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Performance Measurement for Health System Improvement

Brief analytical summaries or syntheses #20 Performance Measurement for Health System Improvement Experiences, Challenges and Prospects Summary Given the increasing demand for measurement of health provider performance, there is a need to better define what role measurement can play in securing health system improvement. This volume, first published in 2009 and now free to download, meets this need by presenting the opportunities and challenges associated with performance measurement in a framework that is clear and easy to understand. Background Performance measurement instruments have two goals to promote accountability and to improve the performance of the health system. The modern health system is immensely complex, comprising diverse agents such as insurers, provider organizations, health-care professionals and central and local governments. Measurement of the actions and outcomes of these agents is a necessary condition if the health system is to be held properly to account by citizens and patients. That accountability may…

Governance in the health sector: a strategy for measuring determinants and performance

Brief analytical summaries or syntheses #22 Governance in the health sector a strategy for measuring determinants and performance Summary Governance in the health sector a strategy for measuring determiMany different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also looked at whether improvements in the way health care services are governed could make a difference. These approaches ask which factors, such as rules and institutions, influence the behaviour of the system, its performance and outcomes. The paper proposes specific measures of governance determinants and performance and describes the instruments available to collect and interpret them. Background While the term “governance” is increasingly being used to draw attention to a number of factors that affect the quality, effectiveness and reach of social services, no consensus has emerged on definitions, frameworks and, in particular, how it applies…

Did changing primary care delivery models change performance? A population based study using health administrative data

Brief analytical summaries or syntheses #24 Did changing primary care delivery models change performance? A population based study using health administrative data Summary Primary care reform in Ontario started with the introduction of new enrolment models, the two largest of which are Family Health Networks (FHNs), a capitation-based model, and Family Health Groups (FHGs), a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups. Background It has been increasingly recognized that health care systems with a strong primary care component are more efficient and better able to handle current and future health care pressures. This has led to several primary care reform strategies in the U.K., Australia, the U.S. and Canada. Common to all of these reform strategies is a movement away from providing service based on…

Health system performance comparison: an agenda for policy, information and research

Brief analytical summaries or syntheses #44 Health system performance comparison an agenda for policy, information and research Summary This WHO policy brief calls for more international comparisons of health system performance. It describes the methodology of international comparative studies, key domain comparators, and cites the benefits of international comparison in policy influence and as a source of evidence. Background This policy brief seeks to summarize the current “state of the art” of health system comparison, identifying data and methodological issues and exploring the current interface between evidence and practice. It also draws out the priorities for future work on performance comparison, in the development of measurement instruments, analytic methodology, and assessment of evidence on performance. It concludes by presenting key lessons and future priorities policy-makers should take into account. Analysis and results Comparing key domains of performance Population health measures often take a broad perspective, which captures the effect of…

Public reporting on quality and costs. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers?

Brief analytical summaries or syntheses #39 Public reporting on quality and costs. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers ? Summary This paper examines whether public reporting of health provider performance leads to better consumer choices and improvements in care. Published in Health Affairs, the paper describes the theory behind public reporting, its evolution over time, and evidence of its ability to improve healthcare quality and lower costs. Background Public reporting is a strategy to address quality and cost in the healthcare system by providing consumers, payers, and healthcare providers, such as doctors and hospitals, with information about the performance of these providers and insurance plans. Public reports can allow for the comparison of costs, quality (such as rates of hospital-acquired infections), and how satisfied patients are with service. Advocates of public reporting believe that it helps consumers make…

The U.S. Health System in Perspective:A Comparison of Twelve Industrialized Nations

Brief analytical summaries or syntheses #26 The U.S. Health System in Perspective A Comparison of Twelve Industrialized Nations Summary This paper analyzes 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Health care spending in the U.S. towers over the other countries and findings suggest opportunities for cross-national learning to improve health system performance. Background Findings from this cross-national comparison of health care systems can inform public policy, highlight areas where nations could improve, and yield benchmarks for high performance. The Organization for Economic Cooperation and Development (OECD) annually tracks and reports on more than 1,200 health-system measures across 34 industrialized countries, ranging from population health status and non-medical determinants of health, to health care resources and utilization. Since 1998, The Commonwealth Fund has sponsored an analysis of cross-national health systems based on OECD health data…

Denmark - Physician Response to Target-Based Performance Payment

In many healthcare systems, payers reward physicians for reaching predetermined performance targets. This paper analyzes physician response to target-based performance payment and shows that responses depend both on payment size and uncertainty about performance. The paper concludes that the design of target-based payment schemes must include baseline measurements to predict physicians’ ability to assess their own performance.

USA - Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study

Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and improve performance) likely depends on local resources. The authors of this study quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity.

Canada - Canadian Public Administration - Special issue on performance measurement, performance management, and accountability

This special issue Includes an editorial and eight original articles (five in English and three in French) on performance measurement, management, and accountability in Canada. It looks at cities (municipal management indicators); provinces (Quebec's health and welfare commissioner); and the national scene (health system performance reporting). Other articles look at performance measurement in public sector management, service delivery and research.

The Netherlands - The Dutch health care performance report: seven years of health care performance assessment in the Netherlands

This study of the Dutch Health Care Performance Report reflects on important lessons learned after seven years of performance assessment in The Netherlands. These include the importance of repeated measurement, the importance of a central role for the patients' perspective in performance assessment and the value of international benchmarking.

International - Paying for Performance in Health Care. Implications for Health System Performance and Accountability

This book from the OECD presents an analysis of 10 international case studies of pay for performance (P4P) programs and highlights the potential impacts of P4P programs on health system performance in diverse settings. It provides critical insights into leveraging P4P experiences to improve system performance and accountability.

Shared-savings payment arrangements in health care. Six case studies

Brief analytical summaries or syntheses #48 Shared-savings payment arrangements in health care. Six case studies Summary American shared-savings programs are an alternative approach to paying health care providers. Providers receive a share of savings achieved by reducing costs for care. This Commonwealth Fund paper presents six case studies of pilot shared-savings programs. Background One of the most talked-about new ideas in health care is rewarding providers for reducing medical spending by giving them a share of the net cost savings. Driven by an interest in seeing medical homes and other providers shift to some form of performance-based payment, as well as by the Affordable Care Act’s push for "accountable care," shared-savings approaches are currently being tested by numerous payer and provider organizations across the United States. A previous Commonwealth Fund policy brief summarized 27 examples of shared-savings initiatives and found wide variation in how participants implemented such initiatives. These variations…

Canada - Paving the Road to Higher Performance: Benchmarking Provincial Health Systems

The Conference Board’s benchmarking report on the overall health of Canadians and the state of provincial health systems shows achievements and gaps in performance that can be used to help determine priorities and improvements that will contribute to improving performance in the future. No province achieves high performance in all four broad categories: lifestyle factors, health status, health system resources and healthcare system performance.

Canada - Comparing Performance of Universal Health Care Countries, 2017

The comparable data assembled in this study suggests that although Canada has one of the most expensive healthcare systems in the OECD, its performance is modest to poor. The study compares the cost and performance of universal healthcare systems in 29 high-income countries. Levels of expenditure are measured by two indicators, while system performance is measured using 42.

USA - Managing for Results: Agencies' Trends in the Use of Performance Information to Make Decisions

Produced by the US Government Accountability Office (GAO), this report is an assessment of 24 US government agencies’ use of performance information from 2007 to 2013. After surveying agency management, the report created an index to measure how performance information is used. Its findings show that the use of performance information did not change over the study period.

Australia - Aboriginal and Torres Strait Islander Health Performance Framework 2017

The Aboriginal and Torres Strait Islander Health Performance Framework 2017 provides up-to-date information on 68 performance measures of health status and outcomes, determinants of health, and health system performance. The measures cover data that has been collected on the entire Australian health system, including Indigenous-specific services and programs, and mainstream services.

Europe — Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects

In a world where there is increasing demand for the performance of health providers to be measured, there is a need for a more strategic vision of the role that performance measurement can play in securing health system improvement. This volume, first published in 2009 and now free to download, meets this need by presenting the opportunities and challenges associated with performance measurement in a framework that is clear and easy to understand.

Canada – Quebec: 2013 Health and social services system performance report

This report from Quebec’s Commissaire à la santé et au bien-être analyzes the performance of the province’s health and social services system on an interregional, interprovincial and international basis. The analysis is based on the framework for assessing the Commissioner’s performance and reflects a major update of the indicators employed that enables connections to be made between the different dimensions of performance.

Australia - National Healthcare Agreement: Performance report for 2009-10

This is the COAG Reform Council’s second year report on the National Healthcare Agreement, reporting progress against the objectives and outcomes compared to the baseline data summarised in the 2008–09 report on performance. The report focus on the following ten issues : prevention, primary and community health, hospital and related care, aged care, patient experience, social inclusion and Indigenous health, sustainability, performance benchmarks, and improvements to the performance reporting framework.

France - Theoretical basis for health system performance assessment

This article proposes a theoretical framework for the concept of performance and performance assessment in France’s health sector. The authors review influential theories on the application of performance assessment.

Finland- Performance Measurement in Healthcare Incentive Plans

This report examines performance measurement of incentive plans in Finnish private sector health care organizations through a quantitative survey and case study. The findings from the case study emphasize the importance of choosing appropriate performance measures; inadequate performance measurement leads to incentive plans that do not help organizations reach their goals.

Europe - Health system performance assessment – Integrated Care Assessment

Commissioned by the European Union (EU), this study reviews integrated care performance in the 28 EU countries and tests a performance assessment framework. Analyzing 71 integrated care policies and 550 initiatives, the review finds that the characteristics, depth and breadth of IC penetration vary considerably across Europe. The study's Integrated Care Performance Assessment Framework contains 58 indicators to track integrated care outcomes and patient experiences.

International Profiles of Health Care Systems

Brief analytical summaries or syntheses #32 International Profiles of Health Care Systems Summary This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the U.S. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views. Background The Commonwealth Fund is a private foundation that promotes a high performance health care system providing better access, improved quality, and greater efficiency. The Fund carries out…

Canada - Comparing Performance of Universal Health Care Countries, 2018

This Fraser Institute study compares the cost and performance of 28 universal healthcare systems in OECD countries. It suggests that Canada has one of the OECD's most expensive systems, with an overall performance that is only modest to poor in terms of access, availability of resources and quality of clinical performance.

International - Pay-For-Performance Incentives in Low- And Middle-Income Country Health Programs

This study from the US National Bureau of Economic Research surveys experience with performance pay in developing country health programs. It focuses on four key conceptual issues: what, who, and how to reward, and the unintended consequences of performance incentives. The paper highlights the fact that the use of performance pay has outpaced growth in evidence about its effects.

Europe - Performance of EU health care systems investigated in new study

A new European research project has been launched to evaluate the performance of European health care systems in terms of outcomes, quality, use of resources and costs. Financed by the European Union and coordinated at the National Institute for Health and Welfare (THL) in Finland, the EuroHOPE project (European Health Care Outcomes, Performance and Efficiency) will focus the evaluation on five key public health problems or diseases: acute myocardial infarction, stroke, hip fracture, breast cancer and low-birth-weight infants.

UK - Funding and Performance of Healthcare Systems in the Four Countries of the UK Before and After Devolution

Political devolution means there are now four National Health Services in the United Kingdom. The health services of England, Scotland, Wales and Northern Ireland are all funded by the UK taxpayer, but have developed different systems of governance and different methods of providing healthcare. This report examines the impact of this by studying key performance indicators for the NHS in England, Scotland, Wales and Northern Ireland at three time points – 1996/7, 2002/3 and 2006/7. The report also undertakes a completely new comparison of NHS performance in the English regions and the devolved countries. This is the first time such an analysis has been conducted.

Europe - Headline Indicators for Structured Monitoring of Health System Performance in Europe

Published by EuroHealth, this article proposes using a prioritized set of indicators identified from 43 health system performance assessments (HSPA) to inform comparative analysis of policy impacts. The set of 95 indicators were assessed for relevance to HSPA domains of access, efficiency, equity and quality of care. Indicators to monitor performance on key public health objectives in were identified.

The Netherlands - Are performance indicators used for hospital quality management: a qualitative interview study amongst health professionals and quality managers in The Netherlands

In this study, researchers interviewed 72 health professionals and quality managers in 14 acute care hospitals to explore the use of performance indicators for internal quality management activities. Differences in hospital data collection made comparisons of outcomes difficult, but the study suggests that robust data collection software, proactive quality managers and engaged medical specialists are positive factors for performance indicator use in hospital quality management.

New Zealand - Measuring health system performance: A new approach to accountability and quality improvement in New Zealand

A new whole-of-system approach to measuring health system performance, based on Triple Aim objectives, is being introduced in New Zealand. This article in Health Policy presents the features of the program, called the Integrated Performance and Incentive Framework (IPIF). Measures will be set at both national and district levels and will be applied first to primary health care before being expanded to other services.

Australia - Healthcare in Focus 2014: How does NSW compare?

Prepared by the Bureau of Health Information (BHI), this report compares the performance of the healthcare system in the Australian state of New South Wales (NSW) with the other six Australian states and 10 countries including Canada. Using patient survey data and 120 performance measures, the report finds that performance in NSW is ahead of other parts of Australia and is in the middle of the pack internationally.

Canada - AQESSS launches a new report on the performance of Quebec health care facilities

The report, entitled "Le réseau en quatre questions: un regard ciblé sur la performance" presents information collected by AQESSS to answer four questions of interest to the public regarding health facilities: Is access adequate? Are care and services of high quality? Is the institution productive? Does it contribute to improving the health of patients and the population? Three performance levels were set: excellent, good and requiring improvement. AQESSS intends to repeat this exercise every two years.

USA - Achieving the Potential of Health Care Performance Measures

In this report, the Robert Wood Johnson Foundation recommends how to develop better performance measures and how to ensure the comparability of publicly-reported performance measure data. It recommends, among other things, moving decisively from measuring processes to measuring outcomes and using measurement to promote rapid-learning health care systems.

Canada - Alberta Health Services (AHS) recently released new performance measures that will help Albertans easily understand how the province’s health system is performing

Alberta Health Services (AHS) has developed 16 new performance measures to help Albertans understand how the province’s health system is performing. The 16 measures better reflect the spectrum of health care in Alberta and will depict health system performance more accurately.

Europe - A New Drive for Primary Care in Europe: Rethinking the Assessment Tools and Methodologies

Overseen by an expert panel convened by the European Union (EU), this report looks at tools used to assess performance in primary care. It explores indicators, methodologies, and quality assurance while seeking to understand the impact of performance assessment. It finds that Europe’s primary care performance assessment systems currently vary in strength and makes seven recommendations to embed performance assessment in policy processes.

International - Building China’s Regional Municipal Healthcare Performance Evaluation System: A Tuscan Perspective

China has yet to build a healthcare performance evaluation system (PES) to optimize resources on a regional basis. This paper looks at the potential for applying the model developed in Tuscany in China, including commissioning a third party agency to evaluate the performance of regional hospitals and community health service centers.

Canada - Canada's International Health System Performance Over 50 years: Examining Potential Years of Life Lost

This report and accompanying web tool compare Canada's international performance in premature mortality — measured by potential years of life lost (PYLL) — with the performance of 17 other high-income countries in the Organisation for Economic Co-operation and Development (OECD) from 1960 to 2010. The report examines how Canada performed overall on PYLL, how Canadian men and women performed in relation to men and women internationally and how Canada performed on 4 specific causes of premature mortality (cancer, heart disease, stroke, and deaths due to external causes).

USA — State Scorecard on Child Health System Performance, 2011

The State Scorecard on Child Health System Performance, 2011, examines states’ performance on 20 key indicators of children’s health care access, affordability of care, prevention and treatment, the potential to lead healthy lives, and health system equity. The analysis finds wide variation in performance across states.

Europe - Health system performance assessment. Reporting and Communicating. Practical guide for policy makers

Published by the European Union (EU), this paper is for policymakers conducting health system performance assessments and provides practical tips and advice on ways to effectively report and communicate their findings. Four steps in the process are described: defining performance assessment goals, identifying target audiences, determining methodology, and implementing monitoring to provide evaluation and effective feedback. Examples are provided for each step.

International - Performance-related pay in the public sector : a review of theory and evidence

The objective of this paper from the World Bank is to provide a review of the theoretical and empirical literature on performance-related pay in the public sector with the aim of distilling useful lessons for policy-makers in developing countries. It finds that the majority of studies find a positive effect from performance-related pay, especially in fields such as education and health care where outputs are more readily observable.

Australia - Can we improve the health system with pay-for-performance?

This Deeble Institute for Health Policy Research Issues brief traces the partial implementation of pay-for-performance models in Australia, looks at experience in other countries and reviews the evidence on, finding mixed results. The author concludes that it is uncertain whether pay-for-performance delivers better value for money and emphasizes that no single measure will improve care, ensure financial sustainability and increase accountability.

Canada - Aligning Health System Performance Frameworks

This new framework provides a system-level overview that allows stakeholders to assess the collective contribution of all parts of the health system and enables people to see how each of the system’s distinct components (such as hospitals or long-term care facilities) connects to overall system performance. This report shows how frameworks can help to build a common language across and within sectors to articulate how they each contribute to, and are influenced by, the performance of the wider health system.

Canada – Appraisal Report of the Performance of the Health and Social Services System 2012. Towards greater equity and better results in mental health in Québec

Rapport d’appréciation de la performance du système de santé et de services sociaux 2012. Pour plus d’équité et de résultats en santé mentale au Québec The report from Québec’s Commissaire à la santé et au bien-être examines care and service performance in mental health. The report was tabled in the National Assembly on December 5, 2012. Two additional documents were made available: a status report on mental health in Québec, and a report on performance indicators in mental health.

Italy - Can equity be included in a performance evaluation system? Some evidences from the Tuscan health care system

In 2005, the health care system in Italy’s Tuscan region began implementing an integrated model for performance measurement that included indicators of equity. This working paper from Tuscany’s Istituto di Management Scuola Superiore Sant’Anna di Pisa takes a look at the evidence to assess whether equity can be meaningfully included in a performance evaluation.

Australia - A new national watchdog for Australia’s health system will soon be formed after legislation to establish the National Health Performance Authority passed the Senate recently

Acting Minister for Health and Ageing Mark Butler welcomed the news and said the National Health Performance Authority is a key part of the Gillard Government’s commitment to provide patients with better information about the performance of public and private hospitals and Medicare Locals through tools like the MyHospitals website.

USA - Rising to the Challenge. Results from a Scorecard on Local Health Performance, 2012

In this Scorecard on Local Health System Performance, the Commonwealth Fund provides comparative data to help communities assess the performance of local healthcare systems. Comparing all 306 designated local health care areas in the U.S., the Scorecard finds that access, costs, quality and health outcomes vary significantly between communities, often with large variations in key indicators. Top-performing areas are concentrated in the American Midwest and Northeast.

UK - The NHS under the coalition government. Part two: NHS performance

Ruling together since 2010, Britain’s coalition government of Conservatives and Liberal Democrats faces an election in May 2015. This paper, the second in a series, looks at the National Health Service’s (NHS) performance under the coalition government. It concludes that NHS performance has slipped since 2008, with sizeable increases in waiting times and an unprecedented number of hospitals reporting deficits.

International - Health System Performance Comparison: New Directions in Research and Policy

Published by the WHO, this special issue of Health Policy draws attention to the growing field of international comparison and performance assessment of health systems. The issue covers five broad areas related to methodological issues, highlights the strengths of current performance comparisons, and outlines the field’s future potential.

Canada - New CIHI online resource shows hospital performance improving

New resource at that looks at clinical and financial performance in acute care hospitals shows that hospitals saw fewer deaths after major surgery, heart attack and stroke; fewer readmissions after heart attack, stroke, and hip and knee surgery; and fewer cases of in-hospital hip fracture in 2010 than in 2007. This resource, a part of the Canadian Hospital Reporting Project at the Canadian Institute for Health Information (CIHI), provides a series of 21 clinical indicators (with risk-adjusted rates) and 9 financial indicators that allows hospitals to compare their performance against those of their peers and to learn from leading practices.

Europe - Tools and Methodologies for Assessing the Performance of Primary Care

Assembled by an expert panel convened by the European Union, this report on tools and methodologies for assessing primary care performance identifies 10 main organizational domains in primary care, including care coordination and integration, and proposes indicators that could be used for comparative assessment. Procedural steps required for establishment of a performance assessment system are explored, and recent experiences from European countries are considered.

The Netherlands - Dutch Health Care Performance Report 2010

The Dutch Health Care Performance Report 2010, published by the National Institute for Public Health and the Environment (RIVM), has recently become available in English. Commissioned by the Dutch Ministry of Health, RIVM monitors trends in the quality, accessibility and costs of health care. Using a finite set of indicators, this third edition of the report assesses the performance of the health care system in 2008 and 2009 and compares it to previous years and to other countries.

Italy — Multidimensional evaluation of performance with experimental application of balanced scorecard: a two year experience

The aim of the study was to verify the opportunity to introduce BSC framework to measure performance in St. Anna University Hospital of Ferrara, applying it to the Clinical Laboratory Operative Unit in order to compare over time performance results and achievements of assigned targets.

UK - Measuring the performance of local health systems. A review for the Department of Health

Conducted for the UK Department of Health, this review assesses measures of the performance of British local government health systems. It recommends the consolidation of three national outcomes frameworks into a single framework covering the National Health Service (NHS), public health and social care, and calls for the development of top-level indicators to present key performance information.

Canada — The Response of Ontario Primary Care Physicians to Pay-for-Performance Incentives

Beginning in 1999, Ontario introduced pay-for-performance incentives for selected preventive primary care services and defined sets of other services provided by family physicians, with the goal of improving the quality of patient care. These performance incentives were considerably expanded in 2004. At the request of the Ministry and as part of the collaborative research program between the Ontario Ministry of Health and Long-Term Care (MOHLTC) and the Centre for Health Economics and Policy Analysis (CHEPA), CHEPA researchers undertook an evaluation of the effect of performance incentives on service provision in Ontario. This report presents the results of that evaluation.

