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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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The Evolution of WHO's Approach to Health System Performance Assessment

Policy makers have long been concerned with improving the performance of their health systems with reforms targeting all system functions – financing, provision, stewardship and resource generation (Maynard and Bloor, 1995; Collins et al., 1999). Yet the evidence of what types of changes to health systems improve their performance is limited, inconsistent and inconclusive. Accordingly, WHO has developed a wide ranging work plan to develop the scientific basis to ensure that its technical advice on health system development is based on the best available evidence. One component of this work was to summarise and disseminate the available evidence on the links between health policy, system design and system performance in the World Health Report 2000 (WHO, 2000) and the Executive Board of WHO has committed the Organization to report on the health system performance of all WHO Member States regularly…

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