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The Performance of Health Systems: An Assessment Framework and Comparison of Developed and Developing Countries

Document Type : Original Article

Authors

1 Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Biostatics, School of Medicine, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 Health Economic, Tehran university of medical sciences, Tehran, Iran

Abstract

Background: In recent decades, especially after the publication of the World Health Report in 2000, many efforts have been made to develop assessment tools and improve the performance of health systems at the global and national levels. The purpose of this study was to design a method and assess the performance of health systems in various countries in its use.
Methods: In this retrospective study, health systems were evaluated using the opinions of experts as well as international data. Health system experts expressed their views on appropriate indicators for evaluation. The performance of the studied health systems was ranked using multi-criteria decision-making techniques (SAW & TOPSIS). Collected data were analyzed using multiple regression analysis.
Results: Data related to 38 indexes in eight general areas of macroeconomics, affordability for health costs, disease control, health care financing, health and nutrition, life expectancy, health resources, and mortality rates were collected in 105 countries from 2018 to 2020. According to the findings of country ranking, the health systems of Sweden, Norway, and Japan have the best performance and Afghanistan, Nigeria and Guinea have the weakest performance in the years examined.
Conclusion: Health systems face major challenges around the world. Scientific evaluations show that spending more resources and costs does not necessarily enhance the performance of health systems, yet using and distributing these resources and costs in health systems could enhance the hope for better performance.

