Why assessing healthcare strengths and weaknesses is so important

Comparing healthcare systems is as rewarding as it is difficult. Health systems are complex anyway, and differ in terms of structure, financing and national cultures. But most strive towards similar overarching aims on safety, quality, accessibility and equity. There’s also much European countries can learn from health system performance assessments as these can promote policy decisions on improving healthcare quality.

Comparing outcomes of our healthcare systems, it is clear that every country in Europe has its own strengths and weaknesses. Sweden, for example, rates high on measuring cancer survival, but low when it comes to care continuity and access to primary care. The UK gets good ratings on continuity and the coordination of care, but performs less well when it comes to breast cancer survival. Poland has a better ratio on that, but has a high rate of diabetes admissions to hospital. One could go on like this, but the bottom line is that all countries still have room to improve their quality, efficiency and general performance. To make a valid and constructive analysis of the underlying reasons for all these differences requires that a number of factors be considered.

Outcome data can be a useful tool for policymakers to detect areas of relative weakness that need improvement. Although the public reporting of outcomes is growing, we are still only at the beginning of this process.

A short survey conducted within an expert group in the EU showed that comparisons between countries was used less for learning than as fuel for political debates. Health systems’ performance assessments had only limited usefulness in policymaking probably because there is a lot more to be done to ensure measuring and reporting is relevant at a political level and can be translated into improving results.

One way to make these performance assessments more relevant is to use them more often at a political level. Today, we invest more in new indicators and ways to collect data than we do in communication. One could even say that the data that already exists is an unexploited goldmine, with some speaking of a data graveyard. Results are sometimes pushed out without any attention to their political usefulness, perhaps because they can be so hard to interpret. We therefore need to present data in ways that makes it much easier to understand. Graphic illustrations are important, and Italy has provided good examples of how to better visualise performance assessments. Another problem is that different contexts mean data has to be further analysed instead of presented in aggregate, but European countries have limited resources for interpreting data and looking for specific explanations.

A third factor is that health system performance assessments tend to be looked on as technical, and suited most to the administrative needs of statisticians and sometimes clinicians. This makes it important to focus assessments more on value-based healthcare, which basically means monitoring whether healthcare systems serve the fundamental aim of improving citizens’ health.

Value-based care is closely related to patient-centred care. In everyday life, shared decision-making, communication and information are important to patients, and looking on healthcare services from a patient’s perspective is increasingly related to better outcomes. Healthcare providers meet their patients for only a very limited time, while the patient lives 24/7 with his or her health problems. Patient experiences should therefore be prioritised when designing assessment indicators. So far the UK has been alone in collecting and using patients’ reports for addressing some diseases. This started with data collected for local improvement work where its limited local value led to wider distribution. Now that patient-reported data is being used more to support improvements, it should be seen as valid and reliable when assessing health systems. Logistics are a challenge, but this kind of data could in the fairly near future be collected through smart phones to support disease management for individuals.

A number of obstacles still need to be overcome if we are to make better use of outcome data. One is resistance to the exposing of data, as that will demonstrate that performances in different countries can vary greatly in quality. Before Sweden started to make its health system performance assessment reports public, there was a lively debate on data quality, on how its potential misuse – in other words, whether data that showed up poor results could lead to the blaming of under-performers. That was a heated debate 15 years ago, but today’s performance assessments show that it was a major driver for improvement. It also showed that poor performers seldom remained at the bottom of the league, but tended to improve and score better in the years that followed.

Assessing the performance of health systems is important at regional, national and international levels. There should be a standard measure for going through existing data, for mapping where we are today and seeing where there is potential for improvement. We should be guided by the knowledge that we have of our own systems, and by cooperation with other organisations. The EU’s work in this field demands close collaboration with the World Health Organisation as well as OECD, for the EU has unique strengths when it comes to making recommendations and guiding countries’ national efforts. Data and performance assessments should be not only nice-to-know but need-to-know when EU recommendations to member states are involved.

Better reporting and assessment may well yield results for a majority of people, but there is also a risk when we focus on the idea of there being an “average patient”. Among the challenges for Europe’s healthcare systems there are those that revolve around minority, vulnerable groups, the less educated and refugees from poorer countries. Their problems are often not easily spotted in overarching health system assessment reports and therefore need further analysis. Even where they can be detected, it is often not the clinical interventions that need improvement but things like access to treatment or to preventive care. This is true of a good many European countries. Performance quality may improve in average terms, but worsens for these underprivileged groups.

The EU as a whole has great potential for strengthening the use of transparent healthcare assessment. European countries could do even more to learn from one another so that their decision-making is based on best practice. The upshot could be a more efficient, patient centred healthcare for Europe’s citizens.