<%Language="VBScript" Response.Write "" %>
<%Language="VBScript" Response.Write "print" %>

Research Programs / Projects

DEVELOPMENT THE METHODOLOGIES FOR HEALTH SYSTEM PERFORMANCE ASSESSMENT

Background

Proper performance assessment of Russian health care system and of its regional subsystems is important to make a correct choice of public health care policy priorities, both on national and regional levels.

In 2000, the Report of the World Health Organization (WHO) proposed the criteria and the procedure of comparative health care performance assessment in various countries. These criteria indicate achievement of three basic goals of health care systems: 1) better health of population; 2) fairness in financial contribution; 3) responsiveness to people’s expectations in regard to non-health matter. Among health care system functions that enable to achieve these goals are the following ones: 1) delivering services; 2) financing; 3) creating resources; 4) stewardship. The WHO approach to comparative assessment could serve as a methodological basis for a set of indicators that compare performance of regional health care systems.

The Russian Federation has had some experience of elaboration methods to assess performance of health care systems; these methods have been used by some federal and regional public bodies. Russian government gave a new incentive to develop these methods when it started to implement result-oriented budgeting rules. Since 2004, as subjects of budget planning, federal ministries (including the Ministry of Health and Social Development) submit annual reports on their performance and main activities. Budget report includes a set of ministry goals and a set of indicators that evaluate their achievement. In a few next years, this practice will be implemented on regional level. Each subject of budget process focuses its reports on priorities in allocation of budget resources and outcomes of such allocation. Although this practice is quite important, it should be noted that due to budget process requirements, the framework of health care system assessment is narrower than in the WHO approach.

The WHO approach enables us to assess performance of territorial health care systems in more wide framework and to compare them with one another and with other countries. At the same time, the WHO approach needs much methodological work to adjust it for peculiarities of Russian health care system and possibilities of corresponding data collection.

The objectives of the project:
1) Analysis of data collection for developing the WHO comparative indicators of health care performance assessment;
2) Development a framework and a set of indicators to assess efficiency of Russian health care system and its territorial subsystems that reflect WHO's functional model of health system assessment and are relevant to the Russian health system, directions of its reforms, as well as its data collection capacity;
3) Elaboration the methodologies of data collection and processing to assess efficiency of territorial health care systems using the previously developed set of indicators.

Main outcomes of the project:

1. To implement the Project a Working Group was set up consisting of:
Ermakov S.P. – Head of the Department of the Moscow Oblast Compulsory Health Insurance Fund;
Kakorina Ĺ.P. – Deputy Director of Department of the Ministry of Health and Social Development of the Russian Federation;
Popovich L.D. – First Deputy Director General – Executive Director of insurance company “ROSNO-ĚS”;
Potapchik Elena G. – Adviser of the World Health Organization, Moscow representative office;
Frid E.M. – Executive Director of the Siberian Foundation for Development of Management, Social Sphere and Insurance;
Sheiman I.M. – Professor of the State University – High School of Economics;
Shishkin S.V. – Research Director of the Independent Institute for Social Policy.

2. The available experience of health system performance assessment in the Russian Federation was analyzed. The data ware capabilities were examined for a set of indicators used by the WHO for assessment of health systems performance.

3. The framework and the set of indicators to assess efficiency of Russian health care system and its territorial subsystems that reflect WHO's functional model of health system assessment and are relevant to the Russian health system, directions of its reforms, as well as its data collection capacity were elaborated.

The proposed set of indicators to assess the performance of regional health care systems in Russia is following:

1) The health status indicator - ĺhe disability adjusted life expectancy (DALE)
2) The index of distribution of health inequality in the population based on DALE calculated for local units in the framework of region
3) The index of overall responsiveness of health system that integrates eleven indices calculated on the data about the calls and complaints of citizens for different reasons that were addressed to the insurers in the compulsory health insurance system
4) The index of fairness of financial contribution on health care.
5) The index of overall health system attainment that integrates the first four indicators.
6) The index of structural efficiency based on three elementary indicators.

The following set of indicators might be used to assess on regional level the performance of municipal health care systems:

1) The health status indicator - the disability adjusted life expectancy (DALE)
2) The index of overall responsiveness of health system that integrates eleven indices calculated on the data about the calls and complaints of citizens for different reasons that were addressed to the insurers in the compulsory health insurance system
3) The index of structural efficiency based on three elementary indices.

The use of more narrow set of indicators to assess the performance of municipal health care systems is caused by constraints on availability of detailed data for each municipality needed for calculation the full set of indicators.

4. The framework, the set of indicators and methodologies were discussed on the seminars held on 10th April, 23th May, and 7th December with participation of the member of the working group, health care officials and experts.

5. The guidelines with detailed methodologies of data collection and calculation the indicators to assess the performance of regional and municipal health care systems was elaborated.

The guidelines has been passed to the Ministry of Health and Social Development.