UK - Funding and Performance of Healthcare Systems in the Four Countries of the UK Before and After Devolution

Political devolution means there are now four National Health Services in the United Kingdom. The health services of England, Scotland, Wales and Northern Ireland are all funded by the UK taxpayer, but have developed different systems of governance and different methods of providing healthcare. This report examines the impact of this by studying key performance indicators for the NHS in England, Scotland, Wales and Northern Ireland at three time points – 1996/7, 2002/3 and 2006/7. The report also undertakes a completely new comparison of NHS performance in the English regions and the devolved countries. This is the first time such an analysis has been conducted.

How health systems make available information on service providers: experience in seven countries

Brief analytical summaries or syntheses #16 How health systems make available information on service providers experience in seven countries Summary This technical report examines seven countries' experience with systems that release information on the performance of healthcare providers. It is meant to guide the further development of quality information systems in Britain's NHS. Systems in Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States are reviewed. Background There is growing interest in the public release of information on the performance of healthcare providers as a means to improve the quality of care and promote transparency and accountability. Countries have made considerable investments in creating systems to make available such information. However, there is lack of systematic comparative assessment of such systems. The report aims to help fill the gap by reviewing the information systems reporting on the quality of healthcare provision in seven countries. Analysis and results The…

UK - Optimal Price-Setting in Pay for Performance Schemes in Health Care

The authors of this economics paper identify a large gap between the incentive literature and actual price-setting behaviour in pay-for-performance schemes. According to the literature, optimal prices should theoretically reflect the marginal benefit of health gains and the opportunity cost of using public funds. However, the authors found that actual tariffs were lower than this, implying that a lower social value is placed on health gains.

USA - The Performance Improvement Imperative. Utilizing a Coordinated, Community-Based Approach to Enhance Care and Lower Costs for Chronically Ill Patients

In this paper, the Commonwealth Fund Commission on a High Performance Health System proposes the US create 50 to 100 voluntary “Health Improvement Communities” focused on patients with multiple, high-cost chronic conditions. Through payment reform, enhanced primary care, and health information technology, it maintains that this effort could yield $184 billion in savings.

USA - No Improvement in Patient Outcomes Seen in Hospitals with Pay-for-Performance Programs

This study from Harvard School of Public Health finds no evidence that America’s largest hospital-based pay-for-performance (P4P) program improved 30-day mortality rates, a measure of whether patients survive their hospitalization. The US currently plans to expand P4P to most hospitals by 2013.

USA - Public Reporting on Quality and Costs. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers?

This paper asks if public reporting of health provider performance leads to better consumer choices and improvements in care. Published in Health Affairs, the paper describes the theory behind public reporting, its evolution over time, and evidence as to whether it improves healthcare quality and lowers costs.

International - Public Health Performance Strengthening at Districts. Rationale and Blueprint for Action

Published by the WHO, this paper documents the proceedings of a 2016 conference in Bellagio, Italy that convened an international group of 19 experts to discuss public health performance strengthening at district levels. Participants concluded that improving district public health practice is now a feasible priority for middle-income countries given the broad range of successful strategies tested in different international contexts.

International - Paying for performance to improve the delivery of health interventions in low- and middle-income countries (Review)

This study published in The Cochrane Library assesses current evidence on the impact of payment for performance on health care and health outcomes in low- and middle-income countries. The authors conducted a literature review, analyzed the grey literature and consulted experts in the field.

Canada - Measuring and reporting on health system performance in Canada: Opportunities for improvement

The paper highlights the need for governments to set clear policy goals with both measurable health outcomes and supporting health indicators in order to hold health system leaders accountable for performance. The paper provides recommendations to governments, at the same time highlighting innovative practices across Canada and in the United Kingdom and Australia that can provide a way forward.

International - Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

This Commonwealth Fund report compares health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Seventy-two indicators were selected in five domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. The U.S. ranked last on performance overall, and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes domains. The top-ranked countries overall were the U.K., Australia, and the Netherlands.

International - The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care: A Systematic Review

Updating a prior review of the effects of pay-for-performance (P4P) programs on processes of care and patient outcomes in ambulatory and inpatient settings, this systematic review of 69 studies finds low-strength evidence suggesting that P4P programs in ambulatory settings may improve process-of-care outcomes over the short term. Many of the positive studies were conducted in the UK, where incentives were larger than in the US.

UK - Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis

This paper from BMC Health Services Research looks at ways to determine financial incentives in pay for performance schemes, testing the idea that performance indicators with larger population health benefits receive larger incentives. The paper concludes that financial incentive size is not but should be linked to expected health gain.

USA - Working Under a Clinic-Level Quality Incentive: Primary Care Clinicians’ Perceptions

Some designers of clinician pay-for-performance programs argue that team-level incentives (where members receive identical incentives based on overall performance) are most effective. This study surveyed 198 primary care clinicians to obtain opinions on a team-based quality incentive awarded at the clinical level. Most of the clinicians (73%) favoured a mix of clinic-level and personal incentives to maintain collaboration while also recognizing individual performance.

USA - Aiming Higher: Results from a Scorecard on State Health System Performance, 2014

The Commonwealth Fund’s 2014 Scorecard assesses US states on 42 indicators of healthcare access, quality, costs, and outcomes between 2007 and 2012, a period that includes the last recession and precedes the expansion of insurance coverage under Obamacare. Changes in health system performance were mixed, with states making progress on some indicators but losing ground on others.

USA - Financial incentives can undermine motivation and worsen performance

This editorial published in the British Medical Journal warns that pay for performance schemes for health professionals undermine motivation, worsen performance and lead to systemic gaming. The editorial, supported by an analysis of financial incentives by Australia’s Bond University, concludes that many such schemes are based on questionable assumptions.

France - Payment for performance in public health. Continual improvement on quality and the pertinence of care. 4-year assessment

Four years into its implementation, the results of the payment for performance program in France known as ROSP shows the practice to be a change lever among more than 110,000 eligible private physicians. Between 2011 and 2015, it encouraged improvements in the management of patients with chronic diseases and more relevant and effective prescriptions that help to control health spending; furthermore, the practice prompted a modernization of medical practices for the benefit of patients.

International - Performance Assessment in Primary Health Care: A Systematic Literature Review

This CEFAGE working paper by researchers at the University of Algarve in Portugal provides a systematic literature review of studies devoted to the performance assessment of primary healthcare providers.

USA - New Study Challenges Conventional Wisdom on Pay-for-Performance Incentive Programs

Two new studies published on September 19, 2013, by Robert Wood Johnson Foundation (RWJF) researcher Dr. R. Adams Dudley, suggest that for pay-for-performance incentives to be effective, they must be carefully targeted and designed. The first study tests the effectiveness of incentives for small medical practices that have implemented electronic health records (EHRs). The second focuses on how incentives should be distributed to achieve maximum effect—to individual clinicians, to their practices, or to both.

Belgium – Performance of the Belgium’s health care system. 2012 Report

This report prepared by the Centre fédéral d’expertise des soins de santé (KCE) studied the performance of the Belgian healthcare system. Results were compared with those of 14 other European countries. On the positive side are the rate of vaccination among children, 5-year survival after breast cancer or colon, the relationship with the GP, the increasing use of cheap drugs. Screening for breast and colon cancer, as well as the monitoring of diabetic patients, remain to be improved.

International - Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation

This paper published in BMC Health Services Research aims to develop a framework for assessing the interactions between performance-based financing and health systems, focusing on low and middle income countries.

USA - The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance

The authors of this working paper, published by the Harvard Business School, examine the relationships between conformance and experiential quality and two important dimensions of hospital performance: cost efficiency and clinical outcomes. They find that hospitals with high levels of both conformance and experiential quality demonstrate better clinical outcomes as measured by length of stay and readmissions, but have worse performance with regard to cost efficiency.

International - Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review

Despite the critical role of nursing care in healthcare delivery, nursing's contribution is rarely quantified. This study, undertaken by researchers at the Université de Montréal and published in BMC Nursing, develops a framework to measure nursing performance.

France - Why Did Most French GPs Choose Not to Join the Voluntary National Pay-for-Performance Program?

In 2009, a voluntary pay for performance (P4P) scheme for primary care physicians was introduced in France through the ‘Contract for Improving Individual Practice’ (CAPI). This study, published in PLOS One looks at factors that motivated general practitioners not to subscribe to the P4P contract. The perceived risk of breaking professional ethics was a key deterrent.

Canada – Health Indicators 2013

Before Health Indicators moves to interactive, digital reporting in the spring of 2014, this final report in the 14-year series presents the initial objectives of the CIHI–Statistics Canada Health Indicators project and some accomplishments in reporting on the performance of the health system and on the health of Canadians. It also introduces a new program of work that CIHI initiated to support Canadian jurisdictions’ efforts to stimulate health system performance.

Belgium - Performance of The Belgian Health System - Report 2015

Using 106 indicators, this report on Belgium’s healthcare system from 2008 to 2013 lists the system’s strengths and weaknesses, and recommends future priorities for performance improvement. Overall, Belgians are satisfied with their health care, and 78% consider themselves healthy. In terms of quality of care, the country is slightly above the European average.

International - Health at a glance 2015

This new edition of Health at a Glance presents the most recent comparable data on the performance of health systems in OECD countries and, where possible, partner countries. As always, it presents indicators of health and health system performance and focuses on the pharmaceutical sector, health workforce migration and the quality of health care.

International - A review of pay-for-performance programs in the inpatient sector in OECD countries

Providing an overview of 30 pay-for-performance (P4P) programs in the inpatient sectors of 14 countries in the OECD, this German review finds that, although the institution of P4P is widespread, country programs and their impacts are very heterogeneous. Results of published evaluations of the 30 P4P programs ranged from no effect to moderately positive effects.

International - Implementation Processes and Pay for Performance in Healthcare: A Systematic Review

Pay-for-performance (P4P) programs have been implemented to improve quality in numerous health systems. This systematic review examined 41 international studies to better understand implementation factors affecting the effectiveness of P4P. It found limited evidence from which to draw firm conclusions, but suggests that P4P programs should align with organizational priorities and undergo regular evaluation.

Australia - Performance indicators show improvements in Indigenous primary health care service delivery

A new report from the Australian Institute of Health and Welfare (AIHW) shows improvements against a range of national key performance indicators for primary health care organizations providing care to Aboriginal Australians. The report shows improvements in 17 of 19 process measures for maternal and child health, preventive health, and chronic disease management.

Australia - Pay-for-performance programs. Do they improve the quality of primary care?

This article published in Australia Family Physician updates recent evidence about the impact of physician pay-for-performance programs (P4P) on the quality of primary care. After reviewing the evidence, the authors conclude that P4P does not improve health outcomes or health system efficiency.

Lunch hour conferences 2013

22_mai_2013.pdf Towards greater equity and better results in mental health in Québec perspective of the Commissaire à la santé et au bien-être regarding improvements in the performance of the health and social services system. March 13, 2013 By Jacques E. Girard, Deputy Commissioner for Assessment and Analysis The CSBE’s 2012 Report on the Performance Appraisal of the Health and Social Services System includes 5 major recommendations and 15 specific actions to improve the performance of the health and social services system in this sector, with the aim of consolidating knowledge gained in recent years and better responding to the needs of persons with mental disorders, in particular, with regard to front-line services. Following an outline of the key findings, the presentation will highlight the need to re-examine the allocation of mental health resources for an optimal supply of services, with an emphasis on continuity, collaborative health care and the provision…

Australia - Healthcare 2010-11: Comparing performance across Australia

This report to the Council of Australian Governments provides a comparative analysis of the performance of governments at meeting the goals of the National Healthcare Agreement. It finds that despite generally good health outcomes, significant disparities exist between States and Territories, especially in rural and remote areas and among indigenous Australians.

International - Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries

Pay-for-performance (P4P) programs have been implemented in the hospital sector to improve quality of care. This paper provides an overview of 34 P4P programs in 14 member countries of the OECD. It notes that the impact of P4P remains unclear, as the programs analyzed are extremely heterogeneous in their aims, selection of indicators, and financial rewards.

International - The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care: A Systematic Review

This systematic review of 69 studies examines the effects of pay-for-performance (P4P) programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings. It finds that P4P programs may be associated with improved processes of care in ambulatory settings, but consistently positive associations with improved health outcomes have not been demonstrated in any setting.

International - Health system performance comparison: an agenda for policy, information and research

This WHO policy brief calls for more international comparisons of health system performance. It describes the methodology of international comparative studies, key domain comparators, and cites the benefits of international comparison in policy influence and as a source of evidence.

Europe - Euro health consumer index 2012

Published by the Health Consumer Powerhouse, the sixth edition of the Euro Health Consumer Index offers a performance-related comparison of 34 national healthcare systems across Europe. This year’s report says user-friendliness has become a major quality performance driver.

France - Ethical issues raised by the introduction of payment for performance in France

Payment for performance was introduced in France in 2009 for primary care physicians. Its objective was to reduce healthcare expenditures while enhancing improvement in guidelines’ observance. The authors of this study, published in the Journal of Medical Ethics, conducted focus groups among physicians who had and had not joined P4P to identify differences in perceived ethical issues arising from P4P.

International - Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

This paper published in PLoS Medicine provides a systematic review of research studies investigating the performance of private and public sector delivery of health services in low- and middle-income countries.

Canada - New data shows continued improvements in Canada’s health system performance

Canada’s health system performance is showing continued improvements according to new data from the Canadian Institute for Health Information (CIHI). The CIHI reports improvements in long-term care (lower usage of restraints and inappropriate antipsychotics); hospital deaths (a 3% improvement in 2015-2016); and wait times in emergency departments (down slightly from 2013-2014).

UK - Can pay for performance improve the quality of primary care?

In 2004, the UK National Health Service (NHS) introduced the world’s largest healthcare related pay-for-performance scheme in primary care: the Quality and Outcomes Framework (QOF). Primary care doctors were paid up to 25% more if they met a complex set of clinical and organizational indicators. This article explores what other countries can learn today from the UK’s experience with the QOF.

USA - Design and Use of Performance Measures to Decrease Low-Value Services and Achieve Cost-Conscious Care

This article, published in the Annals of Internal Medicine, gives an overview of performance measures that target low-value services in order to help physicians understand the strengths and limitations of these measures. It also provides specific examples of measures that assess use of low-value services, and discusses how these measures can be used in clinical practice and policy.

Canada - Comparing Performance of Universal Health Care Countries, 2016

Canada spends more on health care than almost every other comparable country with universal care finds a new study released by the Fraser Institute. The study compares 28 universal health-care systems in developed countries, spotlighting several key areas including cost, use of resources, access to care and treatment, clinical performance and quality, and the health status of patients.

Brazil - Interregional Performance of the Public Health System of a High-Inequality Country

In the decentralized Brazilian health system, the country’s 27 federal units (FUs) are responsible for health care in their jurisdictions. This study examines the efficiency of individual FUs and explores the overall performance of the health system in a country with high rates of social and health inequality.

Canada - Measuring Success: A Framework for Benchmarking Health Care System Performance

This report from the Conference Board of Canada discusses the benefits, process, and methods of benchmarking. The report proposes a detailed framework to guide the upcoming health performance benchmarking report by Canada’s provinces.

USA - Patients Are Loyal to Their Doctors, Despite Performance Scores

A new study reveals that US patients selecting a doctor for a first-time visit were likely to choose someone highly ranked by insurance companies, whereas patients who already had a doctor were unlikely to switch to more highly-rated physicians. The study compared information on 171,581 patients who were in a tiered Massachusetts physician network that ranked quality, performance and health plan efficiency.

UK - The NHS and social care: prospects for funding, staffing and performance in the 2020s

Making projections for funding, staffing and performance, this report on British social care and the National Health Service (NHS) explores the varying organizational structures and delivery mechanisms of the UK's four nations (England, Wales, Scotland and Northern Ireland). It finds no evidence that the purchaser-provider split of NHS England achieves better results than the centralized systems of the rest of the UK.

United Kingdom: Management of NHS hospital productivity

Brief analytical summaries or syntheses #13 United Kingdom Management of NHS hospital productivity Summary Hospital productivity has fallen over the last ten years. There have been significant increases in funding and hospitals have used this to deliver against national priorities. But, according to this report from the National Audit Office, hospitals need to provide more leadership, management and clinical engagement to optimise the use of additional resources. Background In 2000, the Department of Health published the NHS Plan, a ten-year vision for reforming the NHS. The Plan argued that the NHS was failing to deliver because it had been under-funded, and set out to substantially increase funding in order to meet public expectations for more and better paid staff using new ways of working; reduced waiting times; high quality patient-centred care; and improvements in local healthcare buildings. The Plan set out the systemic problems of the NHS, such as a…

Improving and measuring quality of care

Brief analytical summaries or syntheses #8 Improving and measuring quality of care Summary This publication presents new data on patient safety in OECD countries and shows that significant variations in quality of care persist in cancer, acute myocardial infarction and stroke, as well as in services provided by family physicians. The report looks at how countries can improve the measurement of quality, the balance between privacy and transparency in matters of quality and safety, and links between quality indicators and policies to improve the performance of physicians, hospitals and the health system as a whole. Background Health systems face important challenges today an increasingly complex case mix, greater demand for health care services (especially for chronic diseases) and an economic context in which improvements in care must come at the lowest possible cost. Measuring the quality of care becomes increasingly important in this context. Poor quality care undermines the goals…

Europe - Health system performance assessment in the WHO European Region: which domains and indicators have been used by Member States for its measurement?

Health systems performance assessment (HSPA) varies across Europe. This WHO review summarizes 14 HSPA domains and 1,485 indicators used in European HSPA reports. All countries had indicators of service delivery and health outcomes. Other domains, such as safety, efficiency, coverage or responsiveness, were included in only 30% of the documents. The review concludes that further refinement of frameworks is warranted.

UK - Open consultation: Transparency in care: visible ratings for health and care providers

Britain’s proposed 2014 Care Act will give the UK Care Quality Commission (CQC) the power to assess healthcare provider performance and assign ratings. This consultation document seeks views on requiring providers to display performance ratings and includes draft regulations on how the new legislation will work in practice.

Canada - Mental Health and Addictions System Performance in Ontario: A Baseline Scorecard

This scorecard assesses mental health and addictions care in outpatient physician and acute care settings in Ontario from 2006 to 2014. The scorecard comprises 10 performance indicators that describe how well the health system responded to patient needs, along with eight contextual indicators reflecting the services provided and patient outcomes. Performance on each indicator is evaluated by age, sex, geography, neighbourhood income, and immigration status.

UK — How is the NHS performing? Quarterly monitoring report

This monitoring report is the first of a regular quarterly review, which will combine publicly available data on selected NHS performance measures with views from a panel of finance directors on the key issues their organisations are facing. It complements the monthly waiting times tracker and is a continuation of work that has been done historically to assess, analyse and report on the performance of the NHS.

Canada — Did changing primary care delivery models change performance? A population based study using health administrative data

Primary care reform in Ontario, Canada started with the introduction of new enrolment models, the two largest of which are Family Health Networks (FHNs), a capitation-based model, and Family Health Groups (FHGs), a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups.

Switzerland - Development of a monitoring instrument to assess the performance of the Swiss primary care system

Conducted under the auspices of the Swiss Primary Care Active Monitoring (SPAM) program, this study developed an instrument to describe the performance and efficacy of Switzerland’s primary care system. Selecting 56 primary and 80 secondary indicators, the new instrument was deemed capable of effectively monitoring primary care within the Swiss health system’s complex blend of private and public health providers.

International — Governance in the health sector: a strategy for measuring determinants and performance

Many different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also asked whether improvements in the way health care services are governed could make a difference. These approaches ask which factors -- such as rules and institutions -- influence the behaviour of the system in ways that are associated with better performance and outcomes. The paper concludes by proposing specific measures of governance determinants and performance and describes the instruments available to collect and interpret them.

USA - 2018 Scorecard on State Health System Performance

The US states of Hawaii, Massachusetts and Minnesota are this year’s top-ranked performers in the 2018 Scorecard on State Health System Performance. The scorecard assesses 40 measures of access to health care, quality of care, health outcomes, and income-based disparities. The scorecard also reveals that 28 states are losing ground on measures related to life expectancy.

USA - Performance Measurement in Fee-for-Service Medicaid: Emerging Best Practices

Through support from the California HealthCare Foundation, the Center for Health Care Strategies (CHCS), in collaboration with the California Department of Health Care Services (DHCS), sought to better understand how states are using performance measures for Medicaid FFS beneficiaries, particularly those with complex needs. This resulting report outlines emerging best practices for measuring the quality of FFS care culled from the firsthand experiences of nine states as well as numerous interviews with key stakeholders across the country.

International - Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review

Inadequate healthcare provider performance is a major challenge in low-income and middle-income countries (LMICs). This systematic review of 37 studies catalogues 118 strategies to improve LMIC provider performance in order to establish a comprehensive Health Care Provider Performance Review (HCPPR) for future utilization. Thus far, contextual and methodological heterogeneity, as well as low quality evidence, make study and strategy comparisons difficult.

UK - A review of the evidence on the impact, effectiveness and value for money of performance-related pay in the public sector

The British government authorized this review of the evidence on the impact, effectiveness, and value for money of performance-related pay (PRP) systems in the public sector. The report presents evidence on the impact of PRP on compensation, cost effectiveness and staff motivation.

Sweden - Effects of a multifaceted intervention QI program to improve ICU performance

Inadequate intensive care unit (ICU) clinical performance and outcome data were the impetus for this Swedish quality improvement (QI) project. It addressed work processes and issues of competence utilization by forming multi-disciplinary teams (physicians, nurses and physiotherapists) with training in scientific production management and value streaming approaches. A seven-year follow up period revealed reduced ICU length of stay and mortality, as well as improved cost-effectiveness.

UK - How do we compare? - Applying UK pay for performance indicators to an Australian general practice

United Kingdom general practitioners receive payment based on their performance in multiple clinical indicators. Applying UK style pay for performance clinical indicators to an Australian general practice is feasible in a well computerized practice and can identify significant areas for improved clinical care according to the authors of this paper.

Brazil - Considerations on the Brazilian national health system (SUS) performance index

One of the quality measures used by Brazil’s National Health System (SUS) is the Brazilian National Health System Performance Index (IDSUS), which assesses the effectiveness of health care in municipalities and regions. This study looks at the potential of IDSUS to improve Brazilian public health management, but finds that its application and usage remains patchy across the country.

Belgium - A first step towards measuring the performance of the Belgian healthcare system

The present study aims to explore the possibilities to set up a performance measurement system for the Belgian health care system.

