Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Analysing health care systems performance: the story behind the statistics

Analysing health care systems performance: the story behind the statistics Abstract This commentary paper argues that the Asia-Pacific region would benefit from a home-grown version of the European Obser vatory on Health Care Systems to inform health sector policy: an Asia-Pacific Obser vatory. The countries in this diverse region, ranging from highly developed to very poor countries, are undergoing dramatic and diverse health sector changes, often on the basis of little evidence and with little information on successes and failures in neighbouring countries. The inter national community also is interested in knowing more about the many distinctive models of Asia-Pacific health care. While statistical comparisons are impor tant, health policymakers and researchers need to understand the story behind the statistics in order to interpret the numbers and to formulate policies and strategies. Health system profiles therefore are useful instruments that describe how a complex health sector wor ks, offer a comparative framework for cross-national comparisons, identify trends in health system design, and with standardised measures and regular updates measure progress against benchmarks. These repor ts and expanded analyses have influenced both national and Europe-wide debates on health policy. In the Asia-Pacific region, health systems research has built up a critical mass of studies and people with strong links across countries. The next ambitious steps are to identify sponsors able to support an enter prise that transcends national boundaries and to begin a project of comparative studies of national health systems. ( Aust N Z J Public Health 2003; 27: 642-4) Judith Healy Research School of Social Sciences, A ustralian National University Australian , Capital Territory, and formerly European Observatory on Health Care Systems n the past decade there has been considerable effort to contain costs and improve health care system performance. First, there is pressure to improve cost effectiveness since health expenditure is rising in OECD countries.1 For example, Australia experienced a rise from 7.9% to 8.5% of GDP between 1990 and 2000 and from $2,014 to $2,754 per capita in constant prices.2 Second, health care is politically important and more attention is being paid to consumer views. Third, ranking the perfor mance of health care systems, with Australia coming in at number 38 on the World Health Or ganization (WHO) ‘league table’,3 provoked effor ts to do better next time. Fourth, external pressures on the health sector include globalisation, regional realignments and ideological shifts, such as privatisation pressures. Last, there is evidence that a good health care system does improve population health given dramatic advances in diagnosis and treatment.4 For example, nearly four of the seven-year gain in adult life expectancy in the United States of America (US) since 1950 has been attributed to improved medical treatment.5 Health policymakers need information upon which to base health sector reform strategies. Given ongoing ‘reforms’ (often on the basis of little evidence) and the increasing number of statistical comparisons across countries, policymak ers need to understand the context for policy changes as well as the story behind the statistics. Many countries do not possess an over view of that complex entity called a health care system, nor any benchmark against which to measure progress, still less good information on the health care systems of neighbouring countries. This commentar y paper argues that a standardised health care system report is an important tool for health systems analysis, that the European Observatory on Health Care Systems has made valuable contributions to informed health polic ymaking, and that the Asia-Pacif ic region urgently needs better information on the health care systems of countries in this diverse region in order to inform the signif icant changes already under way. European Observatory on Health Care Systems The European Observator y on Health Care Systems was set up in 1998 to support wellinfor med health policymaking across the 51 member states of the European region of the World Health Or ganization. Given rapid changes in health sectors across Europe, policymakers and practitioners were str uggling to stay informed, let alone f ind out which changes were working and which were not and why.6 The European Obser vatory is a new breed of organisation with several par tners that work from different geographic locations. The observatory is a partnership between the WHO Regional Office for Europe, the World Bank, the European Investment Bank, the governments of Norway, Spain and Greece, the London School of Hygiene & Tropical Medicine, the London School of Economics and Political Science, and the Open Society Institute. The secretariat is suppor ted Submitted: March 2003 Revision requested: May 2003 Accepted: September 2003 Correspondence to: Dr Judith Healy, Social Protection Facility, Roland Wilson Building, Australian National University, Canberra, ACT 2600. Fax: (02) 6125 0740; e-mail: judith.healy@anu.edu.au AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2003 VOL. 27 NO. 6 Methods Analysing health care systems performance by the WHO Regional Office for Europe and is based in Brussels, with offices in London, Madrid, Athens and Berlin. One measure of its success is that the funding partners, including banks and gover nments, have invested in the European Observatory for the past five years. Approaches to cross-national health care systems analysis There are several approaches to analysing a complex entity such as a health care system and all have their uses and are complementary. The argument here is that a standardised and comprehensive series of country profiles is a valuable approach for understanding the workings of a health care system, provides a context for interpreting statistics, f acilitates cross-national comparisons of what works and what does not, and provides a basis for building fur ther analysis. move to a social insurance system in the UK. The review of health care in central Asia 11 outlined serious problems in this turbulent region and strengthened international and national health care refor m efforts. The book on re gulation in the health care sector12 demonstrated the impor tance of ensuring safety and quality despite increasing privatisation. Hospitals across Europe have been undergoing rapid changes13 with many countries, including Norway, looking to the experience of others in adopting strategies to overhaul their hospital systems. Other books in progress