Health at a Glance: Latin America and the Caribbean 2020
AUTOR(ES): OECD/The World Bank
RESUMO: Health at a Glance: Latin America and the Caribbean 2020 presents key indicators on health and health systems in 33 Latin America and the Caribbean countries. This first Health at a Glance publication to cover the Latin America and the Caribbean region was prepared jointly by OECD and the World Bank. Analysis is based on the latest comparable data across almost 100 indicators including equity, health status, determinants of health, health care resources and utilisation, health expenditure and financing, and quality of care. The editorial discusses the main challenges for the region brought by the COVID-19 pandemic, such as managing the outbreak as well as mobilising adequate resources and using them efficiently to ensure an effective response to the epidemic. An initial chapter summarises the comparative performance of countries before the crisis, followed by a special chapter about addressing wasteful health spending that is either ineffective or does not lead to improvement in health outcomes so that to direct saved resources where they are urgently needed.
REFERENCIA: OECD/The World Bank (2020), Health at a Glance: Latin America and the Caribbean 2020, OECD Publishing, Paris, https://doi.org/10.1787/6089164f-en.
Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care
AUTOR(ES): Eric C. Schneider, M.D., Dana O. Sarnak, David Squires, Arnav Shah, and Michelle M. Doty
RESUMO: Issue: The United States health care system spends far more than other high-income countries, yet has previously documented gaps in the quality of care. Goal: This 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. Methods: Seventy-two indicators were selected in five domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. Data sources included Commonwealth Fund international surveys of patients and physicians and selected measures from OECD, WHO, and the European Observatory on Health Systems and Policies. We calculated performance scores for each domain, as well as an overall score for each country. Key findings: 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. Based on a broad range of indicators, the U.S. health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries. The results suggest the U.S. health care system should look at other countries’ approaches if it wants to achieve an affordable high-performing health care system that serves all Americans.
Measuring health system performance: A new approach to accountability and quality improvement in New Zealand
AUTOR(ES): Author links open overlay panelToniAshton
RESUMO: In February 2014, the New Zealand Ministry of Health released a new framework for measuring the performance of the New Zealand health system. The two key aims are to strengthen accountability to taxpayers and to lift the performance of the system's component parts using a 'whole-of-system' approach to performance measurement. Development of this new framework--called the Integrated Performance and Incentive Framework (IPIF)--was stimulated by a need for a performance management framework which reflects the health system as a whole, which encourages primary and secondary providers to work towards the same end, and which incorporates the needs and priorities of local communities. Measures within the IPIF will be set at two levels: the system level, where measures are set nationally, and the local district level, where measures which contribute towards the system level indicators will be selected by local health alliances. In the first year, the framework applies only at the system level and only to primary health care services. It will continue to be developed over time and will gradually be extended to cover a wide range of health and disability services. The success of the IPIF in improving health sector performance depends crucially on the willingness of health sector personnel to engage closely with the measurement process.
REFERENCIA: Toni Ashton. Measuring health system performance: A new approach to accountability and quality improvement in New Zealand. Health Policy, Volume 119, Issue 8, 2015, Pages 999-1004, ISSN 0168-8510, https://doi.org/10.1016/j.healthpol.2015.04.012. (http://www.sciencedirect.com/science/article/pii/S0168851015001190)
Measuring the performance of health care services: a review of international experiences and their application to urban contexts
AUTOR(ES): Anna Garcí a-Alté s, Lauriane Zonco, Carme Borrell, Antoni Plasè ncia
RESUMO: Background: The objective of performance assessment is to provide governments and populations with appropriate information about the state of their health care system. The objective of this paper is to present the most recent developments in performance assessment and their application in urban contexts. Methods: Literature review in PubMed (1970-2004). We identified additional papers and grey literature from retrieved references. Results: Performance assessment initiatives were identified in Australia, Canada, the United Kingdom, and New Zealand. The World Health Report 2000 is one of the best known examples of a transnational approach to performance assessment. Conclusion: The best developed initiatives to date are those that define precise categories, criteria and indicators with which to analyse and assess health care systems, based on a solid conceptual framework. Performance assessment fits perfectly in urban contexts, as it is a useful tool for designing and monitoring policies, assessing the quality of the services provided, and measuring the health status of city dwellers. Barcelona and Montreal are currently collaborating together on a project to assess the performance assessment of their respective health care services.