Canada - Value for Money from Health Insurance Systems in Canada and the OECD

This paper compares the economic performance of Canada’s health insurance system against the health insurance systems of 27 other countries that are members of the Organisation for Economic Co-operation and Development (OECD). Economic performance is defined by the availability of medical resources and the output of medical services, as well as the associated level of national health spending as a percentage of GDP. The value for money produced by a country’s health insurance system is defined relative to the economic performance of the health insurance systems of its international peers.

International - Money talks - Paying physicians for performance

Pay-for-performance (P4P) systems that tie physician payment to care quality are popular among healthcare policy makers. This study assessed the effects on patients and physicians of two pay systems: traditional fee‐for‐service, and a blend of fee‐for‐service and P4P incentives. Patients treated under the blended system were shown to receive better treatment.

International - Systematic review: Effects, design choices, and context of pay-for-performance in health care

Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices and contextual mediators on these effects. Effect domains include clinical effectiveness, access and equity, coordination and continuity, patient-centeredness, and cost-effectiveness.

Canada — Family medicine group implemented in Québec: potential and limits to improve healthcare performance

L’implantation du modèle des groupes de médecine de famille au Québec : potentiel et limites pour l’accroissement de la performance des soins de santé primaires The aim of this article is to analyze the potential of the FMG model to be a lever for improving the health system performance as well as to discuss potential improvement for this model.

Europe - Measuring and managing performance

This issue of Eurohealth focuses on performance monitoring to maintain high quality health services. Also covered are the topics of user fees in the Czech Republic; private sector providers in England; barriers to physician workforce development in Uzbekistan; and providing a solid evidence base for policy makers through the ECHI initiative.

USA - The U.S. health care system achieves a score of 64 out of 100 in the third National Scorecard on U.S. Health System Performance

The new U.S. National Scorecard updates assessments of population health and health care quality and access. Across 42 performance indicators, the U.S. achieved a score of 64 out of a possible 100 when comparing national rates with international benchmarks. The Scorecard concludes that the American health system continues to fall short, especially considering how much the country spends on health.

UK - Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the “NHS Services, Seven Days a Week” project 2013–2016

In 2013, the Seven Days a Week Project was initiated to expand full access to the National Health Service (NHS) on weekends. This study analyzes these changes, finding that the adverse clinical outcomes associated with weekends may not be improved by the reorganization. In fact, unless there is additional financial investment, such changes may negatively impact care quality, as seen by the worsening of some outcomes.

Canada - Ontario’s health care system under increased strain

Many parts of Ontario’s health care system are under increased strain, according to Measuring Up 2018, Health Quality Ontario’s 12th yearly report on the performance of the province’s health system. The report’s key findings emphasize the backlog in different parts of the health system, underscoring the hospital overcrowding issue.

Australia - Funding Indigenous organisations: improving governance performance through innovations in public finance management in remote Australia

Commissioned by the Australian government, this report explores how funding modalities can improve governance performance and service delivery outcomes in Australia’s remote Indigenous communities. The report considers current public finance arrangements, examines domestic and international case studies of different funding modalities, and proposes alternative funding approaches.

Australia - Australia's health 2016

Produced by the Australian Institute of Health and Welfare (AIHW), this annual report profiles Australian health issues for the year 2016 in a collection of feature articles and statistical snapshots covering a range of areas. Articles examine health expenditures, major causes of ill health, determinants of health, prevention and treatment, health through the lifecourse, and health system performance.

Canada - Better Value for Money in Healthcare: European Lessons for Canada

This commentary from the C.D. Howe Institute says Canadian health care would benefit from a serious look at European countries’ efforts to align incentives within their health systems to encourage better performance. Health systems in the U.K. and Netherlands have conducted reforms to attain greater value for money while continuing to adhere to equity principles similar to Canada’s.

USA - Physician-Leaders and Hospital Performance: Is There an Association?

This discussion paper from the Institute for the Study of Labour (IZA) in Germany seeks to fill the evidence gap around the assumption that physicians make better hospital leaders than non-physicians. The authors looked at quality data from the top 100 U.S. hospitals and researched the personal histories of the 300 CEOs of these hospitals to classify them into physician and non-physician managers. They found a strong positive association between the ranked quality of a hospital and whether the CEO is a physician.

France - Assessment of new public management in health care: the French case

France has recently reorganized the management of its healthcare system, incorporating centralization, quasi-markets, public private partnerships, and pay-for-performance schemes for general practitioners. This article evaluates these reforms and their effects, finding little evidence of improvement in system performance.

USA - Thomson Reuters Announces Top Health Systems

Thomson Reuters released its fourth annual study identifying the top U.S. health systems based on balanced system-wide clinical performance. The study examined data from more than 300 American organizations and singled out 15 hospital systems that achieved superior clinical outcomes based on measures of quality, patient perception of care and efficiency.

Sweden - A Star Performer in the Eyes of an Emerging Health Leader. Lessons in Quality and Patient Safety

Every year, the Canadian College of Health Leaders (CCHL) takes Canadian health sector leaders on study tours of Sweden’s healthcare system. This report on the 2012 tour provides an overview of Swedish health care, compares health indicators, and discusses lessons learned from Sweden’s performance in the areas of quality and patient safety.

USA - The ABCs of Measurement

This report from the National Quality Forum explains how the science of measuring health care performance is making enormous progress, and continues to evolve. Measures represent a critical component in the national endeavor to assure that all patients receive appropriate and high quality care.

Canada - Measuring Up. A yearly report on how Ontario’s health system is performing

Measuring Up uses the Common Quality Agenda, a set of indicators developed with experts across the province, to see how the quality of care is changing in Ontario — how each local health integration network (LHIN) region is performing, and how the province compares with the rest of Canada and other countries. The report shows that over the past four to 10 years, 13 key performance indicators demonstrate improvement, 20 indicators show no change and two have deteriorated.

Canada - Euro-Canada Health Consumer Index 2010

This is the third annual Euro-Canada Health Consumer Index (ECHCI). The ECHCI is an international comparison of healthcare system performance in 34 countries. All 27 European Union member states are examined, along with Norway, Switzerland, Croatia, FYR Macedonia, Iceland, Albania and Canada. For the third straight year, the Netherlands finishes in first place in the ECHCI, earning 857 out of 1,000 possible points.

Canada - Three Canadian Cities Receive Top Marks in Conference Board’s First City Health Ranking

Saskatoon, Calgary and Winnipeg have earned the top grades in the Conference Board of Canada’s first City Health Monitor benchmarking the health performances of 10 Canadian cities. Each city received a grade on 24 indicators regarding life satisfaction, population health, lifestyle and access to health care. The city of Montreal had the worst scores.

Canada - Québec's health care commissioner releases its 2014 report on the performance of the health and social services system

Published on May 13, this report is based on analysis of a wide range of data from multiple sources at provincial, national, and international levels. Quebec performs very well with regard to wait times to see a specialist, obtain specialized testing, as well as for hospital readmissions, but performs less well on continuity and coordination between specialists and family physicians. Quebec comes dead last in the use of information technology by physicians, access to a regular doctor, and follow-up care.

Lunch hour conferences 2015

By Michel Perreault, psychologist-researcher, Douglas Mental Health University Institute, associate professor, Psychiatry Department, Université McGill Hélène Provencher, professor, Nursing Faculty, Université Laval, researcher, Groupe de recherche sur l'Inclusion sociale, l'Organisation des services et l'Évaluation en santé mentale (GRIOSE-SM), CSSS de la Vieille-Capitale This conference will address the added value question of the intervention focusing on the contribution of peer helpers in care and services network, particularly in the area of mental health. The major findings from two research projects supported by the MSSS will be presented, one about the peer helpers intervention to facilitate access to clinical treatment for people with anxiety disorders with the support group Phobies-Zéro and the other one addressing the peer helpers integration in teams of support in the community for people with severe mental disorders proposed by the “Peer Helpers Network Program” associated with the Association québécoise pour la réadaptation psychosociale. Peer helpers accompany researchers…

Canada - Learning from the best: a comparative study of Québec emergency departments

Apprendre des meilleurs : étude comparative des urgences du Québec The report from the Commissaire à la Santé et au Bien-être documents the performance of Quebec emergency departments and links this performance to practices and processes implemented in emergency departments in order to learn from the best performing hospitals. The report includes an analysis of emergency department data, a review of their practices and processes, and incorporates the results of a consultation session with the Commissioner's Forum.

UK - Consultation on proposed regulations on “duty of cooperation” relating to sharing information about the conduct or performance of health care workers to protect patient safety

The UK Department of Health is consulting on draft regulations which will impose duties on designated bodies, including employers and contractors of health care workers, in all sectors, and regulatory bodies, relating to sharing information about the conduct or performance of health care workers to protect patient safety.

UK - The NHS atlas of variation in healthcare: reducing unwarranted variation to increase value and improve quality

The National Health Service (NHS) Atlas of Variation in Healthcare identifies unwarranted geographical, population, institutional and specialist variations in British healthcare services. Utilizing over 100 indicators and performance measures, the atlas is a key resource to help the NHS identify waste and release resources for higher-value interventions.

UK – Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework—A Systematic Review

Since 2004, British primary care practices have received financial rewards for achieving standards set out by the National Health Service (NHS) Quality and Outcomes Framework. This systematic review from the Annals of Family Medicine examines evidence on the impact the framework has had on primary health care.

Canada - Measuring Up 2017. A yearly report on how Ontario’s health system is performing

Using 50 indicators to assess the annual performance of Ontario’s health system, this year’s report by Health Quality Ontario (HQO) finds improvements in premature mortality, care continuity, screening, surgical wait times and long-term care. It gives black marks to access, equity, caregiver support and transitional and palliative care.

Europe - Understanding the Drivers of Organisational Capacity

Conducted by the RAND Corporation, this study aims to improve the ability of organizations to measure capacity and harness organizational culture to optimize performance. Based on interviews and a literature review, the study analyzes the dimensions of organizational capacity, explores how organizational culture and communication interact with capacity building, and paves the way for future development of a diagnostic tool for organizational capacity assessment.

A CEO Checklist for High-Value Health Care

Brief analytical summaries or syntheses #45 A CEO Checklist for High-Value Health Care Summary This discussion paper reflects an Institute of Medicine Roundtable Discussion among the CEOs of major American health systems. It provides a checklist of 10 strategies that, in their experience, have proven effective and essential to improving quality and reducing costs. Background Leaders of health care organizations are acutely aware of the pressures that rising health care costs place on individuals, employers, and the government, and of unacceptable shortfalls in the quality and efficiency of care. They have also learned, through experiences in their own institutions and through communication and collaboration with colleagues in other institutions, that better outcomes at lower costs can be achieved through care transformation initiatives that yield improved results, more satisfied patients, and cultures of continuous learning. These transformation efforts have generated certain foundational lessons relevant to every CEO and Board member, and…

Health policy responses to the financial crisis in Europe

Brief analytical summaries or syntheses #47 Health policy responses to the financial crisis in Europe Summary This August 2012 report by the Health Evidence Network (HEN) identifies key challenges for European health policy makers in the wake of the ongoing financial crisis. The report focuses on responses to essential service cuts and interruptions in revenue streams, as well as on inefficiencies and exacerbations of adverse effects evident in national health systems. Background The global financial crisis that began in 2007 can be classified as a health system shock – that is, an unexpected occurrence originating outside the health system that has a large negative effect on the availability of health system resources or a large positive effect on the demand for health services. Economic shocks present policy-makers with three main challenges Health systems require predictable sources of revenue with which to plan investment, determine budgets and purchase goods and services.…

Canada - The impact of primary care reform on health system performance in Canada: a systematic review

Using 15 years of records (2000-2015) from Embase, PubMed, and Web of Science databases, this study aimed to draw inferences about whether primary care reforms have improved health system performance based on measures of utilization, processes of care, and physician productivity. It found some evidence that team-based models of care led to reductions in emergency department use and improved care processes.

Europe - Performance of Long-Term Care Systems in Europe

This paper, published by the Centre for European Policy Studies, summarises the results and discusses the policy implications of the evaluation of long-term care (LTC) systems carried out in the ANCIEN project. An overall evaluation was carried out for four representative countries: Germany, the Netherlands, Spain and Poland. The role of the state in funding and organising LTC versus individual responsibilities is one of the most important differences among countries.

Canada - Toward Performance and Quality

This special edition of Healthcare Quarterly highlights the transformation that is under way in Ontario’s healthcare system. Many topics are discussed such as patient-centred care, successful Quality Councils, leadership, links between evidence and quality of care, and The Excellent Care for All Act.

UK - Formal launch of MyNHS

Launched in November 2014, MyNHS is a website where people in the UK can compare their local National Health Service (NHS) hospital, health authority, and health services on a number of performance indicators. MyNHS includes searchable data on hospital food quality, staffing, patient safety and mental health, along with many other areas of care.

Reducing waste in health care

Brief analytical summaries or syntheses #56 Reducing waste in health care Summary A key target in slowing healthcare spending in the US is the elimination of waste, which is thought to constitute over one third of all American health spending. This policy brief published in Health Affairs focuses on the types of waste in health care and ways to eliminate it. Background Health care spending in the United States is widely deemed to be growing at an unsustainable rate, and policy makers increasingly seek ways to slow that growth or reduce spending overall. A key target is eliminating waste — spending that could be eliminated without harming consumers or reducing the quality of care that people receive and that, according to some estimates, may constitute one-third to nearly one-half of all US health spending. Waste can include spending on services that lack evidence of producing better health outcomes compared to…

USA - Rising to the Challenge. The Commonwealth Fund Scorecard on Local Health System Performance, 2016 Edition

Assessing 36 indicators of access, quality, avoidable hospitalization, cost and outcomes across 306 local health systems, this report finds wide variation in health and healthcare across American communities. Overall, health care improve in the period observed (2013-15), and improvement often corresponded to public policy implementation, notably the Affordable Care Act ("Obamacare").

UK - Understanding the Performance and Potential of Specialist Hospitals

The National Health Service (NHS) is considering expanding its network of specialist hospitals, a policy shift applauded in this research, which finds that specialist hospitals are innovation leaders that improve quality standards, attract highly-qualified staff and deliver better outcomes. The authors make recommendations concerning the acceleration of innovation adoption and spread, along with lessons learned for non-specialist hospitals and the NHS overall.

USA - Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System

This report by the Commonwealth Fund advocates tying future increases in US health spending to long-term GDP growth, while simultaneously moving to a high performance healthcare system. The report lays out a three-pronged strategy relying on provider payment reform, policies to encourage high-value choices by consumers, and system-wide action to improve healthcare markets.

Sweden - Saint Göran: A Competitive Hospital in a Universal System

Publically funded but run by a private company, Saint Göran is a Stockholm hospital that regularly stands out in Sweden and internationally on important performance indicators such as emergency room wait times, cost effective management, and patient and staff satisfaction. This article by Quebec researchers analyzes Saint Göran in depth to see what lessons can be drawn for Canadian hospitals.

Canada - Provincial Healthcare Index 2013

The Fraser Institute’s Provincial Healthcare Index 2013 uses public data to measure healthcare provision and expenditures in each province. The provision of healthcare is captured using 46 indicators aggregated into four components: availability and use of resources, access, and the clinical performance of medical goods and services.

Canada - Toward Quality Mental Health Services in Canada: A Comparison of Performance Indicators across 5 Provinces

In 2015, the Centre for Applied Research in Mental Health & Addiction (CARMHA) at Simon Fraser University led an initiative to develop mental health and addictions performance indicators that could be used comparatively across five provinces: British Columbia, Alberta, Manitoba, Ontario and Québec. These two reports present the project: one provides an overall summary and the other details technical information on indicators and results.

Italy - Performance of the health care industry: the Italian case study

This paper from CERIS, Italy’s Institute for Economic Research, analyzes hospital efficiency during the current period of government financial austerity and budget cuts to the Italian healthcare system. The authors develop a formula to calculate maximized production of medical treatments that minimize costs, and discuss definitions of efficiency in health systems.

International - The Changing Role of Government in Financing Health Care: An International Perspective

This paper explores the changing role of governments in health care financing internationally. It reviews the economic literature to analyze policy decisions and performance results in financing incentives, risk pooling, hospital competition, performance-related pay, and wait times. The paper says there is little international evidence that revenue collection mechanisms alone can manage care costs.

USA - Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

This study analyzes data from the 2009–2011 Medical Expenditure Panel Survey to compare the healthcare experiences of high-need adults with those of other adults. The study finds that adults with three or more chronic diseases reported unmet medical needs most often and were less likely to experience good patient–provider communication. Privately insured high-need adults reported the greatest difficulties in having their needs met.

UK - The health and social care ratings review

In 2012, the Nuffield Trust was commissioned by the UK government to review whether ratings of provider performance should be used in health and social care. This report concludes that implementing a ratings system would be favourable for providers of social care and general practitioners (GPs), but offers fewer benefits for hospitals.

Europe - Person-centred care in Europe: a cross-country comparison of health system performance, strategies and structures

Published by the Picker Institute, an international charity based in England, this policy briefing compares patient or person-centred care within healthcare systems in the UK, Germany, Italy, Spain and the Netherlands. The briefing considers health system performance, strategies and structures, along with the cost-effectiveness of national person-centred care schemes.

Europe - A comparative analysis of health policy performance in 43 European countries

This article from European Public Health assesses national variations in health policy and investigates the influence of local political, economic and social determinants. The article reviews the policies of 43 European countries on nutrition, child health, infectious diseases, hypertension, cancer screening, road safety, air pollution, and tobacco and alcohol use.

International - International Profiles of Health Care Systems: Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States

This publication from the Commonwealth Fund provides overviews of healthcare systems in 15 countries, giving information on insurance, financing, organization, cost containment, efficiency, quality of care, health disparities, care coordination, and the use of information technology and evidence-based practice. Summary tables provide data on key health system characteristics and performance indicators.

UK- Making policy count: developing performance indicators for health and social care partnerships in the UK

This paper updates on work underway to develop new performance indicators for adult social care, and health and care partnerships. It sets out its context, recent progress, and asks for stakeholder support through comments and offers to pilot work.

Canada - New Brunswick Health System Report Card: Access Challenges Remains despite Increase in Number of Providers

The New Brunswick Health Council (NBHC) released its second Health System Report Card in January 2012. An important tool measuring the quality of health services delivered in the province, the Report Card also indicates how New Brunswick compares with Canada’s other provinces. The 2012 Report Card gives New Brunswick a “C” as an overall performance grade, unchanged from 2011.

Canada - Performance of an integrated network model. Evaluation of the first 4 years

Conducted by Université de Montréal researchers, this study evaluated changes in accessibility, care experiences, and quality-of-care indicators after a Québec clinic moved to a fully integrated network model. Increases in accessibility were seen after the transition, while improvements in biologic data suggested better quality of care. Patient satisfaction remained high throughout the four-year study.

Canada - Where you live matters: Canadian views on health care quality Results from the 2013 Commonwealth Fund International Health Policy Survey of the General Public

This final bulletin in the Health Council of Canada's Canadian Health Care Matters series presents Canadians’ views on and experiences with health care, based on the 2013 Commonwealth Fund Survey. It focuses on differences between provinces, comparisons among the 11 OECD countries participating in the survey, and changes in Canada’s performance over the past decade. Large variations between provinces in patient experiences, not only around wait times and coordination of care, but also in other areas including out-of-pocket expenses, patient safety, and preventive care, were identified.

Europe - Comparing public and private providers: a scoping review of hospital services in Europe

Authored by two Finnish academics, this scoping review of 24 prior studies (17 on economic issues and six on quality of care) compares the performance of 5,500 public and private hospitals in Europe. Public hospitals were most frequently found to have better economic performances and quality of care than private hospitals. Private for-profit hospitals performed worse on these measures than private non-profit hospitals.

Ireland - The Potential Role of Pay-for-Performance in Irish Health Care

Published in December 2011 by Ireland’s Economic and Social Research Institute, this paper is one of 12 in a special series that adopts an evidence-based approach to tackling issues in Ireland’s current economic crisis. This paper examines international evidence on pay for performance (P4P) schemes to inform policymakers on the potential for implementing P4P in the Irish healthcare system.

Europe - Country-by-country profiles on national health situation relaunched

The WHO is launching a series of publications providing analyses of health situations in European countries. Written in collaboration with ministries of health, the series will be based on the WHO’s Health 2020 indicators, and will provide insights into national health system performance.

Australia - A new way of measuring the performance of the health system

The CEO of Melbourne Medicare Local, Kristin Michaels said recently that a new survey method for measuring the effectiveness of the Australian health system had revealed interesting and challenging results. National research undertaken in June by Crosby/Textor for Eastern Melbourne Medicare Local used a core questionnaire based on the Australian Charter of Healthcare Rights. The Charter is intended to guarantee Australians that the health system delivers seven key health rights: access, safety, respect, communication, participation, privacy and comment.

China - Relative efficiency and productivity: a preliminary exploration of public hospitals in Beijing, China

Public hospitals in Beijing receive a large number of patients and have developed enormous capacity and scale. This study looked at 12 Beijing general hospitals to mount a comparative study identifying efficiencies and productivity factors that drive performance improvement. However, fresh data showed that performance at all of the hospitals had declined since previous surveys.

France - Is quality of care soluble in quantities? A critique of pay for performance

This working document published by Economix presents a critique of pay for performance in medicine. The payment mechanisms seek to encourage doctors to meet quantified standards of quality that are derived from the results of evidence-based medicine (EBM). The author considers that the statistical objects used by this method are problematic and finds it questionable to consider care service as a product that can be reproduced an infinitum.

Europe - Unwarranted variations in health care performance across Europe: Lessons from the ECHO Project

Using evidence from the European Collaboration for Health-Care Optimization (ECHO) Project, the nine articles in this special issue of the European Journal of Public Health consider national variations in healthcare delivery within the European Union (EU). Articles describe variations in comorbidity measures, hospital efficiencies, avoidable hospitalizations, hip replacement surgery, coronary artery bypass surgery and caesarean section. Two papers discuss ECHO itself.

USA - Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance 2017 Edition

The 2017 edition of this scorecard finds that health systems in nearly all US States improved on a broad array of health indicators between 2013 and 2015. During this period, the proportion of people without insurance fell, and more people were able to access needed care, particularly in states that expanded Medicaid programs. On a less positive note, premature death rates rose slightly between 2011 and 2014.

