The answer to this question given by Martin Seychell, Deputy Director-General of DG Health and Consumers of the European Commission, speaking at the European Health Forum Gastein 2014 was a clear “yes”: “Yes the EU cares about health system performance!” And: “Yes, the EU can and will support member states in creating more performing health system”. (For the record: Martin Seychell first said that the answer to the second part of the question was more difficult than the answer to the first part.)
I was pleasantly surprised by the clear answers given during this session!
Health system performance has been a buzz word amongst policy-makers and researchers for quite some time – certainly since the publication of the World Health Report 2000 on “Health Systems: Improving Performance”.
Improving health system performance is currently on the political agenda in almost all EU countries. However, it often remains unclear what people mean when talking about health system performance or about “improving performance”. Are people concerned about efficiency? About health outcomes? About patient experiences? About financial sustainability?
Peter Smith, the author and editor of two books published by the European Observatory on Health Systems and Policies about Health System Performance Comparison and about Performance Measurement for Health System Improvement was present during this session to also give clear answers: “Poor performance means that resources somewhere are wasted – and health suffers because these resources are lacking somewhere else”. More efficient health systems (maximising outputs at a given set of inputs) are certainly better performing than those health systems that waste resources.
However, when actually aiming to measure health system performance, things get much more complicated. There is no consensus about how health systems function or should function, and there is no consensus about what health systems should achieve. Consequently, because performance can only be measured in relation to health systems’ objectives, people inevitably talk about different things when talking about health system performance.
There are different frameworks for conceptualising and measuring health system performance. The OECD framework for health system performance assessment, presented during the session by Francesca Colombo, head of the OECD health division, is one of the more influential frameworks for international comparisons. It is used by OECD in its annual Health at a Glance publication, providing comparative information on the performance of health systems in OECD countries.
National policy makers may have particular needs that might be different from those addressed by international comparisons. For example, in Finland, as pointed out by Liisa-Maria Voipio-Pulkki from the Finnish Ministry of Social Affairs and Health, there is particular interest in having measures of the combined effects of health and social care interventions.
It is clear that national health systems pursue different (but always multiple) objectives and may place different weights on their multiple objectives. Therefore, measuring performance across countries remains challenging, and can not usefully result in simple rankings of countries.
Yet, international comparisons of different aspects of health system performance are very useful: they can help to identify weaknesses of national health systems, and they can provide strong impetus for reform.
The expert group on health system performance assessment that is soon to be set up by the EU Commission may help in developing a European system for health system performance comparison. Ultimately sharing of information on differences in performance and on best practices for performance improvement can certainly contribute to better health systems and better population health.
by Young Gasteiner Wilm Quentin