Is the EU ready for a generic set of indicators for health system performance? A qualitative study

Background

As part of the EU funded BRIDGE Health project, 23 headline indicators for assessing and comparing the performance of public health systems were proposed. They were shortlisted out of the currently existing and often overlapping pool of over 2000 health system performance assessment (HSPA) indicators. In this qualitative study, we explored their validity and perceived national-level utility for policy making and factors affecting the potential uptake of an indicator hierarchy (headline, operational & explanatory levels) at Member States' and EU levels.

Methods

Semi-structured interviews with a purposive sample of 24 policy makers and senior policy advisors from 15 EU Member States and one candidate country were performed between July and November 2018. All interviews were transcribed and coded using summative and directed content analysis to generate thematic categories in MAXQDA.

Results

Preliminary results suggest that experts positively perceived the overall balance of the shortlist across performance domains reflecting most of the important policy areas. However, some further amendments to the generic set of indicators were recommended to increase their policy relevance and measurement validity while keeping the size manageable. The concept and usage of headline HSPA indicators is mostly viewed as a communication tool whereas more granular information at explanatory levels is perceived to be more appropriate for data driven policymaking and cross-country learning.

Conclusions

Interviews showed a considerable heterogeneity in the feasibility of applying a generic HSPA framework in an EU-wide health strategy as a compass for improvement through comparisons of health systems. Factors such as flexibility in adaptation to the national context, improvement in building knowledge capacity, potential misinterpretation in the 'European Semester' context, as well as lack of appropriately defined benchmarks were recurrent themes in hindering its uptake.

Key messages

Policy makers assess explanatory level indicators to be more actionable than headline level indicators. To facilitate the use of headline indicators at EU-level as a navigation tool for health systems, the list has to be stable to create trends and sufficiently flexible in adapting to new priorities.

Health insurance and productivity

AIM

To provide a conceptual understanding of the basic relationship between health insurance and overall economic productivity, and to look at the human development index as a proxy for the quality of human capital.

METHODS

Economic data and data related to human development in Central and Eastern European (CEE) countries, including Croatia, were compared to the European Union (EU) average. Data were selected out of databases provided by the International Monetary Fund, the Organization for Economic Cooperation and Development, and the United Nations. Income and growth rates were related to the EU averages. The human development index was used to compare the level of the average achievements in the longevity of life, knowledge, and quality of living in CEE countries.

RESULTS

Relative to the EU-average, human development is lagging behind in CEE countries. Considering the world as a benchmark regarding human development, 8 out of 13 CEE countries exceed the world. However, all CEE countries have 3-28% lower human development than the industrialized countries.

CONCLUSIONS

The specific challenge for transition countries is how to adopt strategies to translate economic progress into health and social gains through reliable institutions, among them social health insurance bodies. The institutions and the provision of social health insurance are particularly challenged at a turning point when transition in terms of macroeconomic stabilization, along with the consolidated organization and financing of social and health insurance schemes, is accommodated to a business cycle-driven market economy.

Is public health between East and West? Analysis of wealth, health and mortality in Austria, Central and Eastern European Countries and Croatia relative to the European Union

AIM

To provide a conceptual framework for health planning activities in the "middle income" transition countries.

METHOD

Economic, demographic, and disease-related data in Central and Eastern European (CEE) countries, including Croatia and Austria, were compared to the Europen Union (EU) average. Data were selected from the databases provided by the World Health Organization, Organization for Economic Cooperation and Development, World Bank, United Nations, and the European Bank of Reconstruction and Development. Life expectancy and mortality were extrapolated until the year 2000 by using an exponential growth model for the WHO time series data, starting in 1994. Death rates due to ischemic heart diseases (18%) and cerebrovascular diseases (13%) were selected to show frequent causes of death.

RESULTS

Relative to the EU average, the gross domestic product (GDP) share of health expenditures in transition countries was disproportionate to wealth and premature death. The population in CEE-countries was younger and the share of people aged >65 was predicted to remain about 15% below the EU average and Austria. For Croatia, the share of people aged 65 would be on the increase, similar to the share predicted for Austria (slightly above the EU average). Mortality of selected non-communicable, chronic diseases is predicted to increase and remain relatively high. Mortality rates due to infectious diseases have been declining but remained comparatively on a high level.

CONCLUSIONS

Coexistence of demographic and epidemiological transition along with high mortality rates due to infectious diseases creates a "double burden". Economic transition has the potential to comprise both the increase in wealth, and life and health expectancy.