Italy - From measuring the past to strategically framing challenges in the healthcare sector. The role of balance scorecard

The balanced scorecard (BSC) is a planning and management system used by organizations to prioritize projects and services, measure progress toward targets, and align daily work with strategy. This paper investigates potential roles for the balanced scorecard in health care and evaluates how its multidimensional framework might effectively link strategy and performance management in the sector’s fast-paced work environment. The paper includes a case study.

How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children’s Hospital, Stockholm, Sweden

Brief analytical summaries or syntheses #36 How does lean work in emergency care ? A case study of a lean-inspired intervention at the Astrid Lindgren Children’s Hospital, Stockholm, Sweden Summary This study published in BMC Health Services investigates how a package of “lean-like” changes translated into better care process management in a health care setting. The authors studied an intervention in a children’s hospital’s emergency department in Stockholm. Improvements in wait and lead times were sustained following changes to employee staffing, scheduling, and problem solving. Background There is growing interest in applying lean thinking in health care, yet there is still limited knowledge of how and why lean interventions succeed (or fail). Emergency departments (EDs) all over the world are challenged with problems of overcrowding and excessive waiting times. Overcrowding and delays correlate with increased patient mortality, decreased patient and staff satisfaction, and inefficient use of resources. Moreover, as EDs…

International - Future Health Index commissioned by Philips reveals significant gap between perception and reality of how global health systems are performing

This study released by global health technology firm Royal Philips has revealed a large gap between the perceptions of health professionals and the general population with regard to future health system performance. The study also finds that the most significant benefits of connected care technology are seen in diagnosis, home care, and chronic disease management.

Denmark - Hospital centralization and performance in Denmark – ten years on

In 2007, Denmark restructured its 13 counties into five regions, creating administrative units large enough to allow the centralization of specialized care in fewer hospitals. This paper analyses the reorganization of the Danish hospital sector after 2007 and discusses the mechanisms behind the changes. Since the reform, hospital productivity has increased by more than 2% per year and costs have been stable.

International - Health at a Glance 2017. OECD Indicators

This new edition of Health at a Glance presents the most recent comparable data on the health status of populations and health system performance in OECD countries. Where possible, it also reports data for partner countries (Brazil, China, Colombia, Costa Rica, India, Indonesia, Lithuania, Russian Federation and South Africa). This edition contains a range of new indicators, particularly on risk factors for health. It also places greater emphasis on time trend analysis.

International - Multinational Comparisons of Health Systems Data, 2008

This updated Commonwealth Fund chart book uses data collected by the Organization for Economic Cooperation and Development to compare the health care systems and performance across several industrialized countries.

International - International Profiles of Health Care Systems

Produced by the Commonwealth Fund, this publication profiles healthcare systems in 19 countries (Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, Taiwan and the US). System financing and coverage methods are described and country performance measures are presented along with information on providers and spending.

International - Effective coverage as a new approach to health system performance assessment: a scoping review

The WHO introduced the concept of effective coverage as a health system output indicator for performance assessment. This review by Iranian researchers finds that interventions monitored by effective coverage tend to be siloed within child health and obstetrics. It calls for an increased focus on methodology and definitions of measures to better conceptualize and assess connections between coverage rates and effectiveness.

Russian Federation – Health System Review.
Health systems in transition, 2011

Brief analytical summaries or syntheses #37 Russian Federation – Health System Review. Health systems in transition, 2011 Summary The WHO produces health system profiles (HiTs), which are country-based reports providing a detailed description of health systems and policy initiatives. This HiT on the delivery of health care in Russia examines different approaches to the organization, financing and delivery of health services in that country, along with the roles of main local actors. Background At independence from the Soviet Union in 1991, the Russian health system inherited an extensive, centralized Semashko system, but was quick to reform health financing by adopting a mandatory health insurance (MHI) model in 1993. While the health system has evolved and changed significantly since the early 1990s, the legacy of having been a highly centralized system focused on universal access to basic care remains. High energy prices on world markets have ensured greater macroeconomic stability, a…

Canada - Canadian Federal Health Transfers to the Provinces 2012 edition

The continued commitment to growing federal cash transfers to Canadian provinces raises the important question of whether or not marked increases in such transfers have previously been effective at improving Canada’s health care system. To answer this question, this study from the Fraser Institute examines the evidence. The first section outlines federal transfers to the provinces for health. The second examines a series of health care performance indicators in 1997 and 2004, and compares them with current performance to determine if any changes have occurred. The final section provides recommendations.

Canada - Performance-Based Healthcare: How Hospitals Can Leverage Business Intelligence and Information Management to Meet Ontario's Healthcare Reforms

This paper by three consultants with IBM Global Business Services in Volume 10, Number 2 of Electronic Healthcare recognizes that hospitals are at different stages of readiness in information management to align their practice with Excellent Care for All Act quality legislation. It identifies eight key business intelligence dimensions that can help hospitals advance their information management and quality improvement agendas.

Australia - Healthcare in Australia 2012-13: Five years of performance

The COAG Reform Council has released its final report on the National Healthcare Agreement. It shows that Australians have overall good health and enjoy a high quality healthcare system. It notes areas of concern such as obesity and chronic diseases that could put strain on the healthcare system and require attention from governments.

Canada - Perinatal and early childhood health. More appropriate care and services in a timely manner

Périnatalité et petite enfance : Pour des soins et services mieux adaptés en temps opportun This report presents the Commissioner for health and well-being of Québec’s long-term vision of perinatal and early childhood health in Quebec. This view of the health and social services system’s performance follows on two prior efforts by the Commissioner, in 2009 and 2010, to deal with primary care and then chronic diseases. The Commissioner’s analysis of different indicators, review of the literature and consultations revealed a need to better support parents and stakeholders in the societal project that is raising children. The Commissioner recommends the creation of a dedicated website, supported by the Ministère de la Santé et des Services sociaux, that would assemble validated information on the perinatal and early childhood period, and make it easily accessible.

UK - Good Work, Wellbeing and Changes in Performance Outcomes

Produced by independent consultants, this report analyzes people management within the National Health Service (NHS). It finds that NHS organizations using good people management practices were three times more likely to have the lowest levels of staff absences, and four times more likely to have the most satisfied patients. No link was found between people management practices and patient mortality.

International - High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement

Conducted by Australian and UK academics, this systematic review examines research methods used to identify high performing hospitals; the factors associated with high performance; and practical strategies for improvement. Assessment of 19 studies revealed four factors associated with high performing hospitals: positive organizational culture, effective leadership, expertise-driven practice, and interdisciplinary teamwork. Fifty-six practical improvement strategies are catalogued.

Europe - Euro health consumer index 2016

Published annually since 2005, the Euro Health Consumer Index (EHCI) assesses the performance of healthcare systems in 35 European countries. The 2016 EHCI compares systems on 48 indicators, covering areas such as patient rights, access, treatment outcomes, range of services, prevention and use of pharmaceuticals.

USA - Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013

This scorecard from the Commonwealth Fund identifies opportunities for states to improve their health systems for economically disadvantaged populations and provides state benchmarks of achievement. Analyzing 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the scorecard documents sharp healthcare disparities among states.

Canada - Report Card on Wait Times in Canada

The absence of a concerted national effort to reduce wait times is undermining progress on addressing the time lags endured by Canadians needing medical care, warns the Wait Time Alliance (WTA). The 2012 WTA report card gives Canadians a picture of how long they have to wait to access a broad range of medical procedures and services. In a reversal from past years, the 2012 Report Card shows a decline in performance for patients receiving care in the five areas identified as priorities by federal, provincial and territorial governments under the 2004 Health Accord.

International — How health systems make available information on service providers: experience in seven countries

This report reviews information systems that report on the quality or performance of providers of healthcare in seven countries (Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States) to inform the use and further development of quality information systems in the English NHS.

The Netherlands - Dutch Health Care Performance Report 2014

The 2014 edition of this annual report on Dutch health care gives high overall marks for access and quality. However, variations in elder and nursing home care due to insufficient staffing are evident. The Netherlands continues to be Europe’s fourth highest spender on health care, largely because of long-term care costs.

Canada – Presentation from the International Health Observatory’s seminar now available on line

Since its creation in 2009, the International observatory on health and social services (OISSS) has hosted three international seminars, and has just made the presentations available on line. Also available are videos from the most recent seminar, held in December 2011, entitled How do health organizations succeed in increasing their performance? The OISSS’s mission is to analyze health and social service systems in various countries, provinces or regions, tracking developments, changes and trends in order to promote knowledge and align research and decision-making.

USA — Success Factors in Five High-Quality, Low-Cost Health Plans

In this report, the authors conducted case studies of five health plans that received high scores on quality and resource utilization, using data collected by the National Committee for Quality Assurance. The focus of this study was to understand how health plans with delivery systems that include a significant network of independent, community physicians achieve high performance.

France: Health system review. Health Systems in Transition, 2015

Assessing the current performance of France’s healthcare system, this review notes that, while the French population has a good level of health, the overall picture is mixed. Rising healthcare costs along with large-scale health inequalities across socioeconomic and geographical groups are increasingly problematic. Public financing of healthcare expenditure is nearly the highest in Europe.

International - The Impact of Supply Chain Transformation in Global Health Systems

Changing supply chain processes improves safety, quality and performance in health systems. Examining the impact of transformations to health system supply chain infrastructure in Canada, the UK and the US, the research reveals that substantial savings can be achieved through inventory optimization and waste reduction, while automation can increase clinician time for patient care.

International - Health at a Glance: Asia/Pacific 2018. Measuring Progress towards Universal Health Coverage

Looking at health in the world's Asia-Pacific region, this handbook presents indicators of health status, healthcare resources and quality of care across 27 countries. It provides a series of dashboards to compare performance between countries, along with a thematic analysis of health inequalities. Major findings are analyzed and an annex provides additional information on demographic contexts and limitations in data comparability.

Finland - Resource allocation in health care processes: A case study

This ETLA case study looks to models used in analyzing industrial production processes to analyze health care processes. The authors model a process of one clinical unit and use it to analyze how resource allocation affects both process performance and utilization of resources. Efficiency and productivity improvements in health care require measuring, modeling and improving the performance of health care work processes.

Europe - Euro health consumer index 2017

The 2017 edition of the Euro Health Consumer Index (EHCI) has been released, assessing the performance of healthcare systems in 35 European countries. The EHCI analyzes national health care on 46 indicators, looking into areas such as patient rights and information, access to care, treatment outcomes, range and reach of services, and use of pharmaceuticals.

Europe - Measuring efficiency in health care

Efficiency measures are vital for assessing the performance of health systems. This issue of the Eurohealth Observer features two articles that explore issues related to measuring the performance of European health systems. One article identifies the causes of inefficiencies in the continent’s health systems, while the other examines the challenges of using European cross-country comparisons of efficiency to inform national health policy.

Canada - Building better health care: Policy opportunities for Ontario

The province of Ontario’s healthcare performance is uncompetitive among international peers, many of which spend less to achieve better outcomes. This paper urges Ontario to confront its main healthcare cost drivers (technology, drugs, increased service utilization and physician compensation), and recommends abolishing the tax subsidy for employer health insurance benefits.

UK - Improving Patient Access to Care: Performance Incentives and Competition in Healthcare Markets

This working paper published by the Cambridge Judge Business School looks at performance-based compensation used to induce competition on quality and efficiency among healthcare providers contracted by government. The authors show that the joint effect of incentives and competition depends on two factors: 1) the aggressiveness of patient access targets that the payer imposes on providers, and 2) patient sensitivity to the level of access to care.

Germany - Germany: health system review. Health Systems in Transition, 2014

Produced for the WHO, this analysis of Germany's health system reviews recent developments in organization and governance, health financing, healthcare provision, health reforms and system performance. The review focuses on a key feature of Germany's health delivery system — the clear institutional separation between public health services, ambulatory care, and inpatient hospital care.

Canada - The Economic Impact of Improvements in Primary Healthcare Performance

This report from the Canadian Health Services Research Foundation presents the results of four different approaches to evaluate the economic impact of enhancements to primary health care (PHC). These include a synthesis of the literature on the macro- and micro-economic effects of good health; a systematic review of the economic impact of incorporating a pharmacist into a PHC practice; a simulation exercise that evaluates the economic impact of improvements to influenza immunization rates for older adults; and a literature review of reductions in burden of illness associated with four specific enhancements to chronic disease management.

USA - HHS launches new web-based tool to track performance of nation’s health care system

On May 15, 2012, the US Health and Human Services Secretary announced the launch of a new web-based tool, known as the Health System Measurement Project. It will allow policymakers, providers, and the public to develop consistent data-driven views of changes in critical US health system indicators.

Australia - Healthcare 2011-12: Comparing performance across Australia

This fourth report on the National Healthcare Agreement shows that the overall health of Australians and the quality of the healthcare system is improving. Life expectancy is increasing and rates of smoking, low birthweight babies and infant mortality are all improving. However the chronic disease burden is growing, as are costs.

International - International Profiles of Health Care Systems, 2014

This publication presents overviews of the healthcare systems of Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the US. Each overview covers insurance, financing, organization, care quality, cost containment, efficiency and integration, and use of information technology and evidence-based practice. Data is provided on key health system characteristics and performance indicators.

Australia - OECD Reviews of Health Care Quality: Australia 2015. Raising Standards

Published by the OECD, this review provides an overview of Australia’s mixed public and private health sector and the quality of its health services and institutions. It calls for a national approach to raise quality and performance, but says Australia’s health system functions well despite many overlapping jurisdictions that disrupt care funding and continuity.

India - Improving Health Outcomes and Health Care

This overview of health care and outcomes in India says significant gains in the country will come only from improved access to public health care services and efforts to reduce preventable diseases, the chief cause of mortality. While government has scaled up public services, more health professionals and spending are needed to ensure coverage. High impact primary health care must be prioritized.

UK - Growing healthy communities. The Health and Wellbeing Index

Based on the assessment of 33 health determinants and outcomes at the local government level, this health and wellbeing index for the region of England shows the scale and nature of health inequalities across the UK. The authors say the data reinforces the need for a local, place-based approach to tackling health outcomes.

Canada – Measuring Outcomes in the Canadian Health Sector: Driving Better Value from Healthcare

While Canada has a well-established tradition of transparency and accountability for health-system performance comparisons, few measures of outcomes are reported, according to a new report from the C.D. Howe Institute. In “Measuring Outcomes in the Canadian Health Sector: Driving Better Value from Healthcare,” authors Jeremy Veillard, Omid Fekri, Irfan Dhalla, and Niek Klazinga examine the state of outcomes measurement in Canada, and offer recommendations so that the generation of better information on health system outcomes can help achieve greater value in the health sector.

Australia - Most emergency department patients seen on time

A new government report indicates that 74% of Australian emergency department (ED) patients were seen ‘on time’ last year. Almost 100% of resuscitation patients, 79% of emergency patients (requiring treatment within 10 minutes), and 92% of non-urgent patients (requiring treatment within 2 hours) were seen punctually in Australian EDs in 2014.

Australia - What are the reasons for clinical network success? A qualitative study

Clinical networks improve patient outcomes and care processes by implementing projects geared to the needs of local health services. In this study, authors interviewed 10 clinical network chairs on factors influencing network success. It identifies two key ingredients — strategic leadership with strong external stakeholder links; and formal infrastructure and processes to align work plans with health priorities.

International - New partnership to help countries close gaps in primary health care

On September 26, 2015, the Bill & Melinda Gates Foundation, the World Bank Group, and the WHO launched a collaboration to strengthen primary health care and advance progress toward Sustainable Development Goals. It will support countries to strengthen monitoring, tracking and sharing of key performance indicators for primary health care.

USA - The Lean Way: How California Public Hospitals Are Embedding a Culture of Improvement

Lean management is an organizational redesign approach used in health systems to eliminate waste without adding costs. This article describes the efforts of five public hospitals in the San Francisco area to improve performance by integrating Lean techniques at management, clinical and support levels. Case studies highlight progress and lessons learned.

USA - Implementing administrative evidence based practices: lessons from the field in six local health departments across the United States

Administrative evidence based practices (A-EBPs) are agency level structures and activities that are positively associated with performance measures. This study explores differences in local health department (LHD) characteristics that influence the implementation of A-EBPs. It finds that LHDs that implement A-EBPs are more likely to have strong leadership, professional development activities, financial flexibility and academic partnerships.

UK - Creating a better care system. Setting out key considerations for a reformed, sustainable Health, Wellbeing and Care system of the future

Published by Britain’s Local Government Association (LGA), this strategy document develops a framework for improving the UK health and social care system, defines systematic barriers to change, and describes key choices required for meaningful reform. The document calls for an integrated but devolved system supported by local infrastructure, pooled funding, and national policy mechanisms.

Europe - Comparative efficiency of health systems, corrected for selected lifestyle factors

Funded by the European Union (EU), the MACELI (Macro Cost Effectiveness corrected for Lifestyle) Project investigates the cost-effectiveness of European health systems and the impact of lifestyle factors such as smoking, obesity, and alcohol consumption. The report provides better insight into the different mechanisms through which lifestyle affects health system efficiency.

Canada - Quebec: Health accounts 2012-2013, 2013-2014, 2014-2015

This annual publication provides a financial review of health and social service system accounts, looks at changes in expenditures and funding sources as well as various performance indicators. New this year, Section 2 details the expenditures of health and social services institutions according to service programs and support programs.

UK - Care Act first-phase reforms

Britain's 2012 Care Act reduces formal health and social care services, and increases people's responsibility for their own care and support. This report looks at the latest changes to the Care Act that came into effect in April 2015 to see if reform has achieved government objectives and provided value for money. The evidence so far is not encouraging.

Canada - Comparison of Family Health Teams to Other Primary Care Models, 2004/05 to 2011/12

Produced by the Institute for Clinical Evaluative Sciences (ICES), this longitudinal analysis fills a longstanding knowledge gap by comparing outcomes of Family Health Team patients in relation to other Ontario primary care models over time. The report has been released in tandem with a paper addressing population variability in Ontario Community Health Centre (CHC) data.

Europe - Strengthening health system accountability: a WHO European Region multi-country study

This WHO report summarizes European countries' experience with strengthening health system accountability in the context of the momentum created by the Tallinn Charter of 2008 and the Health 2020 policy framework of 2012. Countries have set rigorous goals and are measuring and reviewing health systems' performance, taking significant steps to improve health system accountability.

UK - Are people waiting longer for health care?

Produced by a British charity, this report considers the performance of the UK National Health Service (NHS) in providing timely access to health care over the past five years. After analyzing data across key services (emergency, cancer, and secondary and primary care), the report finds that wait times for cancer treatments have increased. Overall, waits remain shorter than they were 10 years ago.

UK - A guide to quality improvement methods

Developed by the Healthcare Quality Improvement Partnership (HQIP), this guide introduces 12 quality-improvement methods based on a review of the international literature. It describes when and how the methods should be used and presents case examples and tools to assist implementation. Methods include clinical audits, performance benchmarking, and process mapping.

USA - Improving Care Delivery Through Lean: Implementation Case Studies

Lean is an organizational redesign approach increasingly used in health systems to eliminate waste and improve performance without adding costs. This study assesses the application of Lean in six US healthcare organizations. It finds that the goals, content, implementation and context of Lean programs varies widely, perhaps because Lean itself is often described differently in the literature.

USA - U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries

Comparing US healthcare spending, supply, utilization, prices, and health outcomes with 13 other high-income countries, this analysis of data from the OECD shows that the US outspends the rest by a large margin. Americans also had the poorest health outcomes, including the shortest life expectancy and a greater prevalence of chronic conditions.

International - The 2015 Quality of Death Index. Ranking palliative care across the world

The 2015 Quality of Death Index, a measure of the quality of palliative care in 80 countries, shows that income levels are a strong indicator of the availability and quality of palliative care, with wealthy countries clustered at the top. The UK, Australia and New Zealand rank first, second and third, while Canada is in 11th place.

Canada - Quebec Ranks In The Middle Of The Pack On Population Health

Quebecers give themselves top grades for their health. Yet, when Quebecers' health is compared to that of other Canadian provinces and advanced countries, Quebec ranks in the middle of the pack, according to The Conference Board of Canada's How Canada Performs: Health report card. Quebec gets an overall "B" grade and finishes 11th among 29 jurisdictions in the first-ever report card that includes the provinces, territories and 16 peer countries. Quebec places third among the provinces behind British Columbia and Ontario, and just below Canada as a whole.

Europe - Euro Health Consumer Index, 2014

Published by a Swedish firm, this report employs 48 indicators to rate the user-friendliness of national healthcare systems in 35 European countries. In 2014, Switzerland ranks first and the Netherlands second. Overall, the report says European healthcare continues to produce better results in spite of austerity measures. Survival rates for heart disease, stroke and cancer are all increasing.

Luxembourg - The HiT in brief review for Luxembourg reveals some room for efficiency gains

Published by the WHO, this review of health care in Luxembourg says performance in terms of high life expectancy, low infant mortality, and low out-of-pocket payments is better than the European Union (EU) average. Long lengths of stay combined with low occupancy rates signal possibilities for efficiency gains in the hospital sector.

Canada - Delivering a Patient-Centred, High Performing and Sustainable Health System in B.C.: A Call to Build Consensus and Take Action

British Columbia’s Ministry of Health produced this report calling for provincial action in three areas: the delivery of patient-centred services and care; the enhancement of outcomes and services; and the prioritization of cross-sector actions to improve quality and sustainability. The report includes over 50 recommendations.

UK - The NHS under the coalition government. Part one: NHS reform

Britain has been ruled for the past five years by a coalition government between the Conservative Party and the Liberal Democrats. This report examines how the UK National Health Service (NHS) has fared since the coalition government introduced controversial healthcare reforms in 2012 to devolve decision-making, integrate services, and extend competition and choice.

Australia - Efficiency in Health

Issued by Australia’s Productivity Commission, this paper identifies ways to improve the operation of Australia’s healthcare system through small-scale reforms that leave institutional structures alone. The authors find deficiencies in health technology assessment, clinical guideline implementation, provider financial incentives and funding for preventive care. They state that health workforce scopes of practice are limited by current regulations.

Australia - Costs of patient care can be almost twice as high at some hospitals

This report from the Australian National Health Performance Authority reveals significant variations in the cost of average in-patient services provided by major metropolitan hospitals. The average cost of a knee replacement without complications varied from a low of $10,900 to a high of $29,300. This is the first national comparison of hospital costs that accounts for the fact that some hospitals perform more complicated operations or see sicker patients.