address primary health care, social health insurance systems, mental health, pharmaceuticals, and the implications for health systems of an enlarged European Union. Other approaches Other more statistical approaches also cast light on the workings of health care systems in terms of a variety of performance indicators. But they also point to the need to understand the story behind the statistics and for a country to better understand how its own health care system works before making any strategic changes. A third approach, as mentioned earlier, is the development of a composite index of health system performance as produced in The World Health Report 2000,3 which ranked 191 countries of the world in a ‘league table’ in terms of performance on three criteria: good health, responsiveness to the expectations of the population, and f airness in f inancial contributions. The report provoked controversy over country rankings and a lively methodological debate but also focused attention on the evaluation of perfor mance. A fourth approach, the macro-analysis of health care systems, aims to predict health outcomes in ter ms of inputs, throughputs and outputs. For example, the OECD is working with higher-income countries to collect valid, reliable and available measures of health inputs and outcomes at population level.14 A fifth approach examines particular conditions that are amenable to medical care (such as diabetes and heart disease) for which good data are available. Mortality and morbidity rates for conditions amenable to medical treatment might be regarded as ‘sentinel’ indicators to health system perfor mance. For e xample, the decline in deaths from conditions amenable to medical care contributed substantially to overall improvement in life expectancy in western Europe over the past 50 years.15 Standardised country profiles The Health Care Systems in Transition repor ts (HiTs) of the European Observatory on Health Care Systems take a case study approach in ‘telling the story’ of a country’s health system, its structures, processes and issues of concern. The comparati ve framework follows a standard format and incorporates comparison tables, for example, on the number of physicians, drawing where possible on standardised international databases. The reports pull together textual and quantitative information as well as more qualitative ‘to the best of our knowledge’ views. These approximately 80-page reports have been published on over 40 European countries so far, plus selected OECD countries, such as Australia7 and New Zealand.8 The HiTs are widely disseminated and used by policymakers, practitioners, researchers and students, since they offer a concise overview of a country’s health care system, are part of a comparative series, and are updated about ever y three years. Fur ther, they are available in text form (email: observatory@who.dk) or can be downloaded for free from the website (www.observatory.dk). Countries that lack an over view, such as many central and easter n European countries, have found the systematic process of producing HiTs useful in critically reviewing their health care systems and have launched these reports at ministerial-level conferences. The HiTs are also in demand in advanced but rapidly changing health care systems, such as Germany, where they have been influential in shaping the policy debate. In the United Kingdom (UK), the HiTs were drawn upon, including those on Australia and New Zealand, as background documents in the recent Wanless repor t on the future of the National Health Service. 9 An Asia-Pacific Observatory? The pressures to reform health care sectors and to improve population health prompted a demand for more information over the past decade across Europe. Although it is difficult to identify the factors that contrib ute to policy change, better and more widely disseminated information, including outputs from the European Observatory, has influenced the policy debate in several areas. The countries in the Asia-Pacif ic area, however, have only patchy infor mation on their health systems. This very diverse region is home to two-thirds of the world’ poor, 16 but includes highly s developed countries such as Australia and Japan, fast-growing Comparative policy analysis Building upon these countr y prof iles, the European Observatory publishes analyses of health policy issues in association with Open University Press, seeking to learn from successes or failures in different countries. The book on health care system funding,10 among other issues, analysed the relati ve merits of taxation and social insurance and was influential in countering pressure to 2003 VOL . 27 NO . 6 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Healy Article economies such as Malaysia and South Korea, and some of the least developed countries in the world. Many countries are under going rapid social and economic change, are considering how best to overhaul their health systems, and are hampered by limited resources and information. The high and rising level of private expenditure in China and in many poor Asian countries, for example, suggests that there are signif icant inequities in health services use and outcomes. 17 Changes are being made on the basis of little evidence and little infor mation on successes and failures, even in neighbouring countries. The expanding body of health systems research, growing number of researchers, and the establishment of informal associations of policy analysts and researchers demonstrate that there is a critical mass upon which to build a more systematic approach to health systems analysis. Some examples of such research include health systems funding,18 household expenditures on health (the Equitap group), and analyses of health system reform strategies.19,20 The consensus at regional seminars is that policymakers need better information on health care system patter ns and trends. An Asia-Pacific Observatory would need to develop its own form and function, build upon the active core of researchers in the region, begin modestly by profiling a few selected countries, and shape itself to the expertise, resources and politics of the region. The challenge, as always, would be to find sponsors to support an enterprise that transcends national, organisational and disciplinary boundaries. Health sector issues are international issues since much can be learned from experiences elsewhere. The Asia-Pacific re gion would benef it from a partnership that could contribute to building capacity, produce national health system prof iles and under take health systems analysis. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Analysing health care systems performance: the story behind the statistics

