A framework for a health system performance assessment for Germany: development and discussion

Le résumé fourni par la source

Background: Health system performance assessment (HSPA) as a tool for evidence based governance is gaining increased importance internationally, yet, Germany is still lacking such a tool. The step-by-step development of a national HSPA is subject to an ongoing feasibility study. Firstly, a conceptual framework is being developed that is able to i) acknowledge existing international work to ensure international comparability and to ii) reflect on specific characteristics of the German health system. Methods: The conceptual framework was developed by means of a literature review (January- March 2018) on existing HSPA-frameworks, covering 8 international organizations/initiatives and 21 country specific frameworks and was enriched by specifics of the German health system. The draft framework was adapted based on i) written reviews and ii) subsequent group discussions both with two expert groups: a group of seven stakeholders of the German health system and a group of five high-level HSPA experts. Results: At the core of the framework are the dimensions: access and quality as intermediate goals, and population health and responsiveness as final outcomes. Equity considerations are explicitly incorporated in the framework along all aforementioned dimensions (e.g. one category is insurance status), and the population differentiated into six (adapted and newly developed) need-categories. In addition, input information are considered, facilitating the analyses of system-wide efficiency. The framework also reflects on the health system design, policy and context and on non-health care determinants of health. Conclusions: The framework for a German HSPA draws on existing work but also represents further developments contributing to the ongoing discussion on HSPA. The framework embraces specific characteristics of the German health system (e.g. in the equity categories), nevertheless, it can easily be adapted to the specifics of other health care systems. Key messages: A new HSPA framework was developed for Germany, drawing on international work but also reflecting the specifics of the German health care system. The framework incorporates further developments (e.g. regarding equity and need categories) contributing to ongoing discussions on HSPA and can be used for HSPA initiatives in other countries.

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