UK - On targets: How targets can be most effective in the English NHS

The use of encompassing targets in England’s National Health Service (NHS) divides expert opinion. This report focuses on how country-wide targets can improve care quality and uses the evidence supporting their positive impacts to discuss tailoring their scope to effectively confront key challenges facing the NHS.

USA - Follow the evidence - Care Continuum Optimization can minimize clinical variation to drive real quality in healthcare

This paper describes a care quality model called Care Continuum Optimization (CCO), which minimizes clinical variation to improve performance across the care continuum. The model involves clinical care redesign supported by data analysis, care management, and governance models managing provider accountability. Improvements are achieved through management of operational, financial, and clinical data. Advanced data and analytics are vital for identifying areas for process improvement.

UK - Healthy Business? Managerial Education and Management in Healthcare

Also published by the London School of Economics (LSE), this study investigates links between hospital performance and managerial education. The authors collect and assess a large database of management practices and skills in hospitals across nine countries. Analysis shows that hospitals closer to universities with medical and business faculties have better quality management, more MBA-trained managers, and lower mortality rates.

Europe - Commission diagnoses the state of health in the EU

The European Commission has published 28 country health profiles of member-states of the European Union (EU). The EU country profiles consider population health and risk factors while assessing the effectiveness, accessibility and resilience of national health systems. Many EU member states are increasingly focusing on primary care, health promotion, and disease prevention.

France: improving the efficiency of the health-care system

France’s health-care system offers high-quality care according to a new report from the OECD. Average health outcomes are good, public satisfaction with the health-care system is high, and average household out-of-pocket expenditures are low. As in other OECD countries, technology is expanding possibilities for life extension and quality, and spending is rising steadily, while an ageing population requires substantially more and different services. The main challenges are to promote prevention and cost-efficient behaviour by care providers, tackle the high spending on pharmaceuticals, strengthen the role of health insurers as purchasing agents and secure cost containment.

UK - Review of Targets and Indicators for Health and Social Care in Scotland

Scotland’s government commissioned this independent expert review of targets and indicators in Scottish health and social care. The review considers how targets and performance indicators can lead to best outcomes, and looks at how they align with government strategy for the future of health and social care services. The review identifies key principles and recommendations for future development of targets and indicators.

International - Indicators and Measurement Tools for Health Systems Integration: A Knowledge Synthesis

Conducted by Brazilian and western Canadian researchers, this knowledge synthesis identifies indicator domains and tools to measure progress towards integrated care. Establishing measurement domains, the researchers reviewed 7,133 studies and identified 114 tools to measure the integration of care across 16 domains. Few tools were found in the domains of performance measurement, information systems, organizational goal alignment and resource allocation.

USA - A Roadmap for Promoting Health Equity and Eliminating Disparities

The National Quality Forum (NQF) has created a roadmap to reduce US health disparities through performance measurement and policy levers. Focused on cardiovascular and kidney disease, cancer, diabetes, infant mortality and mental illness, the roadmap prioritizes identifying disparities and implementing interventions, making investments in assessment measures, and providing incentives to reduce disparities.

UK - Driving improvement: case studies from eight NHS trusts

Conducted by the Care Quality Commission (CQC), England's independent regulator of health and social care, these case studies of eight autonomous regional National Health Service (NHS) Trust organizations use quarterly inspection reports to examine drivers of service and care. The case studies take into account leadership capacity, culture, strategy, governance, staff and patient engagement, and the drive for continuous improvement.

Australia - Second Atlas highlights opportunities for healthcare improvement

This report by the Australian Commission on Safety and Quality in Health Care shows large variations in the provision of common health treatments across Australia. It examines variations in care for hysterectomy, cataract surgery, knee replacement and potentially preventable hospitalizations.

UK - BMA analysis shows that NHS patients endured one of the worst winters on record, with year-round crisis set to become the norm

An analysis by the British Medical Association (BMA) indicates that the past winter was one of the worst on record for the National Health Service (NHS) in the UK. All NHS performance markers showed a system struggling to cope with demand. The BMA warns that the NHS may now be entering a state of year-round crisis.

Portugal - Health system review

Since the 2008 economic crisis, health sector reform in Portugal has been guided by financing agreements between the Portuguese Government and international lending institutions. While measures mainly focus on containing costs and improving efficiency to ensure financial sustainability, this review says significant health inequalities persist and quality and accessibility of care is likely to be negatively affected by continuing budget cuts.

International - WHO launches new NCDs Progress Monitor

The WHO has released a progress monitor for noncommunicable diseases (NCDs) that charts actions by countries to set targets; implements policies to address four NCD risk factors (tobacco, poor diet, inactivity and alcohol abuse); and builds capacities to reduce and treat NCDs. The progress monitor provides data on 19 indicators.

Europe - Strengthening general practice/family medicine in Europe—advice from professionals from 30 European countries

This study is based on a survey of medical teaching professionals from 30 European countries on how to strengthen general practice and family medicine (GP/FM). It finds substantial variations among GPs/FMs across Europe with regards to governance, workforce competence and performance, and academic standing. Respondents strongly agree that securing GP/FM as an academic teaching and research discipline is essential, as is cementing GP/FM’s position as a highly regarded specialty.

UK - NHS hospitals to be assessed on how they use their resources from the autumn

Starting in fall 2017, the National Health Service (NHS) will begin reviewing how effectively NHS hospitals are using their resources to provide high quality, efficient and sustainable care. As well as hospital finances, the new measure will look at workforce and facilities. Reports with recommendations for improvement will be produced if required.

Canada - Reality Bites: How Canada’s Healthcare System Compares to its International Peers

Canadian provincial healthcare systems fare poorly compared to peer countries according to new research from the C.D. Howe Institute. In “Reality Bites: How Canada’s Healthcare System Compares to its International Peers,” authors Colin Busby, Ramya Muthukaran and Aaron Jacobs examine how the provinces, the major healthcare deliverers in Canada, fare compared to other nations in healthcare provision.

Europe - How to make sense of health system efficiency comparisons?

Improving health system efficiency is a compelling policy goal, especially in systems facing serious resource constraints. This policy brief from the European Observatory on Health Systems and Policies proposes an analytic framework for understanding and interpreting the most common healthcare efficiency indicators.

Australia - Australia's health 2018

The Australian Institute of Health and Welfare (AIHW) released its 16th biennial report on health and health care in Australia. It examines a wide range of contemporary topics in a series of analytical feature articles and short statistical snapshots, and also summarizes the performance of the health system against a set of indicators. Findings are drawn from a wide range of data sources.

UK - Does Leadership Matter for Healthcare Service Quality? Evidence from NHS England

Analyzing four years of English hospital data (2010-2014), this paper argues that leadership quality matters for the quality of healthcare provision. It breaks down individual leadership styles into four categories (oriented toward task, relationships, change or integrity) and compares them to different quality metrics and clinical performance indicators. The paper concludes that a task-oriented leadership style has the strongest relationship with staff-rated hospital quality.

International - How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations

This paper analyzes how strengthening health systems can improve economic efficiency in health services. The authors model three types of strengthening (investing in the efficiency of a shared service delivery platform; relaxing the capacity constraints of a shared platform; and providing an entirely new shared platform). The models extend conventional cost-effectiveness analysis to identify a balance between investing in health system strengthening and expenditures on specific interventions.

Canada - 2018 Cancer System Performance Report

The Canadian Partnership Against Cancer's annual report examines Canada's cancer system to show what’s working and where improvements are needed. The report finds that while many Canadians are still being diagnosed with preventable cancers and waiting too long for diagnostic tests, more people are surviving cancer than ever before.

Austria - Austria Health system review, 2018

Published by the European Observatory on Health Systems and Policies, this snapshot of Austria’s health system in 2018 highlights recent reforms to improve governance, increase healthy life expectancy, and improve quality and efficiency of service delivery. Overall, Austria has one of the most effective health systems in Europe, with coverage, access, patient satisfaction and mortality rates significantly better than the European Union average.

UK - Making the most of the money: efficiency and the long-term plan

Despite recent funding increases, the National Health Service (NHS) is struggling on most major financial and performance indicators. This document sets out the views of 157 NHS provider organizations (hospitals and locally-organized patient services) on how best to achieve efficiency and improve quality across the NHS. Focusing on productivity and cost reduction, the document presents models for efficiently restructuring existing primary care systems.

UK - How good is the NHS?

Comparing the UK National Health Service (NHS) with its international peers, this report shows that treatment wait times are in line with similar countries and that the NHS is relatively efficient, with lower than average administrative costs and widespread usage of cheaper medicines. However, patient outcomes remain poorer than the international average, with higher mortality rates for cardiovascular disease, cancer and stroke.

France - Healthcare establishments - 2018 edition

Les établissements de santé - édition 2018 This annual publication provides a summary of data on healthcare establishments in France. It offers key figures on hospital activity and capacity, personnel and remuneration. Quality and safety indicators are detailed alongside financial results. Information is presented in 35 thematic sections, with tables and charts.

Canada - Improving Accessibility to Services and Increasing Efficiency Through Centralization in Québec

This article provides an overview of the 2014 reorganization of Québec’s health and social services network through the abolition of a regional health authority administrative layer and mergers of health and social service facilities under a new governance structure. While formal evaluations of reform performance have yet to be completed, the authors question whether administrative mergers have increased efficiency through economies of scale.

Canada - How Canadian Health Care Differs from Other Systems

Canada’s approach to health policy is much more restrictive than in other developed countries with more successful universal health-care systems, notably on the use of the private sector and patient cost-sharing, finds a new study released by the Fraser Institute.

International - Which Policies Increase Value For Money in Health Care?

Published by the OECD, this working paper investigates how policies and institutions helped achieve better healthcare value for money across 26 OECD countries from 2000-2015. Findings showed that policies that increase the scope of goods and services covered by basic health care coverage helped achieve better value for money by moderating health spending growth and increasing life expectancy.

USA - The History, Evolution, and Future of Medicaid Accountable Care Organizations

Increasingly prevalent in the United States, accountable care organizations (ACOs) shift more accountability for health outcomes to providers and have shown positive results improving care and reducing costs for government programs like Medicaid. This brief highlights Medicaid ACO programs in 12 American states and examines their evolution over time. It highlights that developing and operationalizing state-wide programs can be a complex undertaking.

Europe - Strengthening the measurement framework

The adoption of Health 2020, the European policy framework for health and wellbeing, marked a shift towards a values-based approach to health that has since proved complex to measure and report on. In response, the WHO convened an expert group to investigate ways to enhance Health 2020 monitoring and reporting. This report outlines recommendations made by the expert group.

Europe - Toolkit to help European Region move towards sustainable health workforce now available online

A toolkit designed to raise awareness that the health workforce is an essential investment in universal health coverage is now available online. Produced by the WHO in collaboration with European experts, the toolkit is framed around four strategic objectives: education and performance, planning and investment, capacity building, and analysis and monitoring.

Australia - A review of the Australian healthcare system: A policy perspective

This article compares Australia’s healthcare system to similar systems internationally in order to highlight major challenges, including resource allocation and improvements to performance and patient outcomes. The article recommends that bureaucratic capacity models be applied to health care to optimize outcomes. It calls for a re-evaluation of current reimbursement methods, along with increased scrutiny of the appropriateness of care.

International - Understanding Variations in Hospital Length of Stay and Cost: Results of a Pilot Project

Published by the OECD, this comparative study of France, Ireland, Israel and Canada measures hospital length of stay and cost for a given condition to explore variations in efficiency. It shows that variations are more likely to exist at hospital level for cardiac surgery, and at the country level for hysterectomies and caesarean sections.

USA - US experience with Accountable Care Organizations: lessons for France?

This article, published in the April issue of Questions d'économie de la Santé, examines the rapid spread of Accountable Care Organizations (ACO) in the United States following the adoption of the Affordable Care Act in 2010. ACOs strengthen primary care and promote coordination between primary care and hospital. More than 800 ACOs are now registered and cover 15% of US policyholders. Presenting a review of the literature, the article describes the characteristics of ACOs, their performance, and the tools and approaches they mobilize.

Canada - Greater efficiencies realized in Ontario's cancer system

The Cancer Quality Council of Ontario has released findings from the 2016 Cancer System Quality Index (CSQI) that measures the performance of the province’s cancer system. The findings indicate that efficiencies, such as new cancer treatment centres, have begun improving patient outcomes and safety by enabling greater capacity in the system.

UK - Outpatient services and primary care: scoping review, substudies and international comparisons

Evidence from this scoping review suggests that substantial parts of care given in UK outpatient clinics could be transferred to primary care. The research supports General Practitioner (GP) visits as an alternative to outpatient follow-up appointments, and a greater role in the care of chronic conditions, and performance of minor surgeries. The findings are in keeping with recent surveys of public sentiment in Britain.

International - Transformational change in healthcare: an examination of four case studies

Investigating examples of transformational change in the health care sector, this Australian study focuses on case studies from the US, the UK, and Australia that exemplify well communicated strategies, innovative redesign, extensive consultation, efficient performance management and high-quality leadership. Despite differences between the case studies, the overall characteristics of success were found to be similar.

Australia - Value co-creation: a methodology to drive primary health care reform

The Medical Journal of Australia (MJA) devotes this issue to a discussion of value co-creation as a methodology to drive Australian primary health care. Nine articles consider the topic from different perspectives, including mental health, the role of consumers, organizational performance, pharmacy structuration, and quality improvement tools and resources.

Canada - Variations in Quality Indicators across Ontario Physician Networks

This chartbook from the Institute for Clinical Evaluative Sciences (ICES) in Ontario reports performance levels for a set of quality indicators that reflect health care delivery across settings of primary and specialty care, acute hospital care and long-term care, as well as shared care and transitions from one setting to another. The quality indicators include screening and prevention, evidence-based medications, drug safety, hospital to community transitions, adverse outcomes, imaging and cancer end-of-life care.

International - Better Ways to Pay for Health Care

Published by the OECD, this briefing document looks at policies used internationally to improve healthcare quality, efficiency, and cost-effectiveness. Many policy efforts now align payer and provider incentives by using evidence-based clinical guidelines and outcomes to inform price setting, which could bolster a patient-centred focus to improve sustainable healthcare delivery and performance in the long-run.

The Netherlands - Health System in Transition, 2016

Produced by the WHO, this review looks at the current state of health care in the Netherlands. While the country has some of Europe's highest per capita health expenditures, costs are slowing considerably following of the introduction of managed system competition and universal social health insurance. Out-of-pocket payments are low from an international perspective, and healthcare quality remains high.

UK - Does Competition from Private Surgical Centres Improve Public Hospitals’ Performance? Evidence from the English National Health Service

This paper examines the impact of competition from private specialty surgical centres (Independent Sector Treatment Centres, or ISTCs) on hospitals in the National Health Service (NHS). It finds that ISTCs lead to greater efficiency — measured by length of stay for hip and knee replacements — at nearby public hospitals. However, ISTCs also take on healthier patients and leave NHS hospitals treating sicker patients with longer hospital stays.

UK - New single oversight framework launched to help NHS providers improve services

The UK National Health Service (NHS) has launched a new single oversight and improvement framework to improve services by NHS providers. The framework identifies where providers may benefit from improvement support across 5 areas: quality of care, finance and resource use, operational performance, strategic change and leadership capability.

Canada - Wait Times for Priority Procedures in Canada, 2016

Variations still exist in the percentage of patients receiving treatment within wait time benchmarks, depending on the province and the priority procedure. Priority procedures reported on include hip replacement, knee replacement, hip fracture repair, cataract surgery and radiation therapy. The overall number of priority procedures done continued to increase between 2011 and 2015, and about 8 out of 10 Canadians continued to receive their procedure within benchmarks. Wait Times for Priority Procedures in Canada, 2016, released by the Canadian Institute for Health Information (CIHI), provides a snapshot of wait times in Canada. Data on trends from 2008 to 2015 is available in CIHI’s online Wait Times tool, organized by province, health region and procedure.

USA - 2016 County Health Rankings Key Findings Report

Ranking the health of the 3,143 counties in the US, this annual report finds that the rate of opioid drug overdoses has increased 79% nationally since 2002. Rural counties have the highest rates of overall premature deaths, while residential racial segregation remains the leading cause of health disparities across the country.

International - International profiles of health care systems 2015

This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations.

International - Comparing the Health Care Systems of High-Performing Asian Countries

The newly industrialized and high-income economies of East Asia perform well on a wide range of health system indicators. This paper examines and compares similarities and differences in healthcare financing and provision in Singapore, Malaysia, Taiwan and South Korea.

Canada - Waiting Your Turn: Wait Times for Health Care in Canada, 2015 Report

Produced annually by the Fraser Institute, this report indicates that Canadian wait times for medically necessary treatment did not improve in 2015. Provincially, Saskatchewan reported the shortest total waits (13.6 weeks), while Prince Edward Island reported the longest (43.1 weeks). In 2015, roughly 2.5% of Canadians were waiting for treatment; the longest waits are for orthopedic surgery (35.7 weeks).

Lunch hour conferences 2016

By Michel Perreault, psychologist-researcher, Douglas Mental Health University Institute, associate professor, Psychiatry Department, Université McGill Hélène Provencher, professor, Nursing Faculty, Université Laval, researcher, Groupe de recherche sur l'Inclusion sociale, l'Organisation des services et l'Évaluation en santé mentale (GRIOSE-SM), CSSS de la Vieille-Capitale This conference will address the added value question of the intervention focusing on the contribution of peer helpers in care and services network, particularly in the area of mental health. The major findings from two research projects supported by the MSSS will be presented, one about the peer helpers intervention to facilitate access to clinical treatment for people with anxiety disorders with the support group Phobies-Zéro and the other one addressing the peer helpers integration in teams of support in the community for people with severe mental disorders proposed by the “Peer Helpers Network Program” associated with the Association québécoise pour la réadaptation psychosociale. Peer helpers accompany researchers…

Europe - 2015 Euro Health Consumer Index

The Euro Health Consumer Index 2015 ranks consumer satisfaction with healthcare systems in 35 European countries. Its rankings show the Netherlands as the country with the best healthcare system, followed by Switzerland. The Index also indicates that survival rates of heart disease, stroke, and cancer continue to increase.

International - A New Resource for Exploring Health Care around the World

This website presents profiles of healthcare systems in 18 countries in Europe, North America, and Asia, along with Australia. Readers can compare health system organization and insurance, financing, quality, coordination, efficiency, integration, information technology use, evidence-based practice, cost containment and recent reforms and innovations.

Canada - Alberta acts on mental health recommendations

Alberta is moving to prioritize recommendations made in a report from its Mental Health Review Committee. The province will add medical detoxification beds, expand access to addiction treatment for youth, develop an opiates addiction action plan, launch a child and youth mental health website, and develop performance monitoring and implementation teams.

International - Which country has the world's best healthcare system?

Comparing health outcomes and value for money, this article from the UK’s Guardian newspaper examines health systems in France, Ireland, Sweden, China, USA, Japan, Spain, Italy, Germany, Russia, Australia and the UK. It finds that the UK has the best healthcare system overall, but notes that it also has the worst cancer outcomes of any rich country.

USA - Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care

The field of behavioural economics is built on the premise that human behaviour is not always rational. This study focuses on principles relevant to influencing physician practice patterns and performance, such as loss aversion, choice overload, and relative social ranking. The authors argue that physicians’ monetary incentive programs should account for how emotions and social status, among other variables, factor into provider decisions.

Canada - Measuring and improving quality in university hospitals in Canada: The Collaborative for Excellence in Healthcare Quality

Produced by the Ottawa Hospital Research Institute, this article describes a 2010-2015 initiative to achieve a higher quality of patient care in Canada’s university hospitals. The bottom-up initiative was successful in engaging healthcare leaders in developing a framework and set of performance measures for reporting and benchmarking.

China - The Structure and Effectiveness of Health Systems: Exploring the Impact of System Integration in Rural China

Using questionnaires, interviews and health ¬insurance records, this paper employs social network analysis to evaluate health system integration in two rural counties in China’s Qinghai province. The paper finds that certain aspects of system integration remain incomplete in both counties, although information-sharing networks have been developed.

Denmark - Primary Care Review of Denmark

Produced by the OECD, this review of Denmark’s primary care system says high-quality care is not always delivered. Rates of avoidable hospitalization are higher than in the rest of Scandinavia, and Denmark is one of the few European countries with no means of monitoring primary care performance. Patients also have no access to their health records.

Canada - Bilateral Health Agreements between the Federal and Provincial/Territorial Governments in Canada

According to this study, bilateral health transfer agreements between Ottawa and the provinces could increase innovation and enhance performance in Canada’s health system. Released by the Institute for Research on Public Policy (IRPP), the study notes that bilateral agreements can be tailored to provinces’ needs or used to promote innovation. The federal government is providing $3 billion through bilateral agreements over the next four years.

Canada - International Comparisons at CIHI

This report from the Canadian Institute for Health Information (CIHI) presents various measures of how health care in Canada compares to that in other countries, and discusses CIHI's contribution to international data and knowledge production. The report highlights some key comparisons in clear graphic form: Canada spends 10% of its GDP on health, compared to the OECD average of 9%; Canada is above average in reducing premature mortality, especially among men; Canada is in the middle of the pack on combined measures of health status, determinants of health, quality of care, patient safety and access to care.

UK - Saving STPs: achieving meaningful health and social care reform

This report, from the think tank Reform, looks at the progress of sustainability and transformation plans (STPs) in England. They have been developed in 44 jurisdictions to break down barriers between different levels of health and social service on a local basis. Interviews with experts across the system reveal some progress, especially in places that already had integration efforts in place, and raise issues that contribute to difficulties.

Europe - BLOCKS: tools and methodologies to assess integrated care in Europe

Released by the EU Expert Group on Health Systems Performance Assessment, this report summarizes tools and methodologies to assess integrated care in Europe. It discusses interrelated system levers for the effective design and implementation of integrated care frameworks that relate to politics, governance, stakeholder engagement, organizational change, leadership, workforce education and training, patient empowerment, infrastructure, financing, monitoring and evaluation.