REFERENCIA: Anna García-Altés, Lauriane Zonco, Carme Borrell, Antoni Plasència. Measuring the performance of health care services: a review of international experiences and their application to urban contexts, Gaceta Sanitaria, Volume 20, Issue 4, 2006, Pages 316-324, ISSN 0213-9111, https://doi.org/10.1157/13091148. (http://www.sciencedirect.com/science/article/pii/S0213911106715114)
Ranked Performance of Canada's Health System on the International Stage: A Scoping Review
AUTOR(ES): Najafizada SAM, Sivanandan T, Hogan K, Cohen D, Harvey J.
RESUMO: INTRODUCTION: Since the release of the World Health Report in 2000, health system performance ranking studies have garnered significant health policy attention. However, this literature has produced variable results. The objective of this study was to synthesize the research and analyze the ranked performance of Canada's health system on the international stage. METHOD: We conducted a scoping review exploring Canada's place in ranked health system performance among its peer Organisation for Economic Co-operation and Development countries. Arksey and O'Malley's five-stage scoping review framework was adopted, yielding 48 academic and grey literature articles. A literature extraction tool was developed to gather information on themes that emerged from the literature. SYNTHESIS: Although various methodologies were used to rank health system performance internationally, results generally suggested that Canada has been a middle-of-the-pack performer in overall health system performance for the last 15 years. Canada's overall rankings were 7/191, 11/24, 10/11, 10/17, "Promising" and "B" grade across different studies. According to past literature, Canada performed well in areas of efficiency, productivity, attaining health system goals, years of life lived with disability and stroke mortality. By contrast, Canada performed poorly in areas related to disability-adjusted life expectancy, potential years of life lost, obesity in adults and children, diabetes, female lung cancer and infant mortality. CONCLUSION: As countries introduce health system reforms aimed at improving the health of populations, international comparisons are useful to inform cross-country learning in health and social policy. While ranking systems do have shortcomings, they can serve to shine a spotlight on Canada's health system strengths and weaknesses to better inform the health policy agenda.
REFERENCIA: Najafizada SAM, Sivanandan T, Hogan K, Cohen D, Harvey J. Ranked Performance of Canada's Health System on the International Stage: A Scoping Review. Classement du rendement du système de santé canadien sur la scène internationale : un examen de la portée. Health Policy. 2017;13(1):59–73. doi:10.12927/hcpol.2017.25191
Health system performance comparison: new directions in research and policy
AUTOR(ES): Irene Papanicolas, Dionne Kringos, Niek S. Klazinga, Peter C. Smith
REFERENCIA: Irene Papanicolas, Dionne Kringos, Niek S. Klazinga, Peter C. Smith. Health system performance comparison: New directions in research and policy, Health Policy, Volume 112, Issues 1–2, 2013, Pages 1-3, ISSN 0168-8510, https://doi.org/10.1016/j.healthpol.2013.07.018. (http://www.sciencedirect.com/science/article/pii/S0168851013002078)
Resolving the challenges in the international comparison of health systems: the must do's and the trade-offs
AUTOR(ES): Ian Forde,David Morgan,Niek S. Klazinga
RESUMO: Countries are increasingly publishing health system performance statistics alongside those of their peers, to identify high performers and achieve a continuously improving health system. The aim of the paper is to identify, and discuss resolution of, some key methodological challenges, which arise when comparing health system performance. To illustrate the issues, we focus on two OECD flagship initiatives: the System of Health Accounts (SHA) and the Health Care Quality Indicators (HCQI) project and refer to two main actors: a coordinating agency, which proposes and collates performance data and second, data correspondents in constituent health systems, who submit data to the coordinating centre. Discussion is structured around two themes: a set of must-do's (legitimacy of the coordinating centre, validity of proposed indicators, feasibility of data collection and technical support for data correspondents) and a set of trade-offs (depth vs. breadth in the number of system elements compared, aggregation vs. granularity of data, flexibility vs. consistency of indicator definitions and inclusion criteria). Robust fulfillment of the must-do's and transparent resolution of the trade-offs both depend upon effective collaboration between the coordinating centre and data correspondents, and a close working relationship between a technical secretariat and a body of experts.
