]: to address a defined set of citizens’ needs and the related health journey, e.g. on health conditions; or to establish networks for vulnerable persons; to reduce the fragmentation of the care and cure services across the settings. Results: The analysis shows that: in the initial status (2000) a few isolated initiatives were in place; the sequence of local initiatives achieved a crucial level of integration after a period of disruptive Health Innovation [7], which changed roles and attitudes of citizens and professionals and gained their satisfaction and commitment; the key enablers for integrated care [8] have been: 1) policy commitment towards a patient-centric model enabling the continuum of care at a local level (municipality), 2) Health and social care professionals have a leading role, 3) Interoperable information systems has fostered the full deployment, 4) The absence of major conflicts between the distribution of resources and the alignment of incentives among primary, secondary and tertiary care and social care has facilitated the overall process; the present fully integrated system evolves through a continuing improvement process, with a lower emphasis on specific initiatives. Discussions: In BSA health and social care centres are under the same governance and organisational structure, sharing the same cultural values and legal framework [3, 4]; the local push was reinforced and aligned with the Catalan integrated care policy. The paper demonstrates how this locality managed the sequence of initiatives according to its priorities, speed and emphasis to fit with its local context and favourable circumstances [8]. Conclusions: The long-term ambition of every locality should be to integrate all the relevant services for all the citizens, through a suitable series of initiatives. Priority and shape of each initiative depend on: regional and national milieu, e.g. regulations, health and social plans, coordination of Local Initiatives, common infrastructures, funding; local circumstances, e.g. epidemiology of health problems; readiness of healthcare facilities and technological infrastructures; culture and engagement of professionals; expected return and possibility to reallocate a reduction in resource usage. Lessons learned: Hundreds of good practices [e.g. 4, 9] give evidence of feasibility, relevance and benefits of diverse approaches on a wide spectrum of Integrated Care models. Each Local Initiative should refer to an explicit policy, to deploy an innovative model in a particular scenario. Experience tells that isolated initiatives have a high risk of failure; in addition, an unplanned juxtaposition of several initiatives may provoke serious and costly troubles to achieve the suitable organisational and technological interoperability. Limitations: Each local roadmap depends on local circumstances, however the basic principles and the various components of the innovative models could be shared across localities. Suggestions for future research: The study of the components of a model and their optimal combination may bring to a methodology to support the planning of local roadmaps and their scaling up at regional level according to an agreed regional Action Plan.

Mutual Learning about Health System Performance in Australia's Intergovernmental Health Committee System?

Since the early 1990s Australia, through the Australian Health Minister’s Advisory Council, began the process of developing a national health system performance framework. This includes service delivery measures for hospitals and has been used as a template for national data collections in mental health services. National performance frameworks have since become part of promoting greater integration of policy making and service delivery across Commonwealth and State jurisdictional health functions. The key focus of this paper is upon inter-governmental processes and routines to develop Australian national performance regimes in the realms of health and mental health care services. It presents initial findings from 26 elite interviews working across the inter-governmental interface, including some data about experiences of service managers. The report provides two contributions to the existing literature on Australia’s federal health system and more specifically health governance. Firstly, it presents a literature review of studies and theoretical concepts that have been deployed to examine cross jurisdictional processes of decision making. There is particular attention for the European literature on inter-governmental committee systems. Secondly, the paper presents initial findings from an explorative study of Australia’s inter-governmental machinery in the realms of health and mental health care services. This explorative study was based upon an initial 26 elite interviews from respondents working (or having worked in) Australia’s inter-governmental machinery, including some respondents from representatives of relevant Commonwealth semi-autonomous bodies. The researcher also observed two inter-governmental committee proceedings although reported data here draws only from interviews. These findings provide a first insight into the inner workings of Australia’s inter-governmental health machinery. It is argued that there has been evidence of mutual learning from Australia’s National Health Performance initiatives, and, exchanges and recommendations for future research to further investigate and pinpoint the causal processes through which mutual learning occurs are provided.

Systematic approach to evaluating and confirming the utility of a suite of national health system performance (HSP) indicators in Canada: a modified Delphi study

ObjectivesEvaluating an existing suite of health system performance (HSP) indicators for continued reporting using a systematic criteria-based assessment and national consensus conference.DesignModified Delphi approach with technical and leadership groups, an...

Evaluation of the performance of national health systems in 2004-2011: An analysis of 173 countries.

