Health systems performance assessment

Comparing the organisation of health systems

To understand better the organisation of health care systems and differences in health care resources in Member States, the EUCOMP 1 (Towards Comparable Health Care Data in the European Union) project was launched in 1999 under the EU Health Monitoring Programme. It was co-ordinated by the North Eastern Health Board (Ireland) with the support of Eurostat and all Member States. The intention was to produce results capable of application in all Member States, with a template for data collection and a toolkit for comparisons. The design of the questionnaire was characterised, firstly, by the inclusion of the list of health care functions from the Dutch CCP project and, secondly, by the functional classification established by OECD for the development of a system of health accounts. EUCOMP has succeeded in providing such a functional breakdown of health care systems for most countries of the European Union and for Iceland and Norway. Metadata have also been gathered to provide an interpretative framework for health care statistics in the future. The functional breakdown of health care systems makes it possible to show the differences between them. A good knowledge of these differences is indispensable in order to be able to judge whether comparison is possible and, if so, to what degree. The starting point for the functional breakdown was the assumption: "The package of functions (activities) in health care is stable, while the providers are different." From this, a questionnaire was developed, based on a list of functions and activities grouped according to the OECD classification of health care functions. Respondents were asked to indicate the functions of the actors known in their health care systems and to provide information on the modes of production using the terminology of the OECD, as far as possible.

The final output contains very useful material: Functional breakdown of health care systems, Glossaries, and EU country profiles in tabular format (Volume A, Volume B).

The EUCOMP 2 - More comparable Health Care Information in the European Union (Phase 2) project, co-ordinated by the North Eastern Health Board (Ireland) with the support of Eurostat and all Member States, will add further information and will also incorporate EU Candidate Countries. It is expected that the results of the EUCOMP project will be provided on a public website in the future. The main objectives are: (i) to improve the quality of the data so that they can be made available on the Commission server, initially to selected users - this will involve re-designing and re-programming the data obtained in EUCOMP so that existing information can be shared and published; (ii) to develop standardised techniques and protocols that can continue to be used by MS even when the project is completed - this will facilitate the updating of metadata in the future and will allow the national data of MS to be compared with European data; (iii) education of a network of MS representatives enabling them to return more comparable, better-quality information as required by the Commission and OECD; (iv) to enhance communication and understanding across MS, allowing information to be presented to the public across Europe based on our improved understanding of health care information; and (v) to explore the possibility of developing a prototype in one of the European countries.

For a good and detailed understanding of health systems in EU Member States and elsewhere, the way they are organised and funded as well as the main reform trends and policy developments, see the website of the European Observatory on Health Systems and Policies (EOHSP). This Observatory is a partnership including various international institutions (the European Commission, the World Health Organization Regional Office for Europe, the World Bank, the European Investment Bank), national governments and decentralized authorities (Belgium, Finland, Ireland, Netherlands, Norway, Slovenia, Spain and Sweden, the Veneto Region, the French Union of Health Insurance Funds), and academia (London School of Economics and Political Science, and London School of Hygiene & Tropical Medicine).

The country profiles (HiTs) produced by the EOHSP provide an analytical description of each health care system and of reform initiatives in progress or under development. HiTs seek to provide relevant information to support policy-makers and analysts in the development of health care systems in Europe. The HiT profiles are building blocks that can be used: to learn about different approaches to the organisation, financing and delivery of health services; to describe the process, content and implementation of health care reform programmes; to highlight challenges and areas that require more in-depth analysis; and to provide a tool for the dissemination of information on health care systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries.

See European Observatory on Health Systems and Policies - HiT country profiles