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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Improving Value for Money in the United Kingdom National Health Service

Performance Measurement and Improvement in a Centralised System

This paper charts the development of performance measures in health care in England and their current use in managing the NHS. The last 10 years have seen a shift from measures of activities and costs, to measures of outputs and outcomes and from a focus on efficiency to a “balanced scorecard” approach to monitoring and measuring performance. It has also been recognised that performance measures are only one element of a performance management system. The current framework for assessing NHS performance, “The Performance Assessment Framework (PAF)” is complemented by mechanisms for defining standards and targets (the NHS Plan, National Service Frameworks and National Institute for Clinical Excellence), by systems of incentives (including NHS Performance Ratings, a system of “earned autonomy” and a new NHS Performance Fund), and by services to monitor and support behavioural change (clinical governance, a Commission for Health Improvement and a Modernisation Agency). The paper reflects on what has been learnt from the NHS’s experience with performance measurement and performance improvement to date. It ends with some thoughts about future developments.

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