Health Systems Performance Assessment: Debates, Methods and Empiricism

Front Cover
Christopher J. L. Murray, David B. Evans, D. B. Evans, Organisation mondiale de la santé
World Health Organization, Nov 6, 2003 - Health & Fitness - 927 pages
This volume reports on a large body of work led by the World Health Organization that is intended to strengthen the foundations for evidence-based policies aimed at health systems development. This has included work to develop a common conceptual framework for health systems performance assessment, to encourage the development of tools to measure its components, and to collaborate with countries in applying these tools to measure and then to improve health systems performance. It began with the enunciation of a framework that specified a parsimonious set of key goals to which health systems contribute, and the first set of figures on goal attainment and health system efficiency in countries that were Members of the Organization was published in The World Health Report 2000.

This book provides a uniquely comprehensive exploration of many different facets of health systems performance assessment. It will be relevant for researchers, students and decision-makers seeking a more detailed understanding of concepts, methods and the latest empirical findings. While most authors in this volume take a global perspective, the findings have important implications for the development of national performance frameworks and the creation of a culture of accountability.
 

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Contents

Western Pacific Regional Consultation on Health Systems Performance Assessment 95
93
Expert Consultation Reports
109
Technical Consultation on Concepts and Methods for Measuring
115
Technical Consultation on Effective Coverage in Health Systems 125
124
Technical Consultation on Stewardship
135
1 Tasks of the stewardship function
136
1 Mapping from unobserved latent variable to observed categorical response
140
Technical Consultation on Statistical Strategies for CrossPopulation Comparability 141
143
1 The dimensions of health system contributions
150
Technical Consultation on the Measurement of Health Inequalities 155
157
Concepts Data Sources and Methodology 185
182
1 Private and public health expenditures by function Sri Lanka
190
1 Health spending by income groups and regions
196
2 Inequality in health spending and income by region 2000
197
Financing
204
1 The process of developing indicators for the financing function
206
1 Indicators for the financing function
207
Provision and Coverage
221
Proposal for Monitoring
235
1 Expenditure shares to salary and drugs and supplies in eight LAC countries
237
4 Matrix of decision autonomy
241
2 Incentives
244
Valid DTP3 and Measles Vaccination in 40 Countries
251
1 Distribution of the probability of valid DTP3
254
1 Summary table of the four inequality indices for DTP3 and measles
255
Validity of Reported Vaccination Coverage in 45 Countries
265
1 DTP3 immunization coverage rates by birth cohort 19851998 from the DHS
267
1 Availability of health technology 1997
274
4 Comparison of total health expenditure THE and total investment in medical
276
1 Classification of human resources for health systems
277
10 Trends in total per capita investments in medical facilities in PPP terms
283
Stewardship
289
1 Health and disability in a single health domain
306
an illustration for mobility
312
Alternative Summary Measures of Average Population Health
319
1 Survivorship function for a population
321
1 SMPH criteria met by various forms of health expectancies
323
Data Methods Results
335
1 Trends in 45q15 from vital registration dataChina 19901998
338
3 Life expectancy at birth years both sexes combined top 10 and bottom
343
4 Distribution of malefemale difference in life expectancy at birth WHO Member
344
9 Availability of vital registration data on mortality in the WHO database
350
Principles Empirical Validation and Application 355
354
1 Annual logit life table values 190095 vs 1900 logit values US males
358
1 Life tables comprising the empirical dataset
360
6 Comparison of observed patterns of 5q0 and e0 vs CoaleDemeny model
365
Empirical Evaluation of the Anchoring Vignette Approach in Health Surveys
369
3 Consistent and near consistent orderings of vignettes by domain in 69
373
4 Median BDROCC across domains
379
6 28 selfresponse and vignette response patterns
385
11 Distribution of respondents in 69 multicountry survey studies by 28 selfresponse
386
8 Cutpoints and vignette ratings for all respondents
391
Unpacking Health Perceptions Using Anchoring Vignettes
401
1 Distribution of sample used in pilot study of health module for the World Health
403
Health State Valuations in Summary Measures of Population Health 409
408
1 Measurement framework for health state valuations
411
2 Regression models for visual analogue scale values
417
3 Average VAS score by condition and country
418
own health state
420
6 Characteristics of the multimethod study population
421
10 Estimation of valuation function
427
