Heath system performance

Performance increasingly features as a key marker of health system functioning and serves as a basis for policy-making. The European Observatory contributes to the development of both theory and practice of performance assessment – a central instrument in the governance of modern health systems.

Performance increasingly features as a key marker of health system functioning and serves as a basis for policy-making. Measuring and tracking health system performance has two primary purposes:  

• promoting accountability – so that citizens, parliamentarians and other stakeholders can check that policymakers, institutions and providers are progressing towards their shared objectives; 
• supporting policy development by informing national health strategies and identifying priorities for improvement.  

Over the past two decades, the European Observatory has been involved in the development of both theory and practice of health systems performance assessment (HSPA), which is now becoming a central instrument in the governance of modern health systems.  

The key objectives of HSPA are to: 

• set out the goals and priorities for a health system; 
• act as a focus for policymaking and coordinating actions within the health system; 
• measure progress towards achievement of goals; 
• act as a basis for comparison with other health systems; and 
• promote transparency and accountability to citizens and other legitimate stakeholders on how money is spent. 

Although HSPA process can be carried out in different ways, there are many generally accepted principles of best practice. These include: 

• a focus on the health system as a whole (including health promotion and public health); 
• expressing health system goals as outcome, rather than process measures;  
• making HSPA a regular process embedded in national health policymaking; and 
• where possible, quantifying progress using internationally accepted and reliable metrics and analytic techniques. 

International comparisons benefit national HSPA efforts in a number of ways, for example by providing the opportunity for cross-country learning in terms of the conducting of HSPA itself, as well as for indicator benchmarking. There have been many international efforts to conduct, or to otherwise support, cross-country performance comparisons as an important element of HSPA. We draw on all if these in our country monitoring work, with products ranging from comprehensive and rigorous health system reviews (HiTs) to succinct and informative State of Health in the EU profiles.