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12 June 2024 | Policy Analysis
Fifth edition of the Belgian HSPA report
7.1. Monitoring health system performance
This section is not included in the current edition of this HiT.
Context and impetus
The performance of the Belgian health system has been regularly assessed by an independent scientific team since 2010. This assessment process was introduced in Belgium following the Tallinn Charter adopted in 2008, which states that Member States must “promote transparency and be accountable for health system performance to achieve measurable results.” In February 2024, the fifth edition of the Belgian Health System Performance Assessment (HSPA) report was published.
Main purpose
The aim of this process is to inform decision-makers about the health system’s performance and its evolution over time, as well as to help them identify warning signals that should be addressed in their policy agendas. An HSPA inter-administration working group has been created to monitor the project and to facilitate communication between the independent scientific group and policy makers.
Content
A helicopter view of the performance is provided using 142 indicators. This fifth edition is based on a new conceptual framework developed in 2023. According to this new framework, the health system’s performance is assessed along six dimensions: quality (including efficacy, safety, continuity, appropriateness, and person-centred care), accessibility (including financial access, workforce distribution, and health services distribution), sustainability (including financial sustainability, workforce capacity, health technologies and infrastructure, and governance), efficiency, equity, and resilience. In addition, it analyzes four specific domains of care: preventive care, mental health care, care for older people, and end-of-life care.
Outcomes
Notable improvements have been observed in many performance dimensions, with overall quality and accessibility being high. For example, treatable mortality, referring to deaths that can be mainly avoided through timely and effective healthcare interventions, was below the EU-14 average. However, many socio-economic inequalities and inequities persist, with social gradients particularly visible regarding indicators on affordable access to care, use of preventive care, outpatient medicines, and outpatient specialist and dental care.
Among the warning signals, preventive care emerges as a domain with significant room for improvement. Despite efforts made in recent years, performance indicators in this domain are often below targets and results are suboptimal. Therefore, prevention needs to be placed high on the political agenda. Additional efforts are also needed to improve the appropriate use of some pharmaceuticals (for example, antibiotics or antidepressants), the appropriateness and continuity of care for some chronic patients (for example, people living with diabetes), and support for the health workforce.
Next steps
A new sub-dimension of sustainability, environmental sustainability, has been added to the 2023 conceptual framework, but the list of indicators has not yet been developed. The next report will focus on selecting indicators to measure the impact of the health system on the environment.
Authors
References
Gerkens S, Lefèvre M, Bouckaert N, et al. Performance of the Belgian health system: Report 2024. Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2024. KCE Reports 376C. https://kce.fgov.be/en/performance-of-the-belgian-health-system-report-2024
Gerkens S, Maertens de Noordhout C, Lefèvre M, et al. Performance of the Belgian health system: Revision of the conceptual framework and indicators set. Health Services Research (HSR). Brussels. Belgian Health Care Knowledge Centre (KCE). 2023. KCE Reports 370. https://kce.fgov.be/en/performance-of-the-belgian-health-system-revision-of-the-conceptual-framework-and-indicators-set