It will examine the quality of care provided by the entire system to the general population and major subgroups. 0000002524 00000 n The National Quality Forum, Washington, DC, United States. (, National Quality Measures Clearinghouse™, of the Agency for Healthcare Research and Quality, US Department of Health and Human Services, United States. This balanced scorecard concept implies that ‘the overall set of indicators should give a balanced picture of the organization’s performance, reflecting the main aspects, including outcomes and the users’ perspective’ [15], and originally includes the four perspectives: service user, internal management, continuous improvement, and financial (taxpayer’s) perspectives [16,17]. For the third goal, fairness in financial contribution, only its distribution, but not its average level, is considered. This toolkit is an information support system that allows PCTs and NHS Trusts to benchmark their performance and that of relevant secondary care providers against peers, hence gaining a better insight into the underlying reasons for their performance variations. The weights came from a survey of goal preferences of some 1006 respondents from 125 countries. Reflections on the development and use of indicators in health care from a public health perspective. This paper explores only the recent past and present experiences of health system performance assessment, especially before and after the World Health Report 2000 [7]. The third type, known as national health service, exemplified by the UK, involves financing mostly by general taxation with mainly public providers, where the government also controls level of health expenditure but microeconomic efficiency is determined by providers and managers purchasing health care for consumers [105]. endstream endobj 66 0 obj <> endobj 67 0 obj <>stream The levels of goal attainment for both health improvement and responsiveness reflect the overall quality of the health system, whereas the distributional measures (each of health, responsiveness, and financial contribution) describe the equity of the system [98]. Health systems are expected to achieve and manage results in line with established objectives and quality standards. In order to achieve this balanced view, six areas of performance are identified within the health authority PAF, namely: (a) health improvement; (b) fair access; (c) effective delivery of appropriate health care; (d) efficiency; (e) patient/carer experience; and (f) health outcomes of NHS care [14]. Why rank countries by health performance? The US has a pluralistic, decentralized health system with mostly private (largely employer-based) funding and variable state and federal regulation [5,66]. This will allow for benchmarking between organizations to boost quality improvement in four dimensions: responsiveness, system competence, work life, and client/community focus. Nevertheless, the distinction between public health (with the wider issues of population health determinants) and health services (with the narrower issues of clinical care and cure) should be made clear, articulating their relationship to the overall health system. A framework is the conceptual underpinning of a study. 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