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Health Economics and Management

Access to healthcare by the health system performance assessment

Mincho Minev, Maria Rohova

Abstract

Access to healthcare is one of the most commonly used domains in conceptual frameworks for health system performance assessment. Despite that, assessing the access to healthcare remains a challenge as there is no internationally accepted methodology for its measurement. Ensuring access to care is one of the recent struggles faced by health systems and relevant measures is expected to have a significant impact on their overall performance. To be effective, policy initiatives ought to be preceded by a substantial assessment of access to healthcare.
The study aims to identify the most commonly used indicators for measuring access to healthcare in the context of health system performance assessment. Through descriptive analysis of relevant scientific literature various definitions and understandings of the category have been identified and commented on. The most commonly used dimensions of access to healthcare are analysed, and the use of three of them is justified for its evaluation in Bulgaria. Based on the literature review, a total of 302 indicators that are identified for measuring access have been collected. Analyses of indicators highlight the most commonly used ones.
The final set of indicators for access assessment should enable scientists and policymakers to identify the main barriers, and thus to develop adequate policies. It should reflect international experience and be in line with national specifics, as well. Finally, the indicators should also provide an opportunity for international comparisons.

Keywords

access healthcare; performance assessment; indicators; health system

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References

Европейска комисия. Съобщение на комисията относно ефективни, достъпни и устойчиви системи на здравеопазване. Европейска комисия. COM (2014) 215 final, 2014. Достъпен на: http://ec.europa.eu/transparency/regdoc/rep/1/2014/BG/1-2014-215-BG-F1-1.PDF.

Заключения на Съвета на министрите на здравеопазването относно общите ценности и принципи в системите на здравеопазване в Европейския съюз. 22.6.2006. ОВ C 146. Достъпен на: https://eur-lex.europa.eu/LexUriServLexUriServ.do?uri=OJ:C:2006:146:0001:0003:EN:PDF.

Aday L, Begley C, Lairson D, Slater C, Richard A, Montova I. A framework for assessing the effectiveness, efficiency, and equity of behavioural healthcare. The American Journal of Managed Care. 1999. 5. p. 25-44.

Aday L, Anderson R. Equity of access to medical care: a conceptual and empirical overview. Medical Care. 1981. 19 (Suppl.). p. 4–27.

Allin S, Hernández-Quevedo C, Masseria C. Measuring equity of access to health care. In: Smith P, Mossialos E, Papanicolas I, Leatherman S, (eds). Performance measurement for health system improvement: experiences, challenges and prospects. Cambridge, UK. Cambridge University Press. 2009. p. 187–221.

Australian Institute of Health and Welfare. Australia’s health 2018. Australia’s health series no. 16. Canberra: Australian Institute of Health and Welfare. 2018. Available from: https://www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihw-aus-221.pdf.aspx?inline=true.

Braithwaite J, Hibbert P, Blakely B, Plumb J, Hannaford N, Long JC, et al. Health system frameworks and performance indicators in eight countries: a comparative international analysis. SAGE Open Med. 2017;5. Available from: https://doi.org/10.1177/2050312116686516.

Canadian Institute for Health Information. Health indicators 2013. Ottawa: Canadian Institute for Health Information. 2013. Available from: https://secure.cihi.ca/free_products/HI2013_EN.pdf.

Clark D. Dimensions of the concept of access to health care. Bulletin of the New York Academy of Medicine. 1983. Vol 59. No 1. p. 5-8.

Communication from the commission to the European parliament, the Council, the European economic and social committee and the Committee of the regions. Solidarity in health: reducing health inequalities in the EU. European Commission. COM(2009) 567 final. 2009. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52009DC0567&from=EN.

Department of Health. The NHS outcomes framework 2013/14. London: Department of Health; 2012. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213055/121109-NHS-Outcomes-Framework-2013-14.pdf.

Devos C, Cordon A, Lefèvre M, Obyn C, Renard F, Bouckaert N et al. Performance of the Belgian health system – report 2019. Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2019. Available from: https://kce.fgov.be/sites/default/files/atoms/files/KCE_313C_Performance_Belgian_health_system_Report.pdf.

ESIF – European Structural and Investment Funds. Technical Toolkit: set of indicators useful for the final evaluation of actions, developed under the project provision of support for the effective use of European structural and investment (ESI) funds for health investments. 2015. Available from: http://www.esifforhealth.eu/pdf/WP3%283%29_Indicators_FINAL_20150211.pdf.

European Social Survey. Round 7 Data. Data file edition 2.2. Norwegian Centre for Research Data. Data Archive and distributor of ESS data for ESS ERIC. Norway. 2014. Available from: doi:10.21338/NSD-ESS7-2014.