Keywords

References
  1. Pan American Health Organization. Health systems performance assessment and improvement in the region of the Americas. Washington: Pan American Health Org; 2001. Available at https://iris.paho.org/handle/10665.2/785.
  2. Lyell D, McDonnell G. A dynamic balanced scorecard for managing health systems performance. IN Proceeding of the 25th International Conference of the System Dynamics Society and 50th Anniversary Celebration 2007 Jul 29.
  3. Health Systems 20/20. 2012. The Health System Assessment Approach: A How-To Manual. Version 2.0. Available at: www.healthsystemassessment.org. Last Access: 2/12/2021.
  4. WHO Regional Office for the Western Pacific. Regional consultation on health system performance; 2001 Jul 3-5; Manila, Philippines; 2001. Available at http://iris.wpro.who.int/handle/10665.1/10669.
  5. Murray CJ, Frenk J. A framework for assessing the performance of health systems. Bull World Health Organ. 2000;78(6):717-31. PMID: 10916909; PMCID: PMC2560787.
  6. Lowinger JS, Stark HE, Kelly M, Hughes CF, Gazarian M, Kaye KI. Improving use of medicines with clinician-led use of validated clinical indicators. Med J Aust. 2010 Feb 15;192(4):180-1. doi: 10.5694/j.1326-5377.2010. tb03473.x. PMID: 20170451.
  7. World Health Organization: Regional office Europe. Pathways to health system performance assessment: A manual to conducting health system performance assessment at national or sub-national level. WHO; 2012.
  8. García-Altés A, Zonco L, Borrell C, Plasència A. Measuring the performance of health care services: a review of international experiences and their application to urban contexts. Gaceta sanitaria. 2006; 20:316-24. doi: 10.1157/13091148.
  9. Murray ChJL, Frenk J. A WHO Framework for Health System Performance Assessment: Evidence and Information for Policy. WHO; 2016. https://apps.who.int/iris/handle/10665/66267.
  10. Almaspoor Khangah H, Jannati A, Imani A, Salimlar S, Derakhshani N, et al. Comparing the Health Care System of Iran with Various Countries, Health Scope. 2017; 6(1): e34459. doi: 10.17795/jhealthscope-34459.
  11. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization; 2010.
  12. Braithwaite J, Hibbert P, Blakely B, Plumb J, Hannaford N, Long JC, Marks D. Health system frameworks and performance indicators in eight countries: a comparative international analysis. SAGE open medicine. 2017 Jan 4; 5:2050312116686516. doi: 1177/2050312116686516.
  13. Healy JM, Tang S, Patcharanarumol W, Annear PL. A framework for comparative analysis of health systems: experiences from the Asia Pacific Observatory on Health Systems and Policies. WHO South East Asia J Public Health. 2018 Apr;7(1):5-12. doi: 10.4103/2224-3151.228421. PMID: 29582843.
  14. Brouwers MC, Lavis JN, Spithoff K, Vukmirovic M, Florez ID, Velez M, Kibria M, Sekercioglu N, Kamler E, Halladay J, Sandhu J, Ali A, Jaffer A, Kiflen R, Pemberton J. Assessment of health systems guidance using the Appraisal of Guidelines for Research and Evaluation - Health Systems (AGREE-HS) instrument. Health Policy. 2019 Jul;123(7):646-651. doi: 10.1016/j.healthpol.2019.05.004. Epub 2019 May 14. PMID: 31160062.
  15. Tashobya CK, da Silveira VC, Ssengooba F, Nabyonga-Orem J, Macq J, Criel B. Health systems performance assessment in low-income countries: learning from international experiences. Global Health. 2014 Feb 13; 10:5. doi: 10.1186/1744-8603-10-5. PMID: 24524554; PMCID: PMC3943387.
  16. Pyone T, Smith H, van den Broek N. Frameworks to assess health systems governance: a systematic review. Health Policy Plan. 2017 Jun 1;32(5):710-722. doi: 10.1093/heapol/czx007. PMID: 28334991; PMCID: PMC5406767.
  17. Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, Jama MA. Framework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy. 2009 Apr;90(1):13-25. doi: 10.1016/j.healthpol.2008.08.005. Epub 2008 Oct 5. PMID: 18838188.
  18. Cassiani SH. Strategy for universal access to health and universal health coverage and the contribution of the International Nursing Networks. Rev Lat Am Enfermagem. 2014 Nov-Dec;22(6):891-2. doi: 10.1590/0104-1169.0000.2502. Epub 2014 Dec 1. PMID: 25591082; PMCID: PMC4309221.
  19. Larson C, Mercer A. Global health indicators: an overview. CMAJ. 2004 Nov 9;171(10):1199-200. doi: 10.1503/cmaj.1021409. PMID: 15534313; PMCID: PMC524951.
  20. Berman P, Bitran R. Health systems analysis for better health system strengthening. Health, Nutrition, and Population (HNP) discussion paper; World Bank. http://hdl.handle.net/10986/13593.
