Health System Goals and their Valuation

Presenter: Margreet Franken, Erasmus University, Rotterdam, The Netherlands

Abstract

Rationale:
Measuring health system performance is vital to health policy evaluation. Currently the Organisation for Economic Co-operation and Development (OECD) and the World Health Organisation (WHO) offer a framework for health system evaluation. The former framework does not allow valuation of its goals in order to obtain an overall measure of performance. The latter one does, but lacks a theoretical foundation. We present an enhanced framework that overcomes these drawbacks and we present relative weights for all goals.

Methods:
We unite the literature on equity, process utility, and health system goals to create theoretical underpinnings of a framework for the evaluation of health systems. This leads to five main goals of health systems. We perform a discrete choice experiment to obtain goal valuations.

Results:
Based on a theoretical framework we obtain five health system goals: health, equitable distribution of health, process utility, equitable distribution of process utility, and equitable distribution of financial contributions. The results of our discrete choice experiment show that –behind a veil of ignorance– all five health system goals significantly affect choice behaviour. An equitable distribution of health obtains the highest weight, followed by average level of health outcome and financial protection against the costs of illness. Average level of process outcome and the distribution of process outcome receive much lower weights.

Conclusions:
We present an international framework that builds on the WHO framework used for the World Health Report 2000. We describe the main goals of health systems and provide evidence of their relative importance. This framework and the goal weights enable international comparison of health systems and national comparison of health systems over time. This allows the evaluation of health policies and could thus help to build an evidence base for health policy making. We demonstrate the feasibility of measuring valuations for health system goals with a discrete choice experiment. Our goal valuations improve upon the methods used to generate previous health system goal weights, such as the weights used in the World Health Report 2000 and related WHO studies, since we use a multi attribute technique based on trade-off questions and obtain the valuations behind a veil of ignorance. Our results show that responsiveness or process utility is much less important than was previously thought. This applies to both in terms of level and the equity of its distribution. Consequently new weights will affect both country rankings and comparisons over time.