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Measuring Health Systems Performance Measuring Health System Performance: A Research Agenda Specific Research Aims Research questions Research questions Research questions Research questions Research Questions Research questions Research questions Research questions Forum of Federations / Forum desfédérationswww.forumfed.org forum@forumfed.orgMeasuring Health System Performance: A Research AgendaCost containment and quality improvement in health careUsing Cross-National Information in Domestic PolicyProblems of Measurement Problems of policy making SpecificResearchAimsContributing to the conceptual and technical development of quality and outcome indicators of health system performance.Investigating the link between performance measurement and performance improvement.Building academic expertise in the measurement of health system performance to contribute to the growing international interest in this subject.Research questionsPERFORMANCE MEASUREMENT AND POLICY–What impact does comparative performance assessment have on decision-making and policy development? –What evidence is there of the link between the expansion in performance assessment and policy change? –How do policy makers utilize analyses of comparative performance in the process of evaluating policy alternatives?Research questionsDIAGNOSTIC INDICATORS–Is it possible to define a small number of, or composite, ‘diagnostic’indicators of service and/or clinical quality as proxies for the wider array of possible indicators?–How would individual indicators be weighted in such an index? –Is it possible to build a ‘balanced scorecard’or a ‘maturity matrix’of health systems performance in the UK that enables UK health system performance to be compared and assessed over time? Research questionsINPUT-OUTPUT RELATIONSHIPS–What is nature of the relationships between indicators of resource input and indicators of health outcome?–What can be inferred, for example, about the performance of health systems, from comparisons of expenditure, real resources and population health?–Is it possible to develop robust statistical models of such relationships that enable resource needs to be estimated in individual health systems now and in the future? Research questionsIMPROVINGPERFORMANCE BY MEASURING PERFORMANCE–Does the measurement of health system performance improve performance?–Do health care organizations use indicators of relative performance to change individual and organizationalbehaviourin order to secure higher levels of performance?–What techniques and tools can help link performance assessment and performance? –What are the incentives to act on performance data? Research QuestionsBENCHMARKING PERFORMANCE–How can ‘benchmarks’of health system performance be set?–Is thisanalogous to the problem of target setting?Howdifficult should it be to be hit the target? –Does the setting of benchmarks and targets create perverse incentives that distort performance?–Is the publication of performance against benchmarks a ‘carrot’or ‘stick’? Research questionsPOLITICAL LEVELS AND MEASUREMENT–Are intra-system differences in performance greater than inter-system differences in performance? –How do ‘sub-national’health systems perform in comparison to similar systems in other places (e.g. deprived urban areas)?Research questionsPATIENT ASSESSMENTS OF PERFORMANCE–Can patient defined views of quality be built in to comparative assessments of system performance? –Do current policy directives to involve patients and the public in decisions about health systems need to be based on a sounder knowledge base? –Can emerging techniques for capturing patients’ views within anyone health system be extended to indicate aspects of best practice for comparisons across systems?–How should information about health systems performance be presented to the public? Research questionsKNOWLEDGE TRANSFER AND POLICY LEARNING–How is learning and knowledge about health system performance measurement transferred between health systems? –Can the link between comparative analysis and learning be improved? –How can we avoid ‘foreign’evidence falling victim to the perception of ‘domestic’policy makers and instead make greater use of evidence and evaluation?