  21. Paoli F, Schmidt I, Wigzell O, Ryś A. An EU approach to health system performance assessment: Building trust and learning from each other. Health Policy. 2019 Apr;123(4):403-407. doi: 10.1016/j.healthpol.2019.02.004. Epub 2019 Feb 12. PMID: 30777300.
  22. Alokozay AM, Ghafari SS, Erfani B, Shayan SJ. Health care Systems and Their Transformation: A Comparing the Health Care System of Three Selected Countries. Indian Journal of Public Health Research & Development. 2020 Mar 1;11(3).  doi: 10.37506/ijphrd.v11i3.2024.
  23. Lee D, Kim KK. Assessing healthcare service quality: a comparative study of patient treatment types. International Journal of Quality Innovation. 2017 Dec;3(1):1-5. doi: 10.1186/s40887-016-0010-5.
  24. Waterkeyn J, Waterkeyn A, Uwingabire F, Pantoglou J, Ntakarutimana A, Mbirira M, Katabarwa J, Bigirimana Z, Cairncross S, Carter R. The value of monitoring data in a process evaluation of hygiene behaviour change in Community Health Clubs to explain findings from a cluster-randomised controlled trial in Rwanda. BMC Public Health. 2020 Jan 23;20(1):98. doi: 10.1186/s12889-019-7991-7. PMID: 31973701; PMCID: PMC6979057.
  25. Bennett S, Peters DH. Assessing National Health Systems: Why and How. Health Syst Reform. 2015 Jan 2;1(1):9-17. doi: 10.1080/23288604.2014.997107. PMID: 31519082.
  26. Roche R, Bain R, Cumming O. A long way to go - Estimates of combined water, sanitation and hygiene coverage for 25 sub-Saharan African countries. PLoS One. 2017 Feb 9;12(2): e0171783. doi: 10.1371/journal.pone.0171783. Erratum in: PLoS One. 2017 Mar 6;12 (3): e0173702. PMID: 28182796; PMCID: PMC5300760.
  27. Hsu J, Flores G, Evans D, Mills A, Hanson K. Measuring financial protection against catastrophic health expenditures: methodological challenges for global monitoring. Int J Equity Health. 2018 May 31;17(1):69. doi: 10.1186/s12939-018-0749-5. PMID: 29855334; PMCID: PMC5984475.
  28. Amaya-Lara JL. Catastrophic expenditure due to out-of-pocket health payments and its determinants in Colombian households. Int J Equity Health. 2016 Nov 10;15(1):182. doi: 10.1186/s12939-016-0472-z. PMID: 27832821; PMCID: PMC5105279.
  29. Barasa EW, Maina T, Ravishankar N. Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya. Int J Equity Health. 2017 Feb 6;16(1):31. doi: 10.1186/s12939-017-0526-x. PMID: 28166779; PMCID: PMC5294805.
  30. Global Burden of Disease Health Financing Collaborator Network. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet. 2019 Jun 1;393(10187):2233-2260. doi: 10.1016/S0140-6736(19)30841-4. Epub 2019 Apr 25. Erratum in: Lancet. 2021 Sep 11;398(10304):956. PMID: 31030984; PMCID: PMC6548764.
  31. Zegeye B, Shibre G, Haidar J, Lemma G. Socioeconomic, urban-rural and sex-based inequality in infant mortality rate: evidence from 2013 Yemen demographic and health survey. Arch Public Health. 2021 Apr 29;79(1):64. doi: 10.1186/s13690-021-00589-1. PMID: 33926550; PMCID: PMC8086275.
  32. Rudakemwa A, Cassidy AL, Twagirumugabe T. High mortality rate of obstetric critically ill women in Rwanda and its predictability. BMC Pregnancy Childbirth. 2021 May 25;21(1):401. doi: 10.1186/s12884-021-03882-7. PMID: 34034687; PMCID: PMC8144868.
  33. İKİNCİ KELEŞ A, KELEŞ G. A comparative analysis of world health systems and Covid-19. Journal of Experimental & Clinical Medicine. 2021 Apr 1;38(2). doi: 52142/omujecm.38.2.11.
  34. Hoffman SJ, Cole CB. Defining the global health system and systematically mapping its network of actors. Global Health. 2018 Apr 17;14(1):38. doi: 10.1186/s12992-018-0340-2. PMID: 29665828; PMCID: PMC5904998.
  35. Pratt B, Sheehan M, Barsdorf N, Hyder AA. Exploring the ethics of global health research priority-setting. BMC Med Ethics. 2018 Dec 6;19(1):94. doi: 10.1186/s12910-018-0333-y. PMID: 30522485; PMCID: PMC6282311.
  36. Steurs L, Van de Pas R, Delputte S, Orbie J. The Global Health Policies of the EU and its Member States: A Common Vision? Int J Health Policy Manag. 2018 May 1;7(5):433-442. doi: 10.15171/ijhpm.2017.112. PMID: 29764107; PMCID: PMC5953526.
  37. Larkan F, Uduma O, Lawal SA, van Bavel B. Developing a framework for successful research partnerships in global health. Global Health. 2016 May 6;12(1):17. doi: 10.1186/s12992-016-0152-1. PMID: 27154550; PMCID: PMC4859962.
Journal of Health Sciences & Surveillance System
Volume 11, Issue 2
April 2023
Pages 342-350
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