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Measuring Up

Improving Health System Performance in OECD Countries

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How can we measure the performance of different health systems, and how can we use such information to support on-going health systems improvement? Those are the central questions addressed in this volume. Health policy makers have a growing interest in finding ways of encouraging health systems to improve their performance, where performance is measured against quality, efficiency or equity goals. Improving performance has the potential to reduce the tensions between rising demands and limited resources. There is also a growing demand for accountability among funders and providers of health services.

This book highlights the core elements of a possible performance measurement framework to assess health systems at the international and national levels. It also addresses further challenges which remain: how do we overcome the lack of health outcome measures? How do we better align performance information and incentives with policy objectives? And how do we reconcile the traditional professional self-regulation approach with greater public accountability for health care quality?

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Can a Tulip become a Rose? The Dutch Route of Guided Self-regulation towards a Community-based Integrated Health Care System

The Dutch health care system has both in financing and health care provision a hybrid nature. Financing is realized through a mixture of public and private insurance executed by care insurers with a (semi) private status. Health care is provided through professions and institutions that function to a large extent as not-for-profit private entities within a highly regulated context, reimbursed through a mixture of budgetary, pro-capita and fee-for-service schemes. The role of the state has changed over the years. Roughly one can claim that in the fifties and sixties the welfare state was created, in the seventies and eighties government tried to control the growing costs through managing the structure of health care by planning regulation and in the nineties the processes within the system (regulated market) were the main policy paradigm. At the turn of the century the steering paradigm is shifting towards the input (needs assessment) and outcome (performance measurement) of the system. Not only production and costs, but also performance in terms of health outcomes and consumer satisfaction are deemed relevant management factors…

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