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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Equity in the Use of Physician Visits in OECD Countries

Has Equal Treatment for Equal Need Been Achieved?

This paper uses methods proposed by Wagstaff and Van Doorslaer (2000) to generate new international comparative evidence for 1996 on the degree of horizontal equity achieved in health care utilisation in 14 OECD countries. The index of horizontal inequity used measures deviations in the degree to which the use of doctor visits is distributed according to need. The data for the 12 European Union member states are taken from the third wave of the European Community Household Panel, the data for Canada are from the second wave National Population Health Survey and the US data stem from the first wave of the Medical Expenditure Panel Survey. We find that in all countries physician visits tend to be significantly more concentrated among the worse-off. After standardising for need differences across the income distribution, significant horizontal inequity in total physician visits emerges in only four of the countries studied: Portugal, the United States, Austria and Greece…

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