Download PDF
3 pages

Loading next page...
 
/lp/wiley/analysing-health-care-systems-performance-the-story-behind-the-VZ6ZJ0XrM3

References (19)

Publisher
Wiley
Copyright
Copyright © 2003 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.2003.tb00613.x
Publisher site
See Article on Publisher Site

Abstract

Abstract This commentary paper argues that the Asia-Pacific region would benefit from a home-grown version of the European Obser vatory on Health Care Systems to inform health sector policy: an Asia-Pacific Obser vatory. The countries in this diverse region, ranging from highly developed to very poor countries, are undergoing dramatic and diverse health sector changes, often on the basis of little evidence and with little information on successes and failures in neighbouring countries. The inter national community also is interested in knowing more about the many distinctive models of Asia-Pacific health care. While statistical comparisons are impor tant, health policymakers and researchers need to understand the story behind the statistics in order to interpret the numbers and to formulate policies and strategies. Health system profiles therefore are useful instruments that describe how a complex health sector wor ks, offer a comparative framework for cross-national comparisons, identify trends in health system design, and with standardised measures and regular updates measure progress against benchmarks. These repor ts and expanded analyses have influenced both national and Europe-wide debates on health policy. In the Asia-Pacific region, health systems research has built up a critical mass of studies and people with strong links across countries. The next ambitious steps are to identify sponsors able to support an enter prise that transcends national boundaries and to begin a project of comparative studies of national health systems. ( Aust N Z J Public Health 2003; 27: 642-4) Judith Healy Research School of Social Sciences, A ustralian National University Australian , Capital Territory, and formerly European Observatory on Health Care Systems n the past decade there has been considerable effort to contain costs and improve health care system performance. First, there is pressure to improve cost effectiveness since health expenditure is rising in OECD countries.1 For example, Australia experienced a rise from 7.9% to 8.5% of GDP between 1990 and 2000 and from $2,014 to $2,754 per capita in constant prices.2 Second, health care is politically important and more attention is being paid to consumer views. Third, ranking the perfor mance of health care systems, with Australia coming in at number 38 on the World Health Or ganization (WHO) ‘league table’,3 provoked effor ts to do better next time. Fourth, external pressures on the health sector include globalisation, regional realignments and ideological shifts, such as privatisation pressures. Last, there is evidence that a good health care system does improve population health given dramatic advances in diagnosis and treatment.4 For example, nearly four of the seven-year gain in adult life expectancy in the United States of America (US) since 1950 has been attributed to improved medical treatment.5 Health policymakers need information upon which to base health sector reform strategies. Given ongoing ‘reforms’ (often on the basis of little evidence) and the increasing number of statistical comparisons across countries, policymak ers need to understand the context for policy changes as well as the story behind the statistics. Many countries do not possess an over view of that complex entity called a health care system, nor any benchmark against which to measure progress, still less good information on the health care systems of neighbouring countries. This commentar y paper argues that a standardised health care system report is an important tool for health systems analysis, that the European Observatory on Health Care Systems has made valuable contributions to informed health polic ymaking, and that the Asia-Pacif ic region urgently needs better information on the health care systems of countries in this diverse region in order to inform the signif icant changes already under way. European Observatory on Health Care Systems The European Observator y on Health Care Systems was set up in 1998 to support wellinfor med health policymaking across the 51 member states of the European region of the World Health Or ganization. Given rapid changes in health sectors across Europe, policymakers and practitioners were