In an effort to improve health service delivery and achieve better health outcomes, the World Health Organization (WHO) has called for improved efficiency of health care systems to better use the available funding. This study aims to examine the efficiency of national health systems using longitudinal country-level data. Data on health spending per capita, infant mortality rate (IMR), under 5 mortality rate (U5MR), and life expectancy (LE) were collected from or imputed for 173 countries from 2004 through 2011. Data envelopment analyses were used to evaluate the efficiency and regression models were constructed to examine the determinants of efficiency. The average efficiency of the national health system, when examined yearly, was 78.9%, indicating a potential saving of 21.1% of health spending per capita to achieve the same level of health status for children and the entire population, if all countries performed as well as their peers. Additionally, the efficiency of the national health system varied widely among countries. On average, Africa had the lowest efficiency of 67%, while West Pacific countries had the highest efficiency of 86%. National economic status, HIV/AIDS prevalence, health financing mechanisms and governance were found to be statistically associated with the efficiency of national health systems. Taking health financing as an example, a 1% point increase of social security expenses as a percentage of total health expenditure correlated to a 1.9% increase in national health system efficiency. The study underscores the need to enhance efficiency of national health systems to meet population health needs, and highlights the importance of health financing and governance in improving the efficiency of health systems, to ultimately improve health outcomes.

Training And Supervision Did Not Meaningfully Improve Quality Of Care For Pregnant Women Or Sick Children In Sub-Saharan Africa.

In-service training courses and supportive supervision of health workers are among the most common interventions to improve the quality of health care in low- and middle-income countries. Despite extensive investment from donors, evaluations of the long-term effect of these two interventions are scarce. We used nationally representative surveys of health systems in seven countries in sub-Saharan Africa to examine the association of in-service training and supervision with provider quality in antenatal and sick child care. The results of our analysis showed that observed quality of care was poor, with fewer than half of evidence-based actions completed by health workers, on average. In-service training and supervision were associated with quality of sick child care; they were associated with quality of antenatal care only when provided jointly. All associations were modest-at most, improvements related to interventions were equivalent to 2 additional provider actions out of the 18-40 actions expected per visit. In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries. Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve.

Association of dental caries experience with individual and contextual variables in Brazilian children

Abstract Context: There is a trend toward reduction in the caries index in populations of schoolchildren in developed and developing countries. In spite of this reduction, 53.4% Brazilian children present caries experience in primary dentition. Aims: To evaluate the association between dental caries experience in 5-year-old Brazilian and individual and contextual variables. Settings and Design: An analytical cross-sectional study was conducted. Materials and Methods: Data of a national oral health epidemiological survey - SB Brazil 2010 were taken. The outcome studied was caries experience measured by the decayed, missing, and filled teeth (dmft) index. The independent variables were classified into individual (sex, occlusion, treatment need, number of persons′ resident in the home, number of bedrooms in the residence, number of goods/assets, and family income) and contextual (family financial aid grand, national health system performance index (Índice de Desempenho do Sistema Único de Saúde [IDSUS]), Gross National Product, per capita, Human Development Index, and fluoridated water) variables. Statistical Analysis Used: The data were initially analyzed by the Chi-square test, then was applied the multilevel model. Results: Only the contextual variable that evaluates access and quality of public services (IDSUS) was observed to affect the children′s dmft index. The individual variables: male sex (P = 0.0005), occlusion (P = 0.0437), dental treatment need (P &lt; 0.0001), number of persons′ resident in the home (P &lt; 0.0001), number of bedrooms in the residence (P = 0.0152), number of goods/assets (P = 0.0147), and family income (P = 0.0044) were significant. Conclusions: There is an impact of social determinants on health at individual level but only the IDSUS contextual variable was associated with dmft. Are necessary development public policies to deal with caries with a focus on these determinants?

Medical teleconsultation to general practitioners reduces the medical error vulnerability of internal medicine patients

Backgrounde-Health strategies are supposed to improve the performance of national health systems. Medical teleconsultation (MT) is an important component of such e-Health strategies. ObjectivesThe outcome of MT was evaluated with regard to the impact on the medical error vulnerability (MEV) of internal medicine patients. MethodsA team of internal medicine doctors plus a network of forty specialists was set-up in one health district belonging to a unified and universal national health system of a country of Western Europe, in order to provide free-of-charge MT to support general practitioners in solving internal medicine cases. In this observational study, the case series of 2013 is reviewed. Resultsa) Only 21% of the MT fell short to the general practitioner's expectations about the case solving focus; b) throughout the medical care process of the patient, 49% of the cases met with one or more of the five MEVs, namely: 1) clinical test mishandling; 2) inaccurate differential diagnosis; 3) inadequate information flow between health providers at different levels of care (transition care); 4) poor coordination between health providers; and 5) poor reconciliation of medications or hazardous therapies. c) MT canceled or prevented MEVs in 56% and mitigate MEVs in 15% of the cases; d) MT canceled or prevented 85% of MEV caused by poor information exchange in transition care, therefore improving patient referral and counter-referral. ConclusionsMT reduces MEV and therefore, whenever implemented to a large extent, may improve the quality of health care delivery and the performance of national health systems.