Methods for Measuring Healthy Life Expectancy
437
1 Life expectancy LE healthy life expectancy HALE and lost healthy years
438
1 Average HALE at birth males and females combined 191 Member States 2000
441
3 Overall prevalence YLD rates for WHO epidemiological subregions for
446
7 Estimated agestandardized prevalence YLD rate versus life expectancy at birth
451
7 Estimation of uncertainty in GBD prior estimates of comorbidityadjusted
452
13 Survey weights by age and sex 63 surveys in 55 countries 20002001
458
Health Inequality
471
1 Healthy life span for an individual
472
4 Mortality rates by age UK females 19011995
474
Adding Individual Variation to GroupLevel
485
1 DHS survey year and sample size
486
1 Distribution of probability of death between birth and age two 2q0 for Benin
488
Results from 39 Countries
497
country name
498
4 Correlation coefficients between measures in the income and burden space
527
Definitional
532
1 Current income permanent income and effective income
534
Summary Measures of the Distribution of Household Financial Contributions
543
1 Standard deviation of HFC and augmented standard deviation based on equal
548
3 HFC distributions Viet Nam and Zambia
553
7 Comparison of different summary measures
554
The Impact of Vertical and Horizontal Inequality on the Fairness in Financial
557
2 Concentration index of HFC CI_HFC vs percentage increase in FFC after
560
a Multicountry
564
1 Data sources and country codes
567
1 Proportion of households with catastrophic expenditures vs share of outofpocket
569
Responsiveness
573
1 Existing questionnaires that incorporate domains of responsiveness
576
2 Operationalization of the domains in the World Health Survey 2002
588
Classical Psychometric Assessment of the Responsiveness Instrument in
597
1 Criteria and approaches for constructing an instrument
598
1 Grouping of respondents completed questionnaires to responsiveness module
602
5 Average item missing rates by survey for 65 surveys
604
10 Confirmatory factor analysis standardized coefficientsinpatients
611
Analysis of Country Variation
631
1 List of 65 surveys analysed survey modes and respondent numbers
632
1 Question on the importance of responsiveness domains asked to respondents
633
3 Domain weights for eight domains across 65 surveys
639
4 Comparison of responsiveness domain weights from 65 national sample surveys
640
Population Surveys from
643
1 National health expenditure compared with inpatient and outpatient responsiveness
649
Population Surveys from 16 OECD Countries
653
1 Information on the countries analysed
654
1 Distribution of responsiveness for 16 countries
658
A1 Inequality scenario 1
664
Composite Attainment
667
1 Sample size and characteristics of surveys used
669
2 Relative weights assigned to the five health system goals by country
671
the Impact of Variability in
676
1 Alternative maximum attainment scores versus original World Health Report
679
SecondStage Efficiency Analysis 693
692
1 Distributions of estimated efficiency for health and overall attainment
694
1 Variables used in the secondstage analysis
695
3 Multivariate analysis for determinants of overall efficiency
697
Time Attribution and Multiple Indicators
699
Towards EvidenceBased Public Health 715
714
1 A taxonomy of evidence relating to population health and health systems
720
Statistical Models for Enhancing CrossPopulation Comparability
727
twostage partial credit
732
partial credit with covariates
733
HOPIT auxiliary question 2
738
hierarchical partial credit δ3
746
Estimating Permanent Income Using Indicator Variables
747
1 Hypothetical indicator cutpoints on the permanent income latent variable
750
3 Indicator variable ladder for 30 indicators Pakistan IHS 1991
756
WHO Multicountry Survey Study on Health and Responsiveness 20002001
761
1 Response category shift different rulers
764
1 Assessment instrument domains
766
2 Quality assurance steps for data
776
2 Distribution of survey countries by WHO regions
778
6 Sample population representativeness by survey mode
786
9B Relationship between missing data and representativeness for DHS surveys
789
11 Average cost per completed interview
790
The World Health Surveys
797
1 Different information collection modes for health information systems
798
1 Modules of the WHS instrument in 20022003
799
2 The WHS 20022003 geographical distribution of participating countries
804
Increasing Policy Relevance
809
1 Assessment of health system outcomes
813
1 Effect of increasing sample size on accuracy of sample and posterior estimates
818
CHOosing Interventions That Are CostEffective
823
1 Leading 10 selected risk factors as per cent of disease burden measured in DALYs
827
2 Annual costs and effectiveness for CVD risk factor interventions AmrA
831
Report of the Scientific Peer Review Group on Health Systems
837
1 Matrix for the assessment of human resource generation
856
3 Indicators discussed with the Scientific Peer Review Group Dec 2001
862
1 A framework for stewardship
869
2 Response category cutpoint shift
900
Index
917
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