Measuring Health System Performance

In recent decades, there has been increased interest in assessing the performance of health systems. Several factors have contributed to this trend. For instance, there has been a greater demand for transparency and public accountability; patients, citizens, and health insurers require information to select health care providers; health system reforms have been implemented that need to be monitored from a policy perspective; and continuously rising health expenditures raise questions about the affordability and efficiency of health systems. In 2008, the European Member States of the World Health Organization (WHO) even signed a Charter, committing themselves to “promote transparency and be accountable for health system performance to achieve measurable results”.

In several countries, health system performance reports have been developed to fulfill (part of) this need for transparency. In addition, several international agencies such as the Organisation for Economic Co-operation and Development (OECD) have performed cross-country comparisons of health systems. Such studies generally aim to provide insight into the quality and efficiency of health systems. Do health systems meet their objectives and at what expense? Given the increased interest in and use of health system performance studies, it becomes all the more important to identify, clarify, and address conceptual and methodological issues at hand. In particular, since the literature has shown that the measurement and interpretation of health system inputs, outputs and the input-output relationship, is open to much debate.