Improving the reformance of health care systems : from measures to action : a review of experiences in four OECD countries / Zeynep Or

There is growing interest in improving the performance of health systems in OECD countries. Many countries are developing initiatives to measure performance to guide and inform the improvement process. Indeed, measurement and improvement are increasingly linked, as is indicated by familiar phrases such as ‘evidence-based medicine’ and ‘evidence-based policy’. This paper summarises the findings of an investigation of recent initiatives to better measure and improve health performance in four OECD countries: France, the Netherlands, New Zealand and Sweden. It highlights a number of case studies in these countries, which have been chosen to illustrate initiatives to improve performance, which paid greater or lesser attention to measurement issues. An attempt has also been made to describe the role of institutional arrangements as well as various policy and management “levers” which are used to bring about change. The case studies and discussion presented in this paper draw upon a more comprehensive report (presented in the Annex) which provides detailed case studies of various initiatives and locates them within the broader institutional context of each country’s health system. Tentative conclusions include: the evidence of success from some initiatives in measuring and improving quality of health services, such as Sweden’s National Quality Registers; the continuing need for self-regulation by health professionals and the case for financial and regulatory support to improve benefits from it; as well as increasing demand for more openness and accountability in health care provision; and the desirability of better evaluation of major health policy reforms, such as the setting up of internal markets. (Πηγή: Τεκμήριο)