USA - NAM Releases Publication on How to Improve Nation's Health System

This paper from the National Academy of Medicine presents a policy framework for US health system improvement. It describes eight actions and infrastructure priorities to significantly advance American health, health care, and science. This publication is part of the National Academy of Medicine’s Vital Directions for Health and Health Care Initiative, which called on more than 150 leading researchers, scientists, and policy makers from across the United States to assess and provide expert guidance on 19 priority issues for U.S. health policy.

UK - Delivering an outcomes-based NHS: creating the right conditions

This paper from the CEO of Britain’s Capitated Outcomes Based Incentivized Care (COBIC) describes the development of an outcomes-centred approach in the UK National Health Service (NHS). It calls for reforms to incentives, infrastructure and service delivery. The paper defines a framework to look at outcomes domains, goals and indicators, and includes case studies.

USA - A Framework for Safe, Reliable, and Effective Care

This white paper from the Institute for Healthcare Improvement describes the framework's two foundational domains: culture and the learning system. The paper defines key strategies for developing leadership, psychological safety, accountability, teamwork and communication, negotiation, transparency, reliability, improvement and measurement, and continuous learning. It further discusses the engagement of patients and families as the engine that drives progress toward safe and effective care.

Italy - Still too much variation in health care quality across Italian regions, says new OECD report

The OECD report on health care in Italy finds that health outcomes are among the best in the OECD, with comparatively long life expectancy and low rates of asthma, COPD and mortality after stroke and heart attack. The report points to significant regional differences and encourages a national emphasis on quality and on reducing disparities.

Canada - Improvements in health system quality still in the future says New Brunswick Health Council

The New Brunswick Health Council (NBHC) has released its 2016 report card for the province’s health system, giving it a C grade that signifies adherence to national standards but no improvements in system performance and quality of care. Primary care and long-term care continue to push New Brunswick’s grade downwards.

International - Visibility: The New Value Proposition for Health Systems

One of the main challenges facing healthcare systems is patient safety: medical errors are now the third leading cause of death in North America. This report from the World Health Innovation Network (WHIN) proposes a new direction to improve patient safety and performance.

International - Universal health coverage: moving towards better health. Action framework for the Western Pacific Region

Published by the WHO for countries of the Western Pacific Region, this framework supports national road maps for universal health coverage. The framework prioritizes 15 relevant planning domains, which it categorizes using five attributes of high-performance health systems: quality, efficiency, equity, accountability, and sustainability and resilience.

USA - Improving the Health Care System: Seven State Strategies

State legislatures play an important role in cutting healthcare waste and improving health systems. This briefing note from the National Conference of State Legislators (NCSL) describes healthcare improvement strategies showing results in Connecticut, Hawaii, Massachusetts, Minnesota, New Hampshire, Rhode Island and Vermont. The state strategies highlight new payment models, patient-centred integrated care, reliance on data, and investments in prevention and safety.

Canada - Getting the Foundations Right: Alberta's Approach to Healthcare Reform

In 2008, Alberta abolished its health regions and integrated providers into the new Alberta Health Services (AHS). This article responds to past critiques of the reforms by describing long-term benefits that include lower administrative costs, greater equity of access, improved intra-provincial learning, and economies of scale. Some benefits have already appeared, but performance should be judged over a multi-year time frame.

The Netherlands - Patient experiences with family medicine: a longitudinal study after the Dutch health care reforms in 2006

In 2006, Dutch healthcare changed to a market-oriented system in which general practitioners (GPs) are paid partly by capitation, and partly by fees for consultations and services. Using annual patient surveys from 2007-2012, this study looked at 78,985 patient assessments of the performance of 2,966 GPs in the years following the reforms. By 2012, patients with positive experiences had increased significantly.

International - Why human resources policies and practices are critical to improving the patient experience

This US paper argues that human resources (HR) policies, procedures and programs are key to improving patient experience by supporting an organization’s vision and culture. As the organization achieves a better understanding of how to best serve patients, HR can build patient care improvement into every aspect of the organization. The author also describes how competency-based performance reviews, compensation and retention strategies should reflect patient-centred values.

Europe – Cost-Containment Policies in Hospital Expenditure in the European Union

This European Union study suggests that the reorganization and rationalization of care is a major factor in hospital cost containment, especially in institutions with high bed densities. It notes the difficulty of gauging the impact of tools to improve performance via structural changes.

USA - In New Survey of 11 Countries, U.S. Adults Still Struggle with Access to and Affordability of Health Care

An 11-country survey has found that US citizens are the most likely to go without needed health care because of cost factors. Americans are also more likely to report having poor health and emotional distress. Bright spots for US health care include collaborative hospital discharge planning and access to specialist care.

Switzerland – Switzerland: Health system review. Health Systems in Transition, 2015

The European Observatory on Health Systems and Policies presents a look at the health system in Switzerland, where life expectancy is the second highest in Europe. It examines efforts since 2000 to improve the country's mandatory health insurance program, and discusses challenges in lowering healthcare spending as a percentage of GDP and reducing the burden of out-of-pocket costs on lower income households.

UK - Monitor sets out how to secure the future of the NHS

Britain’s health regulator has warned the country’s National Health Service (NHS) it must change radically to close a £30 billion ($48 billion) funding gap while also providing quality services free to patients. The health sector regulator, called Monitor, has issued a report outlining 20 cost-effective ways to deliver better care and close the gap.

Canada - Lean in British Columbia’s Health Sector. Annual Report 2010–11

Published in September 2011 by the British Columbia Ministry of Health, this annual report presents seven case studies of Lean process redesign work carried out by B.C. health authorities in 2010-11. In the health sector, Lean is a patient-focused approach that systematically eliminates waste in health care organizational processes in order to improve quality, productivity, and efficiency.

Europe - Strengthening health-system emergency preparedness. Toolkit for assessing health-system capacity for crisis management

In preparing for health crises, health systems face the prospect of multiple hazards, limited resources for dealing with them and high expectations of their performance. With the European Commission Directorate-General for Health and Consumers, the WHO Regional Office has developed a toolkit to assess health-system capacity for managing crises. Pilot tested in several countries since 2007, it helps countries assess the capacity of their health systems to respond to various threats and identify gaps.

Canada - Canada ranks 10th in population health among 17 countries in The Conference Board of Canada’s 2012 Health report card

The Conference Board’s Health Report Card assesses the overall health status of Canadians against that of citizens in 16 other industrialized countries on 11 indicators. Canada receives a “B” grade overall. Canada earns “A” grades on self-reported health status, mortality due to circulatory diseases and premature mortality. Canada receives “B” grades on mortality due to mental disorders and respiratory diseases, and a “C” grade on mortality due to musculoskeletal diseases, cancer and diabetes. Japan, Switzerland, and Italy earned overall “A” grades in this year’s Health Report Card.

UK - Review of evidence on what drives economies of scope and scale in the provision of NHS services

This report by the Centre for Health Economics at the University of York reviews the evidence on what drives economies of scope and scale in the provision of U.K. National Health Service (NHS) services, focusing on hospital services. It considers the evidence base for guidance on which services need to be co-located, and evaluates the minimum scale of those services.

Germany - The private sector within a public health care system: the German example

In Europe, where public financing is as prevalent as in Canada, if not more so, the private for-profit sector has an extensive role to play in delivering service. The German experience shows that private sector involvement and the search for profit, contrary to widespread fears, are correlated with better quality care and can improve the efficiency of low-performance establishments.

UK - Why Lean Matters. Understanding and implementing Lean in public services

This paper from the U.K.’s Advanced Institute of Management Research explains the principles of Lean management practices and provides a framework for the implementation of Lean in Britain’s public services. Lean planning specifies the complex value requirements of customers, identifies the value stream for each service, achieves flow of services through standardization of process, and eliminates as much waste as possible.

International - Provider-payment assessment tool in development

WHO, along with the World Bank and the Joint Learning Network for Universal Coverage (JLN), is developing a diagnostic and assessment guide to support countries making reforms to mechanisms for paying health-service providers. This initiative is part the global effort to achieve universal coverage, which was the theme of the 2010 world health report. The new tool will enable the assessment of provider-payment mechanisms in the wider context of health-system performance, and focus on avoiding unintended consequences from making reforms. Its development will take a year, and will include field tests in selected countries.

Canada - Little change in wait times for Canadians

A new analysis from the Canadian Institute for Health Information (CIHI) reveals that about 8 out of 10 Canadians receive priority-area procedures within the medically recommended time frames. Nationally, 97% of patients receive radiation therapy within the recommended four weeks, 82% of patients receive hip replacement surgery within recommended time frames, as do 75% of patients receiving knee replacement surgery. The wait times are generally similar to last year’s, though some provinces are seeing longer waits for certain procedures.

Telehealth : what can the NHS learn from experience at the U.S. Veterans Health Administration?

Brief analytical summaries or syntheses #35 Telehealth what can the NHS learn from experience at the U.S. Veterans Health Administration? Summary Published on the website, this comparative study examines the largest implementation of telehealth anywhere, the Veterans Health Administration in the U.S. With the British government's announcement of the positive results of the Whole System Demonstrators and the launch of the 3 Million Lives Programme, this report is timely as U.K. stakeholders plan how to implement telehealth widely and deliver significant benefits. Background As a large publicly funded system delivering comprehensive services to a veteran population of 23m and with an annual budget of over £30bn, the VHA has many parallels with the NHS. Extensive studies show that the VHA consistently provides a better quality of care than other health systems in the U.S., and at a lower cost. Central to its strategy of ‘keeping patients healthy’, the VHA…

Canada - Productivity of healthcare logistics activities

La productivité des activités de logistique hospitalière Logistical activities such as purchasing, inventory management and replenishment of goods and services required for the delivery of medical services can represent up to 46% of hospital spending. This report published (in French only) by the Centre for Productivity and Prosperity takes stock of current best practices and offers solutions to improve performance in Quebec.

UK - NHS hospital mergers bring few benefits, research finds

According research from the U.K.’s Centre for Market and Public Organization (CMPO), mergers are unlikely to be the most effective way of dealing with Britain’s poorly performing National Health Service (NHS) hospitals. The study found that hospital consolidation brought few benefits: poor financial performance typically continued and few improvements in clinical quality were seen.

Switzerland - Switzerland’s health system is high-performing but must prepare for the future

Swiss citizens enjoy easy access to health services and choice in insurers and healthcare providers. However, in this new Review of Switzerland’s Health Care System, the OECD and the WHO warn that the Swiss system needs to adapt rapidly to climbing costs and a rising chronic disease burden.

USA - Hospitals and Care Systems of the Future

U.S. industry experts have projected that multiple pressures will drive the transformation of health care delivery and financing from volume- to value-based payments over the next decade. This inaugural report of the American Hospital Association (AHA) Performance Improvement Committee is based on interviews with policymaker to identify the strategies and competencies organizations should establish.

Assessing initiatives to transform healthcare systems:Lessons for the Canadian healthcare system

Brief analytical summaries or syntheses #25 Assessing initiatives to transform healthcare systems Lessons for the Canadian healthcare system Summary Canada has invested significant financial resources and energy (including numerous federal and provincial commissions) in efforts to make the healthcare system more responsive to evolving needs. Nonetheless, there is general consensus that Canada’s healthcare systems have been too slow to adapt. This paper suggests avenues that governments can take to support the transformation of the healthcare system to provide better care and services. Background This paper suggests that money alone cannot improve healthcare. A clear vision and a coherent set of strategies are required to transform the system and achieve better alignment between the care offered and the care the population needs today (primary healthcare, more effective management of chronic diseases, mental health, etc.). Canada has invested significant financial resources and energy (including numerous federal and provincial commissions) in efforts to…

Canada - Recommendations to the New Brunswick Minister of Health. Moving towards a planned and citizen-centered publicly-funded provincial health care system

In 2010, the New Brunswick Health Council (NBHC) solicited New Brunswickers’ views on their health care system. After measuring health care performance and input from citizens and stakeholders, the NHBC has now released a report that calls for an integrated citizen-centered health care system for the province. The report calls on all stakeholders to assume their full responsibilities.

Canada - Learning From the Best: Benchmarking Canada’s Health System

Canada’s health system has mixed results in comparison with its peers in the Organisation for Economic Co-operation and Development (OECD), according to a new report released recently by the Canadian Institute for Health Information (CIHI). Learning From the Best: Benchmarking Canada’s Health System examines Canadians’ health status, non-medical determinants of health, quality of care and access to care. It is based on international results that appear in the OECD’s Health at a Glance 2011, also being released recently, which provides the latest statistics and indicators for comparing health systems across 34 member countries.

Governing public hospitals. Reform strategies and the movement towards institutional autonomy

Brief analytical summaries or syntheses #33 Governing public hospitals. Reform strategies and the movement towards institutional autonomy Summary This study by researchers at the World Health Organization (WHO) explores major developments in the governance of public hospitals in Europe and looks at their implications for national and European health policy. Individual hospitals have been given varying degrees of semi-autonomy within the public sector and have been empowered to make key strategic, financial and clinical decisions themselves. The study includes an in-depth assessment of eight different country models of semi-autonomy. Background For hospital governance to be effective, it must incorporate two powerful and well-developed lines of health sector logic on the one hand, national health policy and objectives; on the other, operational hospital management. One sphere is political, the other technical. One is subjective and value-based, the other is objective, with performance that can be measured both clinically and financially. The…

Responding to the challenge of financial sustainability in Estonia’s health system : one year on

Brief analytical summaries or syntheses #29 Responding to the challenge of financial sustainability in Estonia’s health system one year on Summary This WHO follow-up report looks at changes in Estonian health care financing one year after a comprehensive WHO analysis. It reviews developments in four areas where policy recommendations had been made. Background Health system financial sustainability has always been a central health policy issue, but the recent financial crisis has forced it to the top of the policy agenda the world over. With the aim of supporting a financially sustainable, high-performing health system, this report assesses health financing policy in Estonia. It looks at how well placed current financing policy is to enable goal attainment in the medium-to-long term (to 2030) and identifies ways to strengthen financing policy. The report is the result of a year-long process of stakeholder consultations and expert analysis initiated by the Ministry of Social…

Canada - Primary Care Reform: Can Quebec’s Family Medicine Group Model Benefit from the Experience of Ontario’s Family Health Teams?

This paper published in Healthcare Policy analyzes the family medicine group (FMG) model's potential as a lever for improving health care system performance and discusses how it could be improved. It reviews the history of primary care in Quebec, presents the FMG model and discusses ways of advancing primary care services in Quebec using the family health team (FHT) model developed in Ontario.

International - International profiles of health care systems

This publication from the Commonwealth Fund presents overviews of health care systems in nine European countries, Japan, Australia, Canada, and the U.S. Each overview covers insurance, financing, organization, quality of care, health disparities, efficiency and integration, information technology usage, use of evidence-based practice, cost containment, and reform and innovation. Summary tables provide data on key characteristics and performance indicators.

USA - New health care law provisions cut red tape, save up to $4.6 billion

On April 9, 2012 the US Department of Health & Human Services (HHS) announced changes to the Affordable Care Act that will save health care providers and health plans $4.6 billion over the next decade by simplifying administrative processes for doctors, hospitals and insurance plans.

Canada – CHSRF: Three new reports on healthcare improvement commissioned with the Canadian Nurses Association

The three reports released by the CHSRF in June 2012 are 1) Better Health: An analysis of public policy and programming focusing on the determinants of health and health outcomes that are effective in achieving the healthiest populations, 2) Better Value: An analysis of the impact of current healthcare system funding and financing models and the value of health and healthcare in Canada and 3) Better Care: An Analysis of Nursing and Healthcare System Outcomes.

USA - U.S. Health-Care System Faces Obstacles to Improving Health Care Value

The Boston Consulting Group assessed international progress in adopting value-based health care, and found the US trailing other countries. The assessment evaluates national health systems according to support at a national level for things like common national standards and IT infrastructure and the engagement of clinicians and policymakers. It also considers the quality of a country’s disease registries.

Canada - One in 12 patients readmitted to Canadian hospitals within 30 days - Study examines who is returning and why

This study, undertaken by the Canadian Institute for Health Information (CIHI) and called All-Cause Readmission to Acute Care and Return to the Emergency Department, included more than 2.1 million hospitalizations across the country. It looked at surgical, medical, pediatric and obstetric patients to better understand who returned to acute care after discharge and for what clinical reason. It found that soon after their discharge from hospital, more than 180,000 Canadians were readmitted to acute care in 2010. And in some jurisdictions, nearly 1 in 10 acute care patients returned to the ED within seven days of hospital discharge.

USA - New Study: U.S. Performs Worst On Potentially Preventable Death Rates Compared To France, Germany, and The U.K.

On August 29, 2012, The Commonwealth Fund released a study showing that the U.S. lags three other industrialized nations — France, Germany, and the U.K. — in its potentially preventable death rate, and in the pace of improvement in preventing deaths that could have been avoided with timely and effective health care.

UK - Looking for value in hard times. How a new approach to priority setting can help improve patient care while making savings

This paper published by the Health Foundation describes a priority-setting approach called STAR (socio-technical allocation of resources) that pinpoints additional value from resources through new efficiencies in improving patient care. A National Health Service (NHS) case study is considered.

USA - Health Care Law Saved An Estimated $2.1 Billion For Consumers

According to a September 2012 report by the US Department of Health and Human Services, healthcare legislation in the 2011 Affordable Care Act has saved American consumers an estimated $2.1 billion on health insurance premiums. New rate review rules prevent insurance companies from arbitrarily raising rates.

France - Marisol Touraine proposes a "pact of confidence for hospitals"

On September 7, 2012, the Minister of Social Affairs and Health of France presented the broad lines of new hospital policy. It will see an end to public-private convergence in rates, improve pay for performance and enhance access to emergency care.

USA - A CEO Checklist for High-Value Health Care

This discussion paper reflects an Institute of Medicine Roundtable Discussion among the CEOs of major American health systems. It provides a checklist of 10 strategies that, in their experience, have proven effective and essential to improving quality and reducing costs.

UK - Clinicians in management: does it make a difference?

This report from the Centre for Innovation in Health Management at the University of Leeds adds to the evidence base to support the benefits of clinical leadership by focusing on the strategic governance of NHS hospital trusts in England. The qualifications of board members were matched against performance results in 102 trusts. Among the findings: Increasing the number of doctors on boards significantly increases quality assessed by ratings, lower morbidity rates and increased patient satisfaction.

USA - Competitive bidding saving money for taxpayers and people with Medicare

People with Medicare are already saving money on durable medical equipment through the Medicare competitive bidding program, according to a report released by the US Department of Health and Human Services. The current process is benefiting older people and people with disabilities now, but benefits will expand as the Affordable Care Act broadens application of cost reduction opportunities to other areas.

Canada - A Snapshot of Health Care in Canada as Demonstrated by Top 10 Lists, 2011

The purpose of this publication published by the Canadian Institute for Health Information (CIHI) is to provide an overview of health care use and resource demands. It provides a snapshot of the most common reasons for hospitalization, emergency care and primary care along with the most important costs.

Canada - The Scope of Medicare: What makes sense today? Report from the MUHC-ISAI’s fourth annual conference

The McGill University Health Centre’s Institute for Strategic Analysis and Innovation (MUHC-ISAI) enables the MUHC to contribute to the ongoing development of health care policy. This report presents highlights from the conference it held on October 26 and 27, 2011 to evaluate Canada’s performance against increasing costs and expectations and explore the scope of Medicare with a view to encouraging and supporting an effective framework for change. It includes presentations on health system changes in the U.K. and The Netherlands and talks by Jeffrey Simpson, Pierre-Gerlier Forest, Claude Castonguay, Philippe Couillard, André Picard and others.

USA - Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality

This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country.

Canada - Progress Report 2012: Health care renewal in Canada

This report from the Health Council of Canada looks at progress to date in home and community care, health human resources, telehealth, access to care in the North, and health indicators.

A working guide to international comparisons of health

Brief analytical summaries or syntheses #41 A working guide to international comparisons of health Summary This guide published by the Australian government highlights the types of questions to ask before comparing health systems in countries or presenting health data in an international context. The guide is intended to encourage users of international health-related data to consider the complexities before comparing countries, and to assist them in interpreting the results of these comparisons. It presents examples to highlight the types of questions to ask when using health data in an international context. Background It is common practice to compare health between countries. Such comparisons provide a broader perspective of health and health care. They enable researchers, policy makers and the general public to see how national experiences of health and health care compare on an international scale. These comparisons often attract much attention from the media, particularly if countries are ranked…

Health care for 1.3 billion. An overview of China’s health system

Brief analytical summaries or syntheses #41 Health care for 1.3 billion. An overview of China’s health system Summary This Stanford University paper provides a brief overview of how China’s health system has transformed alongside society and economy since the 1960s. The paper describes how the Chinese system is financed, organized and regulated, and why it is currently being reformed. Background A half century ago, in the early Mao era, China’s population of half a billion people was young (36% aged less than 15), 80 percent rural, one-third illiterate, and living in absolute poverty. By 2010, China’s 6th population census — the largest social survey ever conducted — revealed a population of 1.3397 billion that was fundamentally different ageing (13.3% over age 60 and only 16.6% below age 15); half (49.7%) urban; 96% literate, with 23% attaining a high school or college education; and the second largest economy in the world,…

Canada - Patient Centred Community Designed Team Delivered. A framework for achieving a high performing primary health care system in Saskatchewan

This Government of Saskatchewan document synthesizes the healthcare perspectives of over 400 community leaders, patients, providers, policy-makers and managers. It outlines shared visions for a sustainable primary healthcare system providing a superior patient experience and improved outcomes.

France - Hospital purchases: launch of the Hospital performance for hospital purchases program (PHARE)

Within the framework of the law Hôpital, patients, santé, territoires and in a context of greater control over public spending, the hospital community is now tackling the purchasing function as part of its improvement process. This ambitious program, managed by the Direction générale de l’offre de soins (DGOS), helps hospitals renovate their purchasing functions and become more efficient. Three operational lines structure the PHARE program: enhancing the position of Purchasing Manager within establishments, creating the conditions for genuine dialogue between prescribers and buyers on all categories of expenditure, and increasing access to group markets of the majority hospitals.

US - The Effect of Financial Incentives on Hospitals That Serve Poor Patients

Providing financial incentives to hospitals to improve quality is increasingly common, yet its effect on hospitals that care for poor patients is largely unknown. The aim of this study is to determine how financial incentives for quality performance affect hospitals with more poor patients compared with those with fewer poor patients.

