Study Of National Health System Performance Assessment Models:Theories And Methods

[Objectives] Since the World Health Report2000published and raised the concept of health system performance, the research on National Health System Performance Assessment develops rapidly. World Health Organization (WHO), World Bank (WB), Organization for Economic Co-operation and Development (OECD), European Union (EU), and Commonwealth Fund (CF) start to study the question. Meanwhile, the UK, USA, Australia, Canada and Netherlands, etc. also get much lesson during their national health system performance assessment. Then, national health system performance assessment play important roles in health performance monitor, health decision making, health resource planning, and the improvement of health information systems.However, China still did not establish health system performance assessment scheme or framework, and the researchers also study the theory and method systematically on health system performance assessment. Although there are differences between countries on the assessment for the politics, economics, culture and technologies, it is significant to learn from others through systematic and constructed comparison, such as theories and methods on national health system performance assessment. Then modify and improvement the models for Chinese health system performance assessment.To study and compare the national health system performance framework systematically. Summarize and investigate the theories and methods of national health system performance assessment, and development a national health system performance assessment models and framework to support the research and development of establish of Chinese health system performance assessment framework and scheme. [Methods] Data sources:(A), literatures, including related materials in international and domestic databases, Google Scholar and official website.(B). Regular health statistic data and the fourth and fifth national health services survey data of three provinces in the west of China.(C). The fifth national health services survey data of nine enhanced provinces distributed equably in the east, middle and west of China. Methods:(A). Descriptive Systematic Review and Scientometric methods were used to study the health system theories and methods, and combined with health system classification methods to select the sample countries.(B). System analysis method and comparison analysis method were combined with "ideal type" thinking to compare and investigate the national health system performance frameworks, simple countries’health system performance assessment practices and the core indicators and the method or rules to select them.(C). Unified Model Language (UML) was embedded into the health system performance framework construction pathway to improve the health system performance assessment model.(D). Statistics methods, such as benchmarking analysis method and inequality indicators to study China health system performance.[Results](A). Health system definition must contain both "hardware"-structure, and "software"-relations between structures and goals.(B). National health system performance framework could be classified into two groups based on objectives and functions: international comparative frameworks which were constructed by international organizations and used to compare the health system performance between different countries, such as WHO, WB, OECD, EU and CF; national assessment frameworks which were make up by countries and used to monitor or assessment one country’s health system performance.(C). The national health system performance assessment model contains six key steps:stakeholder participation, conceptual model selection, national policy and societal context analysis, framework construction, assessment implementation and management; and incentive mechanism. The framework construction process is the core step and including the framework objectives, health system borders, health system goals, health system components, framework establishment, and indicators selections.(D). General health system performance frameworks include health system goals, non-medical health factors, health system inputs and outputs. While the narrow health system performance framework only contains health system inputs and outputs sections. The non-medical health factors, health system inputs and outputs could influence the health system goals through population. Meanwhile, the healthcare system (including the inputs and outputs) could also contribution to the health system goals by non-medical health factors.[Conclusions](A). The "hardware","software" and "goals" of health system correspond to the "capability","process" and "outcome". Therefore a comprehensive health system performance assessment framework should contain the "basic structure","middle process" and "final goals" of health system.(B).Unifled Model Language is in according to the ideal of health system performance framework construction key pathway, which improving the pathway in theory and method. The "bottom to up" and "up to down" ideals are useful in construction of health system performance framework.(C).The general health system performance assessment framework model based on Lalonde health promotion model is comprehensive and flexible, which is appropriate for China. The healthcare systems are the core section for a country and the health system goals are the foundation of international comparison. More attention should be paid to both equity and efficiency.(D).Learning from the international lessons on health system performance assessment and the frameworks development, China should national level organization to manager the health system performance assessment, develop the national health system performance assessment frameworks system, improvement the health indicator sets, establish the incentive mechanism and publish the national health system performance assessment report regularly. Finally establish the national health system performance assessment scheme to support health decision making, health resource planning, and reach the goals of health system performance strengthen and population health status improving finally.[Innovations and Limitations] Innovations:(A). Scicentometrics and health system types methods were combined used to identify the classic simple countries.(B). National health system performance assessment key process model and National health system performance assessment framework construction key pathway are established with the common used theories and methods.(C). General national health system performance assessment framework model are constructed and tested in China. Chinese health system performance assessment framework was proposed and benchmarking methods are used during the assessment process. Limitations:(A). Social health insurance countries and low and middle income countries are not included as samples and lesson from them is missing.(B). The selection of indicators are short of quantitative evidences or methods.(C). The empirical study of China only contain parts of the health system performance assessment framework. Thus the integrated results could not reflect all the aspects of health system performance.