Eurostat. Unmet health care needs statistics. 2018. ISSN 2443-8219. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php/Unmet_health_care_needs_statistics#General_overview.

Evans B, Justine H, Ties B. Universal health coverage and universal access. Bulletin of the World Health Organization. 2013. 91:546-546A. Available from: http://hsrii.org/wp-content/uploads/2014/07/13-125450-11.pdf http://hsrii.org/wp-content/uploads/2014/07/13-125450-11.pdf.

Federaal Kenniscentrum voor de Gezondheidszorg. Een eerste naar het meten van de performantie van het Belgische gezondheidszorgsysteem. Federaal Kenniscentrum voor de Gezondheidszorg. Report number: 128 A; 2010. Available from: https://kce.fgov.be/sites/default/files/atoms/files/d20101027325.pdf.

Frenk J. The concept and measurement of accessibility. In: White KL, (ed). Health services research: an anthology. Washington, DC: Pan American Health Organization. 1992. Vol. Scientific Publication No. 534. p. 842-55.

Gauld R, Al-Wahaibi S, Chisholm J, Crabbe R, Kwon B, Oh T, et al. Scorecards for health system performance assessment: The New Zealand example. Health Policy. 2011; 103(2-3): 200-8.

Grech K, Podesta M, Calleja A, Calleja N (eds.). Report on the performance of the Maltese health system – 2015. Ministry for Energy and Health: Parliamentary Secretary for Health. 2015. Available from: https://deputyprimeminister.gov.mt/en/dhir/Documents/HSPA%20%20Malta%20Report%20-%20Final%20050416.pdf.

Health Consumer Powerhouse. Euro health consumer index 2015. Health Consumer Powerhouse. 2016. Available from: https://healthpowerhouse.com/media/EHCI-2015/EHCI-2015-report.pdf.

Hsiao WC. What is a health system? Why should we care? Cambridge, Massachusetts: Harvard School of Public Health. 2003. Available from: https://www.mediastudies.fpzg.hr/_download/repository/Hsiao2003.pdf.

Hurst J, Jee-Hughes M. Performance measurement and performance management in OECD health systems. Organisation for Economic Cooperation and Development Publishing (OECD Labour Market and Social Policy Occasional Paper, no. 47). Paris 2001. Available from: https://www.oecd-ilibrary.org/docserver/788224073713.pdf?expires=1566794512&id=id&accname=guest&checksum=FA50DF7F6EC04798B99B146EE2BFAA92.

Knowles J, Leighton C, Stinson W. Measuring results of health sector reform for system performance: a handbook of indicators. Partnership for Health Reform. Report number: 1. 1997. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.202.795&rep=rep1&type=pdf.

Koolman X. Unmet need for health care in Europe. Comparative EU statistics on income and living conditions: issues and challenges. Proceedings of the EU-SILC conference. Eurostat. Helsinki. 2007 p. 183-191. Available from: https://circabc.europa.eu/webdav/CircaBC/ESTAT/eusilc/Library/7_publications/SILC.pdf

Le Grand J. The strategy of equality: redistribution and the social services. George Allen and Unwin. London. 1982. Published online by Cambridge University Press: 20 January 2009

Masseria C, Allin S, Sorenson C, Papanicolas I, Mossialos E. What are the methodological issues related to measuring health and drawing comparisons across countries? Research note. Brussels: DG Employment and Social Affairs, European Observatory on the Social Situation and Demography. 2007. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.362.2893&rep=rep1&type=pdf.

Mielck A, Kiess R, von dem Knesebeck O, Stirbu I, Kunst A. Association between forgone care and household income among the elderly in five Western European countries – analyses based on survey data from the SHARE-study. BMC Health Services Research. 2009. 9: 52. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-9-52.

Mooney G. Equity in health care: confronting the confusion. Effective Health Care. 1983; 1(4): p. 179–185.

Murray C, Frenk J. A framework for assessing the performance of health systems. Bulletin of the World Health Organization. 2000; 78(6):717–31.

National Institute for Public Health and Environment. Dutch health care performance report 2014. National Institute for Public Health and the Environment; 2015. Available from: https://www.rivm.nl/bibliotheek/rapporten/2015-0050.pdf.

Organisation for Economic Co-operation and Development. Health at a glance: 2013. OECD indicators. OECD Publishing. Paris. 2013. Available from: http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf.

Organisation for Economic Co-operation and Development. Health at a glance: Europe 2018. State of health in the EU cycle. OECD Publishing. Paris. 2018. Available from: http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm.

Osborn R, Doty M, Moulds D, Sarnak D, Shah A. Older americans were sicker and faced more financial barriers to health care than counterparts in other countries. Health Affairs. 2017. Vol 36 No 12. Available from: https://www.commonwealthfund.org/publications/journal-article/2017/nov/older-americans-were-sicker-and-faced-more-financial-barriers.