str uggling to stay informed, let alone f ind out which changes were working and which were not and why.6 The European Obser vatory is a new breed of organisation with several par tners that work from different geographic locations. The observatory is a partnership between the WHO Regional Office for Europe, the World Bank, the European Investment Bank, the governments of Norway, Spain and Greece, the London School of Hygiene & Tropical Medicine, the London School of Economics and Political Science, and the Open Society Institute. The secretariat is suppor ted Submitted: March 2003 Revision requested: May 2003 Accepted: September 2003 Correspondence to: Dr Judith Healy, Social Protection Facility, Roland Wilson Building, Australian National University, Canberra, ACT 2600. Fax: (02) 6125 0740; e-mail: judith.healy@anu.edu.au AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2003 VOL. 27 NO. 6 Methods Analysing health care systems performance by the WHO Regional Office for Europe and is based in Brussels, with offices in London, Madrid, Athens and Berlin. One measure of its success is that the funding partners, including banks and gover nments, have invested in the European Observatory for the past five years. Approaches to cross-national health care systems analysis There are several approaches to analysing a complex entity such as a health care system and all have their uses and are complementary. The argument here is that a standardised and comprehensive series of country profiles is a valuable approach for understanding the workings of a health care system, provides a context for interpreting statistics, f acilitates cross-national comparisons of what works and what does not, and provides a basis for building fur ther analysis. move to a social insurance system in the UK. The review of health care in central Asia 11 outlined serious problems in this turbulent region and strengthened international and national health care refor m efforts. The book on re gulation in the health care sector12 demonstrated the impor tance of ensuring safety and quality despite increasing privatisation. Hospitals across Europe have been undergoing rapid changes13 with many countries, including Norway, looking to the experience of others in adopting strategies to overhaul their hospital systems. Other books in progress address primary health care, social health insurance systems, mental health, pharmaceuticals, and the implications for health systems of an enlarged European Union. Other approaches Other more statistical approaches also cast light on the workings of health care systems in terms of a variety of performance indicators. But they also point to the need to understand the story behind the statistics and for a country to better understand how its own health care system works before making any strategic changes. A third approach, as mentioned earlier, is the development of a composite index of health system performance as produced in The World Health Report 2000,3 which ranked 191 countries of the world in a ‘league table’ in terms of performance on three criteria: good health, responsiveness to the expectations of the population, and f airness in f inancial contributions. The report provoked controversy over country rankings and a lively methodological debate but also focused attention on the evaluation of perfor mance. A fourth approach, the macro-analysis of health care systems, aims to predict health outcomes in ter ms of inputs, throughputs and outputs. For example, the OECD is working with higher-income countries to collect valid, reliable and available measures of health inputs and outcomes at population level.14 A fifth approach examines particular conditions that are amenable to medical care (such as diabetes and heart disease) for which good data are available. Mortality and morbidity rates for conditions amenable to medical treatment might be regarded as ‘sentinel’ indicators to health system perfor mance. For e xample, the decline in deaths from conditions amenable to medical care contributed substantially to overall improvement in life expectancy in western Europe over the past 50 years.15 Standardised country profiles The Health Care Systems in Transition repor ts (HiTs) of the European Observatory on Health Care Systems take a case study approach in ‘telling the story’ of a country’s health system, its structures, processes and issues of concern. The comparati ve framework follows a standard format and incorporates comparison tables, for example, on the