Monitoring Provision and Quality of Monitoring Provision and Quality of ServicesServices

Bakhuti ShengeliaRegional Adviser for Health Policy and Equity

Division of Country Health Systems

WHO-EURO

Health System Metrics MeetingHealth System Metrics Meeting

Glion, September 28-29, 2006Glion, September 28-29, 2006

The Goals and Functions of Health Systems

Health

Financing (collecting, pooling

and purchasing

Creating resources(investment and training)

Stewardship(oversight)

Fair financial contribution

Responsiveness (to people’s non-medical

expectations)

Delivering services

(provision)

OUTCOMESOUTCOMESINPUTSINPUTS

The US Health System Performance Scorecard Framework

Long, healthy & productive

livesQuality Access Efficiency Equity

Mortality amenable to health care

The right care Universal participation

Potential overuse

Long healthy and productive livesEfficiency in

accessInfant mortality Coordinated care Variation in

quality and costs

Quality

HALE at age 60

Safe care

Patient-centred,

Affordability

Universal participation and affordabilityInsurance

admin. CostsActivity limitation under age 65 Coordinated

and efficient care

Info systems to support efficiency

Children school absenteeism

timely care

How Does the US Perform?

EURO Health Consumer Index

Domains Indicators Relative weight

Patient rights and information 10 1.5

Waiting time for treatment 5 2.0

Outcomes 6 2.0

Provision levels (“Generosity” of the public health care system)

3 1.0

Pharmaceuticals (Access to new drugs, speed of development of novel cancer drugs, etc.)

4 1.0

Health System Performance

Dimensions

QUALITY Access Cost/

Expenditure

Health care needs

Effectiveness Safety Responsiveness /

Patient centeredness

Staying healthy

Getting better

Living with illness or disability

Coping with end of life

Outcomes Process StructureOutcomes Process Structure

OECDOECD FRAMEWORK FRAMEWORK

Challenges for the Framework

• Capturing the parameters strictly specific to health service delivery function

• Universality

• Accommodating differences in the level of health system development and the resources

• Keeping pace with development of knowledge and technology

• Adapting to the changing health care needs

Multi Tier Framework for Service Delivery

Physical accessPhysical access

Waiting timeWaiting time

AmenitiesAmenities

AffordabilityAffordability

Efficiency of infrastructureEfficiency of infrastructure

Productivity of human Productivity of human resourcesresources

Use of pharmaceuticalsUse of pharmaceuticals

Efficiency of operationsEfficiency of operations

AccessibilityAccessibility QualityQuality Technical efficiencyTechnical efficiency

EfficiencyEfficiencyEffective Effective coveragecoverage

EquityEquity

Safety Safety

AppropriatenessAppropriateness

Adequate supplies Adequate supplies and technologyand technology

EffectivenessEffectiveness

Domains   Year Value Score Trend in the last 5 years

Effective coverage 2003 60% 85

           

Access

Physical access 2003 50

Waiting time 2003 70

           

Quality

Safety 2003 80

Effectiveness 2003 70

Appropriateness 2003 65

Adequate supplies & technology 2003 60

Implications For Measurement

• Building effective coverage measures into population surveys

• Improving the quality measures at outpatient level

• Greater investment in facility surveys