Overview

Individual nations are increasingly seeking to introduce more systematic ways of assessing the performance of their health systems, and of benchmarking performance against other countries. Policy-makers recognize that without measurement and comparison, it is difficult to identify good and bad delivery practice or good or bad practitioners (‎“what or who works”)‎, to design health system reforms, to protect patients and payers, or to make the case for investing in health care.

Measurement is also central to promoting accountability to citizens, patients and payers for health system actions and outcomes. This focus on assessment coincides with the enormous increase in the capacity for measurement and analysis of the last decade, driven in no small part by massive changes in information technology and associated advances in measurement methodology. However, notwithstanding major progress by organizations such as the European Commission, the OECD, the Commonwealth Fund, WHO and individual countries, performance comparison efforts are in their early stages, and there are many challenges involved in the design and implementation of comparison schemes. This policy brief seeks to summarize the current “state of the art” of health system comparison, identifying data and methodological issues and exploring the current interface between evidence and practice. It also draws out the priorities for future work on performance comparison, in the development of measurement instruments, analytic methodology, and assessment of evidence on performance. It will conclude by presenting key lessons and future priorities policy-makers should take into account.