number of physicians, drawing where possible on standardised international databases. The reports pull together textual and quantitative information as well as more qualitative ‘to the best of our knowledge’ views. These approximately 80-page reports have been published on over 40 European countries so far, plus selected OECD countries, such as Australia7 and New Zealand.8 The HiTs are widely disseminated and used by policymakers, practitioners, researchers and students, since they offer a concise overview of a country’s health care system, are part of a comparative series, and are updated about ever y three years. Fur ther, they are available in text form (email: observatory@who.dk) or can be downloaded for free from the website (www.observatory.dk). Countries that lack an over view, such as many central and easter n European countries, have found the systematic process of producing HiTs useful in critically reviewing their health care systems and have launched these reports at ministerial-level conferences. The HiTs are also in demand in advanced but rapidly changing health care systems, such as Germany, where they have been influential in shaping the policy debate. In the United Kingdom (UK), the HiTs were drawn upon, including those on Australia and New Zealand, as background documents in the recent Wanless repor t on the future of the National Health Service. 9 An Asia-Pacific Observatory? The pressures to reform health care sectors and to improve population health prompted a demand for more information over the past decade across Europe. Although it is difficult to identify the factors that contrib ute to policy change, better and more widely disseminated information, including outputs from the European Observatory, has influenced the policy debate in several areas. The countries in the Asia-Pacif ic area, however, have only patchy infor mation on their health systems. This very diverse region is home to two-thirds of the world’ poor, 16 but includes highly s developed countries such as Australia and Japan, fast-growing Comparative policy analysis Building upon these countr y prof iles, the European Observatory publishes analyses of health policy issues in association with Open University Press, seeking to learn from successes or failures in different countries. The book on health care system funding,10 among other issues, analysed the relati ve merits of taxation and social insurance and was influential in countering pressure to 2003 VOL . 27 NO . 6 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Healy Article economies such as Malaysia and South Korea, and some of the least developed countries in the world. Many countries are under going rapid social and economic change, are considering how best to overhaul their health systems, and are hampered by limited resources and information. The high and rising level of private expenditure in China and in many poor Asian countries, for example, suggests that there are signif icant inequities in health services use and outcomes. 17 Changes are being made on the basis of little evidence and little infor mation on successes and failures, even in neighbouring countries. The expanding body of health systems research, growing number of researchers, and the establishment of informal associations of policy analysts and researchers demonstrate that there is a critical mass upon which to build a more systematic approach to health systems analysis. Some examples of such research include health systems funding,18 household expenditures on health (the Equitap group), and analyses of health system reform strategies.19,20 The consensus at regional seminars is that policymakers need better information on health care system patter ns and trends. An Asia-Pacific Observatory would need to develop its own form and function, build upon the active core of researchers in the region, begin modestly by profiling a few selected countries, and shape itself to the expertise, resources and politics of the region. The challenge, as always, would be to find sponsors to support an enterprise that transcends national, organisational and disciplinary boundaries. Health sector issues are international issues since much can be learned from experiences elsewhere. The Asia-Pacific re gion would benef it from a partnership that could contribute to building capacity, produce national health system prof iles and under take health systems analysis.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Dec 1, 2003

There are no references for this article.