Australia - Australia's Health 2010

Australia's Health 2010 is the 12th biennial health report of the Australian Institute of Health and Welfare (AIHW). It constitutes the nation's premier source of statistics and informed commentary on: determinants of health and keys to prevention; diseases and injury; health’ variation across population groups; health across the life stages; health services, expenditure and workforce; the health sector's performance.

USA - U.S. Still Not Getting Good Value for Its Health Care Dollars

Despite having the most expensive health care system, the United States ranks last overall compared to six other countries—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—on measures of health system performance, according to a new Commonwealth Fund report.

US - Starting on the Path to a High Performance Health System: Analysis of the Payment and System Reform Provisions in the Patient Protection and Affordable Care Act of 2010

This report, originally published in December 2009 and since updated to reflect the March 2010 passage of the Patient Protection and Affordable Care Act, analyzes the provisions in the new law that will affect providers' financial incentives, the organization and delivery of health care services, investment in prevention and population health, and the capacity to achieve the best health care and health outcomes for all.

International - Value for Money in Health Spending

This publication examines current efforts to improve health care efficiency, including tools that show promise in helping health systems provide the best care for their money, such as pay for performance, co-ordination of care, health technology assessment and clinical guidelines, pharmaceutical reimbursement and risk-sharing agreements and information and communication technology.

UK - The NHS White Paper: evolution or revolution?

In the first of a new series of Centerpiece articles analysing policy innovations by the coalition government, Zack Cooper assesses the plans for healthcare reform in the light of recent Centre for Economic Performance research.

Canada - Canada Health Consumer Index 2010

The annual Canada Health Consumer Index evaluates healthcare-system performance in the ten provinces from the perspective of the consumer. For the third straight year, Ontario and British Columbia finish with the top scores in the CHCI’s overall rankings.

Canada – ER Advisor Recommends Improvements to Emergency Health Care in Nova Scotia

Dr. Ross's report includes 26 recommendations to : create same-or next-day access to primary care by creating collaborative health care teams, explore more innovative ways to pay physicians, make hospital funding models outcome and performance-based, enhance the role and scope of work for all health care professionals, adopt and implement emergency care standards, enhance the roles of paramedics and HealthLink 811, change the way hospitals provide services to seniors, and enhance access to mental health services.

International - Improving Value in Health Care. Measuring Quality

This report gives new evidence on patient safety across OECD countries, and shows that large variations in quality of care remain for cancer, stroke, heart attacks, and services provided by family doctors. It addresses the various ways countries can improve measuring quality; the need for a balance between privacy concerns and transparency on quality and safety and how links can be made between quality indicators and policies to improve the performance of physicians, hospitals and the health care system as a whole.

Canada - Measuring performance is essential to patient-centred care

A paradigm shift is needed in Canada toward a patient-centred health system according to this editorial by Paul C. Hébert, Editor-in-Chief, CMAJ. Change will only occur if patients have access to the necessary information to make their health care decisions. Without comparative measurements, decisions focused on the interests of institutions and health practitioners will continue to be made by administrators and bureaucrats because of limited public engagement.

Canada - The implementation evaluation of primary care groups of practice: a focus on organizational identity

Since 2002 the Health Ministry of Quebec (Canada) has been implementing a primary care organizational innovation called 'family medicine groups'. This is occurring in a political context in which the reorganization of primary care is considered necessary to improve health care system performance. More specifically, the purpose of this reform has been to overcome systemic deficiencies in terms of accessibility and continuity of care. This paper examines the first years of implementation of the family medicine group program, with a focus on the emergence of the organizational identity of one of the pilot groups located in the urban area of Montreal.

International - Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies

The eight agencies working in global health (Bill & Melinda Gates Foundation, GAVI, Global Fund to Fight AIDS, Tuberculosis & Malaria, UNAIDS, UNFPA, UNICEF, World Bank, World Health Organization) agree that it is critical to strengthen the five key data sources and capacity for analysis, synthesis, validation, and use of health data in countries. This should enable countries to better monitor and evaluate their own progress and performance and, secondarily, allow them to respond to the increased emphasis on results and accountability. The eight agencies propose four global actions to support these country goals.

Canada - Alberta: Quality and Patient Safety Dashboard Indicators

Alberta Health Services announced a new “dashboard” of measurements designed to gauge its performance and drive improvement throughout the health system. The Quality and Patient Safety Dashboard will measure 26 quality- and safety-related indicators and identify potential areas for improvement. The Alberta Health Services Board, through its Quality and Safety Committee, will monitor the dashboard on a regular basis. About half of the dashboard indicators will be reported in 2010, with the remainder reported by 2013, as some indicators require the implementation of a program or data collection processes.

Brief analytical summaries or syntheses

The brief analytical summaries or syntheses focus on a specific subject, whether a government policy, a strategy, a policy orientation or evaluation document, a study related to the reform of a health system or social services system, governance, modes of organization or the performance of health and social services systems. Each summary provides an accurate and succinct overview of the article in question to be referred to for more details.

International - Health Care Systems: Efficiency and Institutions

This paper presents a set of indicators to assess health care system performance. It also presents new comparative data on health care policies and institutions for OECD countries. This set of indicators allows the empirical characterisation of health care systems and the identification of groups of countries sharing similar health institutions. It also helps to uncover strengths and weaknesses of each country’s health care system and assessing the scope for improving value-for-money.

Canada – Quality Monitor. Ontario Health Quality Council. 2010 report on Ontario’s health System

The report shows that although there have been some modest improvements in quality across Ontario’s health system, there is room for more improvement. There are examples of higher performance that could be applied more broadly. The top-line findings underscore areas of concern that are of critical importance: wait times; the accuracy and completeness of medical information; chronic disease management; access to primary care; and patient safety.

Australia - Building a 21st Century Primary Health Care System. Australia's First National Primary Health Care Strategy

This strategy represents the first comprehensive national policy statement for primary health care in Australia. It provides a road map to guide current and future policy and practice in the Australian primary health care sector. The four priorities are: improving access and reducing inequity, better management of chronic conditions, increasing the focus on prevention, improving quality, safety, performance and accountability.

Australia - New health investments in the 2010–11 Budget

The 2010–11 Budget delivers a further investment of $2.2 billion in the National Health and Hospitals Network over four years. This includes: $772 million to improve access to General Practitioners (GPs) and primary health care; $523 million in training and supporting Australia's nurses; $467 million to modernise the health and hospital system; $400 million to drive efficiency and high performance.

Europe – Health at a Glance: Europe 2010

This special edition of Health at a Glance focuses on health issues across the 27 European Union member states, three European Free Trade Association countries (Iceland, Norway and Switzerland) and Turkey. It gives readers a better understanding of the factors that affect the health of populations and the performance of health systems in these countries. Its 42 indicators present comparable data covering a wide range of topics, including health status, risk factors, health workforce and health expenditure.

International - Health at a Glance: Asia/Pacific 2010

This first edition of Health at a Glance: Asia/Pacific presents a set of key indicators of health status, the determinants of health, health care resources and utilisation, and health care expenditure and financing across 27 Asia/Pacific countries and economies in the Asia/Pacific region. Drawing on a wide range of data sources, it builds on the format used in previous editions of Health at a Glance: OECD Indicators, and gives readers a better understanding of the factors that affect the health of populations and the performance of health systems.

Canada — Innovation Procurement in Health Care: A Compelling Opportunity for Canada

Governments are the largest purchasers of health care products and services in Canada. Procurement —what governments and public institutions buy and how they buy it—therefore offers huge potential to improve health system performance and value. But a Conference Board of Canada report finds that Canadians are still hesitating, while others, notably the United Kingdom, use new approaches to procurement to drive fundamental improvements in public health care. The report calls for action on four fronts to seize these opportunities: federal leadership; targeted funding; regional implementation; and culture and attitudes.

Canada — Progress Report 2011: Health care renewal in Canada

This report on Canada's health care performance is a pan-Canadian look at five key commitments of the 2003 First Ministers' Accord on Health Care Renewal and the 2004 10- Year Plan to Strengthen Health Care, and it highlights the progress being achieved to date on wait times, pharmaceuticals management, electronic health records, teletriage, and health care innovation since 2003.

Managed competition in the Netherlands: an example for others?

Brief analytical summaries or syntheses #21 Managed competition in the Netherlands an example for others ? Summary The introduction of managed competition in the Netherlands in 2006 fundamentally changed the roles of patients, insurers, providers and the government. This article, included in the last issue of Eurohealth, discusses the challenges presented by the introduction of managed competition in the Netherlands. Background After almost two decades of preparation, major health system reforms were introduced in the Netherlands in 2006. These brought important new structures and regulatory mechanisms to the Dutch health system, including managed competition among actors in health care. The basic aims of the reform were to contain rising health expenditures by increasing health system efficiency (i.e. higher quality at lower costs) through the introduction of managed competition; reduce system inequities related to age, income and health status (under the new system everybody is insured under the same conditions and…

USA - The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations

This paper in the July 2011 issue of the Commonwealth Fund publication Issues in International Health Policy analyzes 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Health care spending in the U.S. towers over the other countries and findings suggest opportunities for cross-national learning to improve health system performance.

USA - Primary Care: Today and Tomorrow

This issue brief from consultancy Deloitte was prepared to anticipate new need for primary care generated by the increase in insured patients that will come with implementation of the Affordable Care Act in the U.S. It considers new models and tools for primary care as well as new incentives, such as pay for performance and value-based design, medical homes, and Accountable Care Organizations (ACOs). It also discusses some of the barriers to implementing new models.

Portugal - Portugal: Health system review. 2011

This European Observatory Country Profile provides a detailed description of the health system and of policy initiatives in progress or under development in Portugal. It shows a population that enjoys good health and increasing life expectancy, a health system that has not undergone any major changes on the financing side since the early 1990s, and a steady growth in public health expenditure. The system is financed largely through taxation, but co-payments have been increasing, primarily for pharmaceuticals. Recent measures have aimed to improve performance.

USA - Public Health Accreditation Board (PHAB) Launches National Accreditation for Health Departments

The goal of PHAB’s accreditation program, initiated and supported by the Robert Wood Johnson Foundation (RWJF) and the Centers for Disease Control and Prevention (CDC), is to protect and improve Americans’ health by advancing the quality and performance of all of the nation’s public health departments — state, local, territorial and tribal. It aims to create a national standard for public health. Accreditation is seen as a powerful way to publicly recognize that health departments are doing a good job, while at the same time driving them to continuously improve.

UK - Does better disease management in primary care reduce hospital costs?

This new study from the University of York examines whether better primary care management of 10 chronic diseases leads to reductions in hospital costs. Analysis of a U.K. database of 5 million patients in 8,000 general practices revealed that only primary care performance in stroke care is associated with lower hospital costs.

USA — Lessons Learned in Public Reporting: Crossing the Cost and Efficiency Frontier

This brief provides lessons from communities involved in Aligning Forces for Quality, the Robert Wood Johnson Foundation’s signature effort to lift the quality of care in America. Public reporting is a cornerstone of the Aligning Forces for Quality program. This brief focuses on the evolving process of public reporting and the challenges associated with adding cost and efficiency measures to reports of quality performance data.

Canada — Canadian Alliance for Sustainable Health Care Launched To Tackle the Full Spectrum of Canadian Health

The Conference Board of Canada recently launched the Canadian Alliance for Sustainable Health Care (CASHC), a five-year, multi-million dollar initiative that seeks to improve the Canadian health system as a whole – as well as health-care practices within firms and organizations. The work of CASHC will help Canadians to better understand the conditions for a sustainable health-care system, which includes dimensions of financial sustainability, firm-level performance, and institutional factors.

UK - Do quality improvements in primary care reduce secondary care costs? Primary

The introduction in 2004 of the Quality and Outcomes Framework (QOF) in UK general practice represents one of the most ambitious efforts to measure and incentivise quality improvements in primary care. This report takes advantage of a large database of over 50 million English citizens to determine whether the levels of QOF attainment in general practices have led to improvements in two major outcomes: mortality and the costs of hospital inpatient and outpatient use. The findings are that primary care performance improvements are associated with some modest but measurable improvements in subsequent outcomes and costs.

Strengthening primary and chronic care: state innovations to transform and link small practices

Brief analytical summaries or syntheses #14 Strengthening primary and chronic care state innovations to transform and link small practices Summary This report examines the roles states are playing to reorganize the delivery of primary and chronic care to produce more efficient and effective care. Through short case studies developed via interviews with state officials and physicians in Colorado, Michigan, North Carolina, Oklahoma, Pennsylvania, and Vermont, the authors highlight several state-based initiatives that seek to create high-performing health systems by targeting local and regional strengths. Background Although most of the debate preceding the passage of the Affordable Care Act in March 2010 was focused on improving access to care, it is widely agreed that without equal attention to reforms that address cost and quality, the United States is destined to continue its path of uncontrolled, spiralling costs and poor overall performance. The issues are complex, and there is no silver bullet…

Subnational health spending and soft budget constraints in OECD countries

Brief analytical summaries or syntheses #3 Subnational health spending and soft budget constraints in OECD countries Summary Government spending on health has grown as a percent of GDP over the last 40 years in industrialized countries. Widespread decentralization of healthcare systems has often accompanied this increase in spending. This paper explores the effect of soft budget constraints on subnational health spending in a sample of OECD countries. It finds that countries where subnational governments rely primarily on central government financing and enjoy large borrowing autonomy have higher healthcare spending than those with more restrictions on subnational government borrowing. Background There has been a tendency toward decentralization in the health systems of OECD member countries over the last 40 years. The tendency reflects government desire to bring fiscal decisions closer to voter preferences and to improve the efficiency of transfer payments. Subnational spending makes up a large portion of total healthcare…

The impact of global processes on health systems in Europe

Brief analytical summaries or syntheses #11 The impact of global processes on health systems in Europe Summary The relationship between globalization and health systems is a complex one, where both positive and negative influences are reported. This unsystematic literature review explores the impact of globalization on European health systems and emphasizes the need for national policy-makers and leaders to consider global processes when designing national health systems. Background The world is changing rapidly with increasing life expectancies and improving child survival rates. Globalization has contributed to economic growth. In addition to global economic integration, globalization entails the mobility of capital, goods, services and labour, and can be said to be part of an ideological process justifying neo-liberal economic policies. Globalization is also a dynamic process of global interconnectedness influenced by a number of driving and constraining forces such as technological developments, political influences, economic pressures, changing ideas, and greater awareness…

USA - Realizing Health Reform's Potential: How the Affordable Care Act Will Strengthen Primary Care and Benefit Patients, Providers, and Payers

Although primary care is fundamental to health system performance, the United States has undervalued and underinvested in primary care for decades. This brief describes how the Affordable Care Act will begin to address the neglect of America’s primary care system and, wherever possible, estimates the potential impact these efforts will have on patients, providers, and payers. The health reform law includes numerous provisions for improving primary care: temporary increases in Medicare and Medicaid payments to primary care providers; support for innovation in the delivery of care, with an emphasis on achieving better health outcomes and patient care experiences; enhanced support of primary care providers; and investment in the continued development of the primary care workforce.

Do quality improvements in primary care reduce secondary care costs ?

Brief analytical summaries or syntheses #15 Do quality improvements in primary care reduce secondary care costs ? Summary The introduction in 2004 of the Quality and Outcomes Framework (QOF) in general practice in the United Kingdom represents one of the most ambitious efforts to measure and incentivise quality improvements in primary care. The report takes advantage of a database of over 50 million English citizens to determine whether quality and outcomes efforts in general practice have led to improvements in two major outcomes mortality and the costs of hospital inpatient and outpatient use. The study finds that primary care performance improvements are associated with some modest but measurable improvements in outcomes and costs. Background The report seeks to determine whether the levels of QOF attainment in general practice have led to quality improvements in two major indicators mortality and the costs of hospital inpatient and outpatient care. The NHS faces…

Decentralization in health care

Brief analytical summaries or syntheses #18 Decentralization in health care Summary The Spring issue of Euro Observer looks at decentralization as a governance tool in health care. Case studies on Norway, Spain and the United Kingdom (U.K.) highlight how decentralized arrangements work in practice in these countries. Background A common challenge across most countries in Europe is finding the appropriate level for the making and implementation of policy and administration, particularly in health care. Many countries have decentralized, recentralized and then decentralized again in an ongoing cycle, searching the right balance of efficiency and responsiveness in their health care system. Looking at the arguments for and against, in many cases the same reasons are used to justify movement in opposite directions. This issue of Euro Observer looks at whether decentralization is purely a politically driven phenomenon or the wrong instrument used for the right objective. The debate about decentralization is…

USA — Medicare Launches Quality-Based Payment System for Hospitals

After a decade or so of collecting information from hospitals on the quality of their care, the Medicare program announced recently that it will finally start using what the data actually reveals about a hospital's performance to set the level of payments it receives.

USA — Accountable Care Organizations Have Potential to Curb Costs and Improve Health Care

If implemented successfully, accountable care organizations (ACOs) have the ability to achieve better care, better population health, and lower costs, according to a new report released recently by the Commonwealth Fund Commission on a High Performance Health System. Implementing ACOs effectively will be vital to their success and, to that end, the Commission report also includes 10 recommendations for effective implementation, focusing on the design, payment and functioning of ACOs.

Europe — Launch of a two-year process that will shape Health 2020, the new European policy for health

In Andorra, the first meeting of the European Health Policy Forum of High-level Government Officials opened on 9 March 2011, to launch a two-year process that will shape Health 2020, the new European policy for health. Four working papers have been submitted for discussions: Developing the new European policy for health – Health 2020, Interim report on implementation of the Tallinn Charter, Strengthening Public Health Capacities and Services in Europe: A Framework for Action, and Assessing System Performance for Health Governance.

Canada - Professionalism: How payment models affect physician behaviour

This article from the Canadian Medical Association Journal (CMAJ) discusses the effects of different physician compensation models on the practice of medicine. Payment schemes mentioned include fee-for-service, salaries in group practice, pay-for-performance, and capitation models.

USA - Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Published by the Institute of Medicine (IOM), this report from the Committee on the Learning Health Care System explores the economic challenges of US healthcare today. The report analyzes imperatives for change and discusses the financial, administrative and technological solutions that will make needed transitions successful.

Canada - Quality of care: How the provinces fare internationally

For the first time, provincial and international health care systems can be compared in terms of quality of care. The Canadian Institute for Health Information(CIHI) found that the results of these comparisons are mixed, with no province being consistently the best or worst performer across the Organisation for Economic Co-operation and Development (OECD) quality of care indicators. CIHI provides snapshots of international comparisons for each province through a new interactive tool. A companion report, International Comparisons: A Focus on Quality of Care, contains essential information and context for interpreting Canada’s performance on various indicators and identifies potential quality improvement strategies.

Canada - Saying what you do and doing what you say: The performative dynamics of lean management theory

How do theories influence institutional practice? This study looks at Québec’s public healthcare system, where the theory of “lean management” has become dominant in organizational practice. Using a longitudinal approach, the study focuses on the conditions that encourage a theory-based approach to performance.

Canada - Canada's Quality Improvement Conundrum

The Health Council has published Proceedings of the National Symposium on Quality Improvement held last October. The symposium provided an opportunity for 200 senior leaders from across Canada to discuss health system performance measurement and reporting, as well as the need to build capacity and capability for quality improvement.

USA - The 10 Building Blocks of High-Performing Primary Care

This article by US researchers describes the 10 building blocks of high-performance primary care. They include four foundational elements: engaged leadership, data-driven improvement, empanelment (linking a patient with a care team) and team-based care. These support the implementation of six other elements — patient-team partnership, population management, care continuity, access, coordination, and a template for future care.

USA - County Health Rankings & Roadmaps 2014

County Health Rankings uses available data to measure the overall health of each county in the 50 US states. The roadmaps that accompany the rankings describe corresponding preventative and public health measures. The 2014 version includes comparisons between the healthiest and least healthy counties in the US.

Canada - Wait Times Holding Steady Across Canada. Demand for priority procedures continues to rise

Last year, 8 out of 10 patients received priority surgical procedures within medically acceptable wait times, a figure that has not improved over the past three years, according to the Canadian Institute for Health Information (CIHI). CIHI’s new report, Wait Times for Priority Procedures, 2014, focuses on wait times for five key priority procedures: knee and hip replacement, hip fracture repair, cataract surgery and radiation therapy. The report focuses on the degree to which patients received these procedures within benchmarks established by the federal government and provinces in 2005.

Canada - For a Universal and Efficient Health Care System: Six Reform Proposals

This report from Yanick Labrie at the Montreal Economic Institute presents six concrete ideas to reform Quebec's health care system that are inspired by the experience of OECD countries. Greater private participation and competition, along with performance-based hospital funding, figure among the reform proposals.

Canada - Emergency department overcrowding and access block

In this position paper, the Canadian Association of Emergency Physicians (CAEP) recommends national benchmarks for ED performance to help get admitted patients into beds faster. They suggest aiming for a median one hour to physician assessment and median 2 hours to transfer to in-patient bed, among other targets.

Europe - Euro Health Consumer Index 2013

The Euro Health Consumer Index (EHCI) is produced annually by the Health Consumer Powerhouse to report on European healthcare systems from the perspective of consumers and patients. The EHCI offers reality checks for policy makers, empowerment to consumers, and an opportunity for stakeholders to highlight weak and strong aspects of health care.

New Zealand - Emergency department (ED) use and patient experience in New Zealand

Two reports were released by the New Zealand government on September 12, 2013: the first focuses on the number of people who have used an ED in the last 12 months, looking at the reasons why they went to the ED and whether they thought they could have received treatment at a medical centre if one was available. The second provides insight into how people feel about the services they receive from their general practitioners, practice nurses, ED doctors and medical specialists, and about their experiences of continuity of care.

UK - Health Secretary Jeremy Hunt recently set out the Government’s plans to help prevent future failures of care and safety at NHS hospitals

Hospitals in the National Health Service (NHS) with the highest standards of patient care and safety will be partnered with hospitals placed under "special measures" due to high mortality rates, and will be reimbursed for the time spent bringing their partner up to standards. Additional measures are also foreseen to deal with hospitals that do not achieve good ratings.

International - Health Landscape in Six Regions Reveals Rapid Progress Made and Daunting Challenges from Hundreds of Diseases, Injuries, Risk Factors

These reports from the World Bank Group explore changes in the leading causes of premature mortality and disability in different parts of the world and compare the performance of countries in a range of health outcomes. Individually, they document how each region is working to reduce health loss from most communicable, newborn, nutritional, and maternal conditions and what new challenges lie ahead.