The challenges of developing and implementing a Health System Performance Assessment Framework in small states – the experience of Malta and Estonia

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 …

National Health Systems and Unmet Need for Antiretroviral Medication and HIV/AIDS-Related Healthcare in African Countries Emerging from Conflict

This article examines challenges faced by the national health systems of African countries emerging from conflict in the provision of antiretroviral (ARV) medication and HIV/AIDS-related healthcare. It analyses resource profiles, the unmet need for antiretroviral medication, and progress in the provision of HIV/AIDS-related healthcare in Burundi, Liberia, Mozambique, Rwanda, Sierra Leone and Uganda, using data from the Global AIDS Response Progress Reports (GARPR) of 2011. Findings indicate that challenges to the health systems in post-conflict countries are immense and should not be underestimated, particularly in the context of HIV/AIDS. Policy recommendations for bolstering the performance of national health systems of post-conflict countries in the context of HIV/AIDS are proposed.

Hospital care in Iran: an examination of national health system performance

This study examines hospital care system performance in Iran. We first briefly review hospital care delivery system in Iran. Then, the hospital care system in Iran has been investigated from financial, utilization, and quality perspectives. In particular, we examined the extent to which health care system in Iran protects people from the financial consequence of health care expenses and whether inpatient care distributed according to need. We also empirically analyzed the quality of hospital care in Iran using patient satisfaction information collected in a national health service survey. The Iranian health care system consists of unequal access to hospital care; mismatch between the distribution of services and inpatients' need; and high probability of financial catastrophe due to out-of-pocket payments for inpatient services. Our analysis indicates that the quality of hospital care among Iranian provinces favors patients residing in provinces with high numbers of hospital beds per capita such as Esfahan and Yazd. Patients living in provinces with low levels of accessibility to hospital care (e.g. Gilan, Kermanshah, Hamadan, Chahar Mahall and Bakhtiari, Khuzestan, and Sistan and Baluchestan) receive lower-quality services. These findings suggest that policymakers in Iran should work on several fronts including utilization, financing, and service quality to improve hospital care.

Perception of health state and the use of vignettes to calibrate for socioeconomic status: results of the World Health Survey in Brazil, 2003

As part of the World Health Organization (WHO) project focused on assessing the performance of national health systems, the World Health Survey (WHS) was carried out in many member countries. In order to enable comparison of self-rated health between different cultures of the same country or between different nations, the WHS questionnaire included vignettes of sample cases, that is, hypothetical stories that describe the health problems of third parties. The objective of the present study is to evaluate the possibility of using vignette ratings to implement a socioeconomic calibration scale for self-rated health in Brazil. Using Brazilian WHS data, perceptions of state of health, measured through two different strategies (self-rating and vignette-rating), were compared. The effects of socioeconomic status (educational level and number of household assets) on health domain ratings were estimated via multiple regression models, controlled for age and sex. The effects of socioeconomic status were significant for the majority of health domains in the case of self-perception, but statistically null in the case of third party ratings. It is concluded that the WHO vignettes are not appropriate for calibrating self-rated health measures in Brazil.

Health workforce imbalances in times of globalization: brain drain or professional mobility?

The health workforce is of strategic importance to the performance of national health systems as well as of international disease control initiatives. The brain drain from rural to urban areas, and from developing to industrialized countries is a long-standing phenomenon in the health professions but has in recent years taken extreme proportions, particularly in Africa. Adopting the wider perspective of health workforce balances, this paper presents an analysis of the underlying mechanisms of health professional migration and possible strategies to reduce its negative impact on health services. The opening up of international borders for goods and labour, a key strategy in the current liberal global economy, is accompanied by a linguistic shift from 'human capital flight' and 'brain drain' to 'professional mobility' or 'brain circulation'. In reality, this mobility is very asymmetrical, to the detriment of less developed countries, which lose not only much-needed human resources, but also considerable investments in education and fiscal income. It is argued that low professional satisfaction and the decreasing social valuation of the health professionals are important determinants of the decreasing attraction of the health professions, which underlies both the push from the exporting countries, as well as the pull from the recipient countries. Solutions should therefore be based on this wider perspective, interrelating health workforce imbalances between, but also within developing and developed countries.

World Health Report 2000 "Financial fairness indicator": useful compass or crystal ball?

The World Health Report 2000 generated a huge amount of controversy when it set out to rank the performance of national health systems using data, statistical measures, and an explanatory rationale that were neither well understood nor broadly accepted. This article demystifies the conceptual and empirical underpinnings of the report's "financial fairness index," which resulted in country rankings that often seem counterintuitive. The author concludes that the index is seriously flawed, that rankings produced by the index should not be used, and that future WHO reports should avoid imputing financial fairness scores for countries that do not have real data.