REFERENCIA: Ian Forde, David Morgan, Niek S. Klazinga. Resolving the challenges in the international comparison of health systems: The must do's and the trade-offs, Health Policy, Volume 112, Issues 1–2, 2013, Pages 4-8, ISSN 0168-8510, https://doi.org/10.1016/j.healthpol.2013.01.018. (http://www.sciencedirect.com/science/article/pii/S0168851013000341)
Methodological concerns and recommendations on policy consequences of the World Health Report 2000
AUTOR(ES): Celia Almeida,Paula Braveman,Marthe R Gold,Celia L Szwarcwald,Jose Mendes Ribeiro,Americo Miglionico,John S Millar,Silvia Porto,Nilson do Rosario Costa,Vincente Ortun Rubio,Malcolm Segall,Barbara Starfield,Claudia Travassos,Alicia Uga et al.
Estudo exploratório dos modelos de avaliação de desempenho em saúde: uma apreciação da capacidade avaliativa
AUTOR(ES): Reis Ana Cristina, Santos Elizabeth Moreira dos, Arruda Marcela Rocha de, Oliveira Paulo de Tarso Ribeiro de.
RESUMO: Este artigo identifica e analisa os modelos de avaliação de desempenho de sistemas de saúde, considerando-se a sua capacidade avaliativa. Realizou-se a revisão sistemática da literatura, identificando-se seis artigos que apresentaram o modelo adotado para a avaliação de desempenho. Procedeu-se à apreciação da capacidade avaliativa segundo critérios definidos de meta-avaliação. Conclui-se que o foco dos debates em torno dos modelos enfatiza as dimensões avaliativas, o perfil e qualidade dos indicadores em detrimento da compreensão pactuada do 'avaliando' e do processo de valoração. Espera-se ter contribuído para a sistematização de critérios de meta-avaliação de modelos avaliativos.
REFERENCIA: REIS, Ana Cristina; SANTOS, Elizabeth Moreira dos; ARRUDA, Marcela Rocha de and OLIVEIRA, Paulo de Tarso Ribeiro de. Estudo exploratório dos modelos de avaliação de desempenho em saúde: uma apreciação da capacidade avaliativa. Saúde debate [online]. 2017, vol.41, n.spe, pp.330-344. ISSN 0103-1104. http://dx.doi.org/10.1590/0103-11042017s24.
Indicators of quality of care in general practices in England
AUTOR(ES): Jennifer Dixon, Emma Spencelayh, Anna Howells, Abraham Mandel, Felix Gille
RESUMO: In the summer of 2015 the Health Foundation was asked by the Secretary of State for Health to review indicators of the quality of care provided by general practices in England. We looked at how indicators could be developed to generate meaningful information that supports improvements to care and helps the public choose which practice might best meet their needs. Within the short timeframe available for the review (June to September 2015), the Foundation consulted with a wide range of organisations and individuals with an interest in how information about general practice care quality is collated and published. We assessed the literature, analysed indicators currently used as well as the websites on which they are published, and worked with insight agency BritainThinks to understand the public’s views. Our review focused on publication of indicators for the purposes of supporting local improvement of care, patient choice and voice, and the accountability and performance management of general practices. The review also strongly advises against making a composite score out of selected indicators to indicate the quality of care overall in general practice, or for particular population groups.
REFERENCIA: The Health Foundation, an independent health care charity, was asked by the Secretary of State for Health to review indicators of the quality of general practice in England. We looked at how they could be made better to support improvements to care, including how they are selected and presented. Within the short timeframe available for the review (June to September 2015), the Foundation consulted with a wide range of organisations and individuals with an interest in general practice and information. We assessed the available literature and analysed current indicators as well as the websites on which they are published. Our review focused on publication of indicators for the purposes of supporting local improvement of care, patient choice and voice, and the accountability and performance management of general practices. While our review was commissioned by the Department of Health, the Health Foundation did not receive any funding for completing the work. The Health Foundation retained full editorial control of the report’s content.
