Monday, June 12, 2017

Key Metrics to Measure Functioning of a Healthcare System

Helped a friend some time ago to research key metrics that a government can use to monitor the efficiency of its health system. Thought will share it on my blog as well.

The health metrics used by governments around the world are highly contextual, geared at their specific targets. The presented metrics are based on internet search and can be further improved by conducting country specific research and employing health care professionals. As a disclaimer, I am not a health specialists and have relied heavily on the WHO framework. All sources used are duly mentioned below the post. I have tried to zero down on 10 key metrics as a way to focus on the basics and with a belief that doing everything often means doing nothing. I believe that starting with these would give an excellent start and help put in place a framework to support further improvement.

The aim is to help policy makers save time by presenting a one page memo for key items to focus on that help them create a widespread image of efficiency and transparency (people feel the system is functioning well), aiming for KPI management. While a ground up build up of health system is ideal, the framework would help to address visible change. More fundamental question of how to ensure long term improvement of the health system (e.g. having enough medical staff in the long run, promoting healthy lifestyle, planning investment into beds/ equipment etc.) is not directly addressed by these, though inevitably these would have to be considered to deliver these metrics in the long run. Happy for suggestions to improve this keeping in mind the objective.

Please note that some metrics are measures (need effort to quantify but can be quantified), others are boolean flags (it is done or not done). Use of technology would be critical for measuring success.
My key 10 metrics are:
1. Under 5 mortality rate per 1000
2. % of pregnant women with  at least 4 antenatal care visits during last pregnancy
3. % of 1 year olds fully immunised
4. % of women reported knowing about means of avoiding sexually transmitted diseases/ HIV/ birth control
5. Premature mortality rate (% of people dying before reaching the average life expectancy) with causes
6. Respect for the dignity of the patient (includes aspects of the interaction with providers such as courtesy and sensitivity) using surveys
7. Prompt attention to health needs: time lag between a person identifying the problem & coming to the hospital (distance travelled to get to the facility), being seen by the doctor & provided medicine (promptness of care/ availability of enough doctors & nurses), and cured (effectiveness of diagnosis: segment by disease)
8. Availability of basic amenities for patients: clean waiting rooms, adequate beds, and healthy/clean food when admitted
9. Cost of service delivery benchmarked against a standard cost (calculation methodology to be same), including efficiency of purchasing (cost and quality)
10. Provision for strategic leadership, preparation of financial statements and independent audits

Other metrics that you may want to consider once you have the above in place are:
1. Under 5 chronic malnutrition per 1000
2. Analysis of consumer protection cases to identify problem hospitals
3. State of communication of existing government hospitals with each other so that resources can possibly be pooled
4. Availability of physicians, nurses, community health workers etc. as perceived by patients
5. % of population denied care due to cost (if significant, explore options/cost for social insurance, increasing competition, etc.)
6. Controls in place to reduce shrinkage (theft, corruption) and use resources more efficiently
7. Resource analysis by key health facilities (how much money comes from government, fund-raising, donations, NGOs)

Key Sources:
1. WHO Urban HEART: Measuring Urban Health
2. WHO Framework for Health System Performance Assessment
3. Measurement Framework: Evaluating Efficiency Across Patient-Focused Episodes of Care (NATIONAL QUALITY FORUM, US)
4. European Observatory on Health Systems and Policies (LSE)

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