Papanicolas I, Smith P, (ed.). Health system performance comparison: an agenda for policy, information and research. Maldenhead; Open University Press. 2013. Available from: http://www.euro.who.int/__data/assets/pdf_file/0009/244836/Health-System-Performance-Comparison.pdf.

Penchansky R. The concept of access, a definition. National Health Planning Information Center, Bureau of Health Planning Resources Development, Department of Health, Education and Welfare 1977.

Pechansky R and Thomas W. The concept of access. Medical Care FEBRUARY 1981. 19(2):127-14

Peric N, Hofmarcher M, Simon J. Headline indicators for monitoring the performance of health systems: findings from the European Health Systems Indicator (euHS_I) survey. Arch Public Health. 2018. 76(32).

Rachel B, Maresso A, van Ginneken E. Health system in transition – template for authors 2019. WHO Regional Office for Europe. 2019. Available from: http://www.euro.who.int/__data/assets/pdf_file/0009/393498/hit-template-eng.pdf?ua=1

Radley D, McCarthy D, Hayes S. Aiming higher: results from the Commonwealth Fund scorecard on state health system performance. New York: The Commonwealth Fund; 2017. Available from: https://interactives.commonwealthfund.org/2017/mar/state-scorecard/assets/1933_Radley_aiming_higher_2017_state_scorecard_FINAL.pdf

Saurman E. Improving access: modifying Penchansky and Thomas’s theory of access. Journal of Health Services Research & Policy. 2016. Vol. 21(1). p. 36–39.

Spranger A, Dimova A, Rohova M, Koeva S, Atanasova E, Koeva-Dimitrova L, et al. Over-utilising inpatient care: development and reforms to the Bulgarian hospital sector. Eurohealth. 2018. Vol. 24 (4) p. 25-28.

Szigeti S, Evetovits T, Gaal P, Pusztai Z, (eds.). Strengthening health system performance assessment in Hungary: analysis and recommendations. Copenhagen: WHO Regional Office for Europe. 2014. Available from: http://www.euro.who.int/__data/assets/pdf_file/0006/294882/Strengthening-HSPA-Hungary-Analysis-Recommendations.pdf.

Vrijens F, Renard F, Camberlin C, Desomer A, Dubois C, Jonckheer P, et al. Performance of the Belgian health system – report 2015. Belgian Health Care Knowledge Centre. Report number: 259C. 2016. Available from: https://kce.fgov.be/sites/default/files/atoms/files/KCE_259C_performancereport2015_0.pdf.

Vrijens F, Renard F, Jonckheer P, van den Heede K, a Desomer A, van de Voorde C, et al. The Belgian health system performance report 2012: snapshot of results and recommendations to policy makers. Health Policy. 2013; 112(1-2). p. 133-40.

World Health Organisation. Global reference list of 100 core health indicators. Geneva: WHO. 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/173589/WHO_HIS_HSI_2015.3_eng.pdf?sequence=1.

World Health Organisation. Global reference list of 100 core health indicators (plus health–related SDGs). Geneva: WHO. 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/259951/WHO-HIS-IER-GPM-2018.1-eng.pdf?sequence=1&isAllowed=y.

World Health Organisation Regional Office for Europe. Armenia health system performance assessment 2009. Copenhagen: WHO Regional Office for Europe. 2009. available from: http://www.euro.who.int/__data/assets/pdf_file/0020/103385/E92994.pdf?ua=1.

World Health Organisation Regional Office for Europe. Estonia health system performance assessment – 2009 snapshot. WHO Regional Office for Europe. 2009. Available from: http://www.euro.who.int/__data/assets/pdf_file/0015/115260/E93979.pdf?ua=1.

World Health Organisation Regional Office for Europe. Georgia health system performance assessment. WHO Regional Office for Europe. 2009. Available from: http://www.euro.who.int/__data/assets/pdf_file/0012/43311/E92960.pdf.

World Health Organisation Regional Office for Europe. Portugal health system performance assessment. Copenhagen: WHO Regional Office for Europe. 2010. Available from: http://www.euro.who.int/__data/assets/pdf_file/0006/131766/E94518.pdf?ua=1.

World Health Organisation Regional Office for Europe. Turkey health system performance assessment 2011. Copenhagen: WHO Regional Office for Europe. 2012 Available from: http://www.euro.who.int/__data/assets/pdf_file/0004/165109/e95429.pdf.

World Health Organisation. Everybody’s business: strengthening health systems to improve health outcomes. WHO’s framework for action. [online] Geneva: World Health Organization. 2007. Available from: https://www.who.int/healthsystems/strategy/everybodys_business.pdf.




DOI: http://dx.doi.org/10.14748/hem.v19i2.6248

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