Random variation and rankability of hospitals using outcome indicators
AUTOR(ES): Van Dishoeck A, Lingsma HF, Mackenbach JP, et al
RESUMO: OBJECTIVE: There is a growing focus on quality and safety in healthcare. Outcome indicators are increasingly used to compare hospital performance and to rank hospitals, but the reliability of ranking (rankability) is under debate. This study aims to quantify the rankability of several outcome indicators of hospital performance currently used by the Dutch government. METHODS: From 52 indicators used by the Netherlands Inspectorate, the authors selected nine outcome indicators presenting a fraction and absolute numbers. Of these indicators, four were combined into two, resulting in seven indicators for analysis. The official data of 97 Dutch hospitals for the year 2007 were used. Uncertainty in the observed outcomes within the hospitals (within hospital variance, σ(2)) was estimated using fixed effect logistic regression models. Heterogeneity (between hospital variance, τ(2)) was measured with random effect logistic regression models. Subsequently, the rankability was calculated by relating heterogeneity to uncertainty within and between hospitals (τ(2)/(τ(2) +median σ(2))). RESULTS: Sample sizes varied but were typically around 200 per hospital (range of median 90-277) with a median of 2-21 cases, causing a substantial uncertainty in outcomes per hospital. Although fourfold to eightfold differences between hospitals were noted, the uncertainty within hospitals caused a poor (<50%) rankability in three indicators and moderate rankability (50-75%) in the other four indicators. CONCLUSION: The currently used Dutch outcome indicators are not suitable for ranking hospitals. When judging hospital quality the influence of random variation must be accounted for to avoid overinterpretation of the numbers in the quest for more transparency in healthcare. Adequate sample size is a prerequisite in attempting reliable ranking.
REFERENCIA: Van Dishoeck A, Lingsma HF, Mackenbach JP, et al. Random variation and rankability of hospitals using outcome indicators. BMJ Quality & Safety 2011;20:869-874.
Do all paths lead to Rome? Comparative analysis in the institutionalization of the evaluation
AUTOR(ES): Aquilino, N., Ballescá , M., Potenza, F., Rubio, J.
RESUMO: In recent years, evaluation has gained importance within public administrations of different countries. Even still, in many cases, it is implemented in a fragmented manner, in response to specific and isolated requests. On the other hand, to speak of a “system” with regards to monitoring and evaluation (M&E) implies that the practice derives from stable institutional arrangements that distribute the functions between those involved in the process, as well as other definitions with an orientation towards quality assessment information in a regular and sustained manner. This document analyzes different institutional arrangements of a set of countries with federal governments with respect to M&E. Those analyzed include Canada, Spain, Mexico, Brazil and Argentina. The case studies of the following sub-national governments are included as well: Catalonia, Jalisco, Pernambuco and the Autonomous City of Buenos Aires. Said studies demonstrate that if a single pattern of institutionalization of M&E functions does not exist, it is important to consider transversal aspects that affect its development. The formation of a system does not end with the creation of an agency or body responsible for M&E. For this organism to have the necessary capacities to carry out its functions, it requires an institutional insertion that guarantees a certain degree of political independence, while also enabling it to promote evaluations as a management tool. Likewise, it is necessary to establish rules defining responsibilities, rules that establish the obligation to evaluate and define quality standards in addition to defining a financing mechanism that guarantees the autonomy, perdurability of the system, and the commitments of evaluated programs or organisms. With respect to the evaluative practice, it is important to consider, not only the definition of an evaluative plan, but also quality control of information produced, and the promotion of evaluation, the use of which improves accountability, transparency of government actions, and decision making. This last facet requires the instauration of mechanisms promoting the use of information in management but also the generation of M&E information that could easily translate into decisions, improving programs and policies. The analyzed case studies demonstrate that M&E systems have started to expand to a level of sub-national states. These governments should act as an active partner in the design and implementation of the national M&E systems and promoters of their own systems. Because of this, the development of capacities and the institutionalization of areas in the government with these specific attributions from said matters are key.
REFERENCIA: Aquilino, N., Ballescá, M., Potenza, F., Rubio, J. (June de 2017). Do all paths lead to Rome? Comparative analysis in the institutionalization of the evaluation. Working Paper No. 159 Buenos Aires: CIPPEC.
Ranking hospitals: do we gain reliability by using composite rather than individual indicators?
AUTOR(ES): Hofstede SN, Ceyisakar IE, Lingsma HF, et al.