Europe - Identifying targets and indicators for monitoring Health 2020: results of regional consultation published

Following a web-based consultation with input from 30 Member States, this report presents revised indicators to measure progress in reaching the six Health 2020 targets. They and the proposed monitoring framework will be presented and submitted for approval to the sixty-third session of the WHO Regional Committee for Europe later this month.

Canada - Health Minister Hébert announces increased staff for 60 family medicine groups (FMGs) in Quebec

The addition of professionals such as nutritionists, social workers or kinesiologists to doctors is a way to support medical practice in FMGs as it allows for better patient follow-up, especially for patients with chronic diseases. The additional staff will be provided to FMGs that meet certain performance criteria.

USA - United States of America. Health systems in transition, 2013

This analysis of the United States health system examines the system's organization, governance, financing, physical and human resources and presents health reforms currently underway and an assessment of the health system in the US.

International - International Profiles of Health Care Systems, 2013

This publication presents overviews of health systems in Australia, Canada, Denmark, Great Britain, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the US. Each overview covers health insurance, public and private financing, system organization and governance, healthcare quality and coordination, efficiency and integration, information technology use and evidence-based practice, cost containment, and recent reforms and innovations.

Canada - Top performing hospitals and health regions across Canada identified on new website

On November 7, 2013, the Canadian Institute for Health Information (CIHI) launched a new website called It presents comparable, interactive and easily understood information about Canada’s health system, from the national level down to the local and facility levels. It shows which health regions have top results for indicators such as how many people have a regular family physician; life expectancy at birth; how many patients have repeat hospital stays for mental illness; and which hospitals had the top results for low readmission rates within 30 days of discharge.

France - Short hospital stays: Evolution of market share between 2003 and 2011

The implementation of payment by activity in short-term hospital stays in France, in 2004, led healthcare institutions to improve their efficiency by developing their activities, and control costs and length of stay. This report covers the period between 2003 and 2011, and finds that changes in population structure were responsible for 80% of the increase in the number of stays over this time period.

International - Accountable care organisations (ACOs) in the United States and England: testing, evaluating and learning what works

In the US, accountable care organizations (ACOs) are health providers responsible for the comprehensive care of a given population over a specified period of time. This study describes different types of ACO and presents early evidence on their performance. The authors then discuss the implications of ACO development for integrated care initiatives in England.

International - Taking care of innovation. The HRM innovation process in healthcare organizations

Employees are of crucial importance for the performance of healthcare organizations. This dissertation examines innovations in human resources management strategies in the health sector. It looks at the adoption, implementation and spread of innovations in both work design and employment practices.

Canada - Your Health System website reveals Canadian health care statistics by hospital, region, province and territory

The Canadian Institute for Health Information (CIHI) has launched a website that allows the Canadian public to find accessible and easy-to-understand information about Canada's healthcare system. Information is available on access to care, quality of care, spending, health outcomes and much more. Interactive graphics enable comparison between Canada and other countries, between provinces, regions and even individual hospitals on the different measures.

Europe - Economic crisis, health systems and health in Europe: impact and implications for policy

The European Observatory on Health Systems and Policies monitors the effects of the economic crisis on health systems and health. This report, undertaken jointly with the WHO Europe, analyses the impact of the crisis between 2008 and 2013 on government and household finances, spending on health, health coverage, health system performance and population health.

UK – Future organisational models for the NHS. Perspectives for the Dalton review

In 2014, the UK government instituted the Dalton Review, investigating how the best-performing organizations within the country's National Health Service (NHS) could establish national groups of hospitals and services as centres of excellence. This report from the Kings Fund solicits the views of British healthcare policymakers, academics and experts on the mandate and aims of the Dalton Review.

Italy - Budget cuts and regional disparities increase the pressure on the Italian health system

Part of a series reviewing European health systems, this report on Italy discusses the country’s ability to reduce health care costs while accommodating increased demand. Belt-tightening responses to Italy’s fiscal crisis have exacerbated inequities across regions. Gaps in service provision and variations in health system performance persist.

Canada - Measuring Up. A yearly report on how Ontario’s health system is performing

This report marks the first time Health Quality Ontario (HQO) has used the Common Quality Agenda – a set of about 40 indicators created by HQO in consultation with health partners and system leaders — to monitor the quality of health care. Comparisons with other provinces and countries are included for some indicators.

International - Health at a Glance: Asia/Pacific 2014. Measuring Progress towards Universal Health Coverage

Published by the OECD, this book presents indicators related to health status, access to care, quality of care and health financing, expenditure, and resources in 27 Asian and Pacific countries. Indicators are presented with charts, brief descriptive analyses and methodological context. An annex provides information on country health systems and local demography.

UK - Using NICE’s approach to base policy decisions on evidence could help save billions

The National Institute for Health and Care Excellence (NICE) provides the UK National Health Service (NHS) with recommendations on evidence and best practices, and is known for rigour and objectivity. The British government is now applying the NICE model to public policymaking to variously help school principals, police chiefs, and other civil servants save billions of pounds of taxpayers’ money by using evidence-based decision making.

Canada - Canada Needs Federal Leadership to Accelerate Health Innovation and Improve System Performance

On December 2, 2014, 39 national healthcare organizations that comprise the Health Action Lobby (HEAL) issued a consensus statement calling for the federal government to embrace the Canadian Way of addressing national health issues through compassion, consensus, and collaboration. The statement is intended to prompt federal parties to articulate their positions on health care in advance of elections in 2015.

Europe - Public reporting in health and long-term care to facilitate provider choice

Public reporting is a term used to describe the publication of information and reports on the quality of health care and long-term care providers. This WHO summary looks at public reporting in Europe, examining national contexts, reporting system design and policy issues and implications.

France - ERs: Half of all patients wait less than two hours, while those requiring observation wait longer

A national survey conducted by the DREES in France examined the ER use of 52,000 patients who presented to the ER on June 11, 2013 in 736 emergency care settings. The report describes the wait time (less than 2 hours for half of patients, longer for those who required observation); the main reason for the visit (traumatic injuries account for 36% of cases), transportation, and the age groups that most often use the ER (people aged 75 and older and infants).

UK - NHS waiting times for elective care in England

The UK Parliamentary Public Accounts Committee has published its 54th annual report into waiting times for elective care within Britain’s National Health Service (NHS). The report says waiting times are increasing for many procedures and that penalties for providers who flout waiting time standards are not succeeding in driving improved performance.

UK - The four health systems of the United Kingdom: how do they compare?

This report is the fourth in a series looking at how the publicly financed healthcare systems in the four countries of the UK (England, Wales, Scotland and Northern Ireland) compare in terms of quality and productivity. The report finds that mortality rates are considerably lower in England, as are median wait times for medical procedures.

Germany - Health Care Lessons from Germany

Published by Canada’s Fraser Institute, this study compares the German and Canadian healthcare systems. The study concludes that the German system performs at a level similar to Canada, with a stronger performance in patient safety. Germany’s health expenditures, as an age-adjusted share of GDP, were 22% lower than Canada’s. Germany also has higher ratios of physicians and hospital beds per population and shorter wait times for all types of care.

USA - Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally

In this latest update of the Commonwealth Fund's comparative assessment of healthcare systems, the US once again comes first in expense and last or near last in access, efficiency and equity. The UK ranks first on most measures, despite coming in 10th out of 11 countries in terms of healthy lives.

Canada - Release of 2014 Report Card on Wait Times in Canada - Time to Close the Gap

The Wait Time Alliance (WTA) released its 2014 Report Card on June 3. It finds that medical wait times have improved since the signing of the 2004 Health Accord, but progress has been uneven. While Newfoundland and Labrador, Ontario and Saskatchewan have made or are beginning to make substantive and sustained progress, other provinces continue to struggle and there remain significant variations within provinces and communities.

Canada - Reforming Canadian Primary Care – Don't Stop Half-Way

Strong primary care is a fundamental underpinning of high-performing health systems. Sadly, primary care infrastructure and performance in Canada lag behind many of our international peers. Although substantial reforms have been implemented over the past decade, progress has been uneven, and no province has all the essential system elements in place. Continued investment is both needed and affordable, according to this paper.

UK - Helping the NHS to provide better care and to improve health services

The National Health Service (NHS) in England will be collecting basic information from electronic medical records to improve the way health care is delivered. Strict rules govern how information is stored and used and patients can request that their information not be shared outside their GPs practice.

UK - A decade of austerity: the funding pressures facing the NHS from 2010/11 to 2021/22

This report from the Nuffield Trust is part of a series focusing on improvements in patient care in the face of budget pressures affecting Britain’s National Health Service (NHS). The report quantifies NHS financial pressures until 2022 while estimating the beneficial impact of three key factors: pay restraint, improved care, and increased productivity in acute care.

A guide to physician integration models for sustainable success

Brief analytical summaries or syntheses #49 A guide to physician integration models for sustainable success Summary As health care delivery and financing shifts from a volume-based to a value-based business model, improved alignment between hospitals and physicians becomes essential. This guide, published by Health Research & Educational Trust, describes the prerequisites for successful hospital-physician integration and offers an overview of integration models currently used in American hospitals and health systems. Background This guide offers an overview of physician integration models currently deployed at hospitals and health systems. These models include a wide array of programs, covering customer service offerings, contractual ventures, joint venture/shared equity arrangements and employment/practice acquisition models. The legal, taxation and regulatory issues surrounding hospital-physician integration are complex and changing. Analysis and results As health care delivery and financing shifts from a volume-based to a value-based business model, provider success will be achieved through offering services with the…

Canada - Measuring What Matters: The Cost vs. Values of Health Care

This white paper on Canada’s healthcare system from the Ivey International Centre for Health Innovation considers five key questions about stakeholder values and their alignment with funding, reimbursement, measures, and incentives. It also assesses whether Canada’s health care values and performance outcomes compare well over time to other OECD nations.

UK - More people are waiting longer to see a doctor or nurse at A&E departments

Results from a survey by the UK’s Care Quality Commission show that British patients are waiting longer for medical attention in hospital emergency rooms (ERs). The results showed that 33% of the 46,000 patients visiting ERs in 2012 waited over 30 minutes before receiving attention, an increase from 29% in 2008.

Re-orienting health systems : Towards modern, responsive and sustainable health promoting systems

Brief analytical summaries or syntheses #55 Re-orienting health systems Towards modern, responsive and sustainable health promoting systems Summary This position paper from EuroHealthNet is the culmination of a policy dialogue process with stakeholders, experts and European Union (EU) institutions to identify key contributions to sustainable health systems across Europe. The paper frames its findings in the context of the EU 2020 Europe strategy for continental growth. Background The sustainability of national health systems is a core concern of the European Member States, the European Commission, and the World Health Organisation. As early as 2001, the European Commission identified ‘financial viability’ as one of three long-term objectives for national health systems, along with accessibility and quality. Since then, the development of high-quality, accessible and sustainable services has been in the spotlight of different EU policy agendas social protection, public health, and economic and financial affairs. Initially, the issue was incorporated in…

UK – The NHS reforms and efficiency savings: an early assessment of the impact on cancer services in England

Produced by Cancer Research UK, this report assesses the impact on cancer services of current British health reforms and efficiency gains. The report analyses trends in cancer care wait times, diagnostic wait times and expenditures from 2010 onwards, and conducts interviews with key stakeholders to explore experiences in eight cancer networks.

Australia - Blueprint for better healthcare in Queensland

This report from the Queensland government outlines structural and cultural improvements to establish Queensland as the leader in Australian healthcare in terms of value-for-money, performance and delivery. The report focuses on four principal themes: health services focused on patients and people; empowering the community and health workforce; providing value in health services; and investing, innovating and planning for the future.

Canada - Reviewing the Potential Roles of Financial Incentives for Funding Healthcare in Canada

This report from the Canadian Foundation for Healthcare Improvement (CFHI) describes the methods and results of different approaches to funding healthcare, including global budgets, activity-based funding (ABF), and pay-for-performance (P4P). These are described in detail and contextualized to the Canadian healthcare setting. The report looks at recent provincial initiatives for funding healthcare services.

UK - New HiTs (Health Systems in Transition) health system reviews for the United Kingdom (Northern Ireland, Scotland, and Wales) have just been released

In November 2012, the European Observatory on Health Systems and Policies released Health Systems in Transition (HiT) reviews for British health systems in Northern Ireland, Scotland and Wales. HiT health system reviews are country or region-based reports providing a detailed description of local health system reforms and policy initiatives.

Canada - The Inconvenient Truths about Canadian Health Care

This briefing from the Conference Board of Canada says Canada’s health system has slipped to 10th place internationally and is in urgent need of transformation. The briefing identifies key issues in Canadian healthcare and outlines priorities for reform, saying the country must abandon an obsolete model.

Israel - Excellent primary health care, but hospitals must improve

Israel has world class-primary care services and should now focus efforts on bringing its hospitals up to the same high international standards, according to the OECD Reviews of Health Care Quality: Israel. While most OECD countries grapple with rising healthcare costs, Israel has maintained tight control – limiting health spending to about 8% of GDP, the eighth lowest across OECD countries – and still offers universal coverage and high-quality primary health care services.

USA - Alternatives to Fee-for-Service Payments in Health Care. Moving from Volume to Value

This report from the Center for American Progress examines the fee-for-service payment model and explores alternatives, including bundled payments, patient-centred medical homes, and accountable care organizations. The report compiles recent data from organizations that have tested each approach.

New Zealand - More kiwis satisfied with health services

Health targets are playing a key role in improving services and increasing the numbers of New Zealanders satisfied with hospital care. New Zealand’s Health Ministry says that surveys show consistent improvements in satisfaction levels since health targets were introduced in 2009.

Canada - Strong Action to Improve Health Care. McGuinty Government Launches 2012 Progress Report

This report released on October 26 details Ontario's accomplishments in putting patients first, while ensuring the future sustainability of the health care system. It highlights initiatives such as improved access to immunizations, nurse-practitioner-led clinics, an increase in home care and the expansion of Family Health Teams.

International - Designing a results framework for achieving results: a how-to guide

Published by the World Bank, this booklet provides how-to guidance for designing results frameworks in the field of development. It discusses definitions, uses, requirements, formats, and challenges, and provides examples of frameworks at international, national and organizational levels.

Australia – Over 150 potentially low-value health care practices: an Australian study

This study from the Medical Journal of Australia describes a method for scanning a range of sources to identify non-pharmaceutical healthcare services of questionable benefit. The study also provides a list of services that warrant further investigation, a move that will aid prioritization in health technology reassessment initiatives.

Brief analytical summaries or syntheses available on our website

The brief analytical summaries or syntheses focus on a specific subject, whether a government policy, a strategy, a policy orientation or evaluation document, a study related to the reform of a health system or social services system, governance, modes of organization or the performance of health and social services systems. Each summary provides an accurate and succinct overview of the article in question to be referred to for more details.

New Zealand - National Health Committee. Report on Priorities, Activities and Next Steps

In 2011, a National Health Committee was set up in New Zealand to help cut healthcare costs by prioritizing evidence-based health interventions that were cost effective and sustainable. This report describes the activities of the Committee to date in establishing an evidence-based system for setting priorities in national decisions.

China - Chinese-Style Decentralization and Health System Reform

This article from PLOS Medicine concerning China’s health system reform highlights the fact that the country’s social sectors are heavily decentralized, giving China’s Health Ministry limited influence over the regional implementation of reforms. The article calls for a health management information system and performance-based staff management strategy that will enhance central oversight.

Australia - Health Care Lessons from Australia

This paper is the first in a series from the Fraser Institute that examines the way health services are funded and delivered in other nations. The nations profiled all aim to achieve the noble goal of Canada’s health care system: access to high quality care regardless of ability to pay. The first nation studied in this series is Australia, which provides some of the best outcomes among developed nations with universal health care insurance.

Canada - Report Card on Wait Times in Canada : Progress Has Stalled

Canadians are waiting as long, if not longer, than previous years for medical care, the eighth report card issued by the Wait Time Alliance has concluded. The 2013 WTA report card, entitled "Time for transformation: Canadians still waiting too long for health care," gives Canadians a picture of how long they have to wait to access a broad range of medical procedures and services.

Sweden - Quality and Efficiency in Swedish Health Care. Regional Comparisons 2012

This is the seventh report comparing healthcare quality and efficiency that the Swedish National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions have published jointly. The report provides information and data for use in the public debate about the healthcare system and supports efforts by the county councils to analyse, improve and manage the healthcare services they provide. Results on 169 indicators are presented.

Canada - Nine out of 10 emergency visits take 7.5 hours or less

This report from the Canadian Institute for Health Information (CIHI) is based on data covering more than half of all visits to the emergency department (ED) in Canada. The analysis reveals that complex patients can expect to spend more than twice as long in the ED as minor/uncomplicated patients. Nine out of 10 complex patients spent 10.5 hours or less in the ED in 2011–2012. In comparison, nine out of 10 of the minor/uncomplicated patients spent 4.2 hours or less in the ED. Data tables are available on the CIHI website.

China - Hospital Reforms in Rural China Increased Patient Satisfaction

In 2009, the Chinese province of Henan began reforms in rural public hospitals that included adopting computerized clinical pathways, shifting from fee-for service to case-based payment, and introducing performance-based payment for care providers. This World Bank article describes how the reforms have reduced medical expenses, improved quality of care, and dramatically increased patient satisfaction in Henan.

New Zealand - New health data will help drive improvements in patient safety

This report from the Health Quality and Safety Commission of New Zealand provides data on the quality and safety of care in each District Health Board (DHB). Measures include falls, healthcare-associated infections, hand hygiene and perioperative harm and enable comparison between different DHBs and a view of progress made in each against baseline measures.

Canada - Putting Innovation to Work: Improving chronic disease management and health system sustainability in Ontario

Produced by the Better Care Faster Coalition, a group of health service providers, professionals, charities, and patient groups, this report issues recommendations for improvements to chronic disease management in Ontario, and identifies barriers to innovation in this area. The report calls for standardized evaluation formats, simplified tracking and reporting of performance indicators, and greater flexibility for innovation at the local level.

Canada- Implementing Lean Health Reforms in Saskatchewan

Saskatchewan has gone further than any other Canadian province in implementing health system process improvements using Lean, a production line discipline originating in the automobile industry. This paper from Health Reform Observer examines the implementation of Lean in Saskatchewan and its success at improving system performance by bringing about long-term changes in institutional behaviour.

Canada - Health care reforms not keeping pace with needs of Canadians, says report

The Health Council of Canada progress report highlights five key areas: wait times, primary health care and electronic health records, pharmaceuticals management, disease prevention/health promotion and Aboriginal health. It finds significant variability across Canada and shortcomings in many areas. To achieve better health care for all Canadians, the report calls for governments to set clear policy goals with clear lines of responsibility, to continue the spread of innovative practices, and to support collaborative efforts across all jurisdictions, including the federal government.

Vietnam - The Political Economy of Healthcare Commercialization in Vietnam

Published by Oxford University, this paper addresses the impact of the commercialization of healthcare services in Vietnam. Drawing on analyses and field studies, the paper suggests that changes in both health financing and the institutions that govern access to services are needed to reduce individual financial burdens, increase access, and improve the quality and effectiveness of health care.

Canada - Exploring the Dynamics of Physician Engagement and Leadership for Health System Improvement. Prospects for Canadian Healthcare Systems

This literature review led by Quebec’s École nationale d'administration publique (ENAP) synthesizes knowledge on how to foster physician engagement and leadership to improve organizational and health system performance. Among the authors’ findings: a full range of physicians rather than only individual physicians must be targeted to produce meaningful engagement, and it is not enough to simply place physicians in managerial and administrative positions.

Europe - Governing Public hospitals

This special issue of EuroHealth, the quarterly of the European Observatory on Health Systems and Policies, focuses on public hospital governance across Europe. It features such topics as hospital autonomy in Spain, pay-for-performance in Macedonia, and innovative governance in Norway.

Canada - Healthcare Reform in the NHS England: More Lessons for Ontario

Two years of hard bargaining led to legislation in 2012 to transform England’s National Health Service (NHS). This Change Foundation report comparing health reform in England and Ontario examines the journey to the UK Health and Social Care Act. The report describes how Ontario can learn from England’s experience in patient engagement, performance measurement, and service provision and quality of care.

Australia - Healthy Communities: Australians’ experiences with primary health care in 2010-11

This report by Australia’s National Health Performance Authority's (NHPA) looks at community-based healthcare services in 61 local areas around the country. It examines how Australians view their health and analyzes patient experiences with local general practitioner services.

Europe - Output and productivity growth in the healthcare sector: a study of four European countries

Funded by the European Union (EU), this study created indicators to study the performance of healthcare service sectors in four countries (UK, Spain, Hungary, and Germany). Separate sets of indicators provide information on market and non-market services while describing trends in growth and productivity. The authors also develop experimental indicators covering insurance, collective services, and research sector output.

Japan - Health Care Lessons from Japan

This paper from Canada’s Fraser Institute is part of a series examining the way health services are funded and delivered internationally. The paper focuses on Japan’s healthcare system, identified as providing superior access and superior outcomes with fewer resources. Japan’s system outperforms Canada’s with regard to infant mortality, cancer survival and in-hospital mortality.

International – WHO statistics show narrowing health gap between countries with best and worst health status

The world has made dramatic progress in improving health in the poorest countries and narrowing the gaps between countries with the best and worst health status in the past two decades, according to the World Health Statistics 2013. The WHO annual statistics report highlights how efforts to meet the Millennium Development Goals (MDGs) have reduced health gaps between the most-advantaged and least-advantaged countries.

France – New program to improve bed management

On April 26, 2013, the Ministre des Affaires sociales et de la Santé of France launched a program designed to reduce overcrowding in emergency departments to the benefit of patients, professionals and institutions. The regional health agencies identified 150 establishments to be accompanied by the Agence nationale d’appui à la performance des établissements de santé et médico-sociaux (ANAP) to implement a new organization of emergency departments.

USA - America's Health Rankings 2014

First published in 1990, America’s Health Rankings presents comparative health data for all 50 US states. The 2014 edition finds that Hawaii is the healthiest US state due to low rates of smoking, obesity, income disparity and cancer mortality. The state of Mississippi ranked 50th, coming in last on 18 of 26 measures.