RESUMO: Background Despite widespread use of quality indicators, it remains unclear to what extent they can reliably distinguish hospitals on true differences in performance. Rankability measures what part of variation in performance reflects ‘true’ hospital differences in outcomes versus random noise. Objective This study sought to assess whether combining data into composites or including data from multiple years improves the reliability of ranking quality indicators for hospital care. Methods Using the Dutch National Medical Registration (2007–2012) for stroke, colorectal carcinoma, heart failure, acute myocardial infarction and total hiparthroplasty (THA)/ total knee arthroplasty (TKA) in osteoarthritis (OA), we calculated the rankability for in-hospital mortality, 30-day acute readmission and prolonged length of stay (LOS) for single years and 3-year periods and for a dichotomous and ordinal composite measure in which mortality, readmission and prolonged LOS were combined. Rankability, defined as (between-hospital variation/between-hospital+within hospital variation)×100% is classified as low (<50%), moderate (50%–75%) and high (>75%). Results Admissions from 555 053 patients treated in 95 hospitals were included. The rankability for mortality was generally low or moderate, varying from less than 1% for patients with OA undergoing THA/TKA in 2011 to 71% for stroke in 2010. Rankability for acute readmission was low, except for acute myocardial infarction in 2009 (51%) and 2012 (62%). Rankability for prolonged LOS was at least moderate. Combining multiple years improved rankability but still remained low in eight cases for both mortality and acute readmission. Combining the individual indicators into the dichotomous composite, all diagnoses had at least moderate rankability (range: 51%–96%). For the ordinal composite, only heart failure had low rankability (46% in 2008) (range: 46%–95%). Conclusion Combining multiple years or into multiple indicators results in more reliable ranking of hospitals, particularly compared with mortality and acute readmission in single years, thereby improving the ability to detect true hospital differences. The composite measures provide more information and more reliable rankings than combining multiple years of individual indicators.
REFERENCIA: Hofstede SN, Ceyisakar IE, Lingsma HF, et al. Ranking hospitals: do we gain reliability by using composite rather than individual indicators? BMJ Quality & Safety 2019;28:94-102.
The multiple aims of pay-forperformance and the risk of unintended consequences
AUTOR(ES): Friebel R, Steventon A
REFERENCIA: Friebel R, Steventon A. The multiple aims of pay-for-performance and the risk of unintended consequences. BMJ Quality & Safety 2016;25:827-831.
Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017
AUTOR(ES): Zimmerman FJ, Anderson NW.
RESUMO: Importance Health equity is an often-cited goal of public health, included among the 4 overarching goals of the Department of Health and Human Services’ Healthy People 2020. Yet it is difficult to find summary assessments of national progress toward this goal. Objectives To identify variation in several measures of health equity from 1993 to 2017 in the United States and to test whether there are significant time trends. Design, Setting, and Participants Survey study using 25 years of data, from January 1, 1993, to December 31, 2017, from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System to assess trends in health equity and health justice by race/ethnicity, sex, and income in 3 categories by year. Main Outcomes and Measures Health equity was assessed separately for each of 2 health constructs: healthy days—the average of physical and mental healthy days over the previous 30 days—and general health in 5 categories, rescaled to approximate a continuous variable. For each health construct, average health was calculated along with 4 measures of health equity: disparities across 3 income groups; black-white disparities; health justice—a measure of the correlation of health outcomes with income, race/ethnicity and sex; and a summary health equity metric. Results Among the 5 456 006 respondents, the mean (SD) age was 44.5 (12.7) years; 3 178 688 (58.3%) were female; 4 163 945 (76.3%) were non-Latinx white; 474 855 (8.7%) were non-Latinx black; 419 542 (7.7%) were Latinx; and 397 664 (7.3%) were of other race/ethnicity. The final sample included 5 456 006 respondents for self-reported health and 5 349 527 respondents for healthy days. During the 25-year period, the black-white gap showed significant improvement (year coefficient: healthy days, 0.021; 97.5% CI, 0.012 to 0.029; P < .001; self-reported health, 0.030; 97.5% CI, 0.025 to 0.035; P < .001). The health equity metric for self-reported health showed no significant trend. For healthy days, the Health Equity Metric declined over time (year coefficient: healthy days, −0.025; 97.5% CI, −0.033 to −0.017; P < .001). Health justice declined over time (year coefficient: healthy days, −0.045; 97.5% CI, −0.053 to −0.038; P < .001; self-reported health, −0.035; 97.5% CI, −0.046 to−0.023; P < .001), and income disparities worsened (year coefficient: healthy days, −0.060; 97.5% CI, −0.076 to −0.044; P < .001; self-reported health, −0.029; 97.5% CI, −0.046 to −0.012; P < .001). Conclusions and Relevance Results of this analysis suggest that there has been a clear lack of progress on health equity during the past 25 years in the United States. Achieving widely shared goals of improving health equity will require greater effort from public health policy makers, along with their partners in medicine and the sectors that contribute to the social determinants of health.
REFERENCIA: Zimmerman FJ, Anderson NW. Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017. JAMA Netw Open. 2019;2(6):e196386. doi:10.1001/jamanetworkopen.2019.6386