Performance Measurement

Health Systems are undoubtedly a critical component of each country's development and functioning, as far as the services offered for the wellbeing of the citizens are concerned. With significant amounts of money and resources spent towards improvement and service users' demands of high quality in care constantly increasing (Smith et al., 2010), delivering sustainable results should be one of the fundamental targets of a health system's regulation. Therefore, it is imminent not only to develop and implement an appropriate scheme and framework around health care provision, but also to continuously monitor and evaluate its performance in order to maintain effectiveness and overcome possible failures.

Managing and measuring the performance of such a complex system that is healthcare, however, is rather challenging especially when it comes to prioritizing which indicators should be perceived as part of the measurement process (Royal Statistical Society, 2004). Measurement indicators, as suggested by Roberts et al. (2008) should "reflect the results, consequences, or outcomes of the health sector". It is critical to define a set of specified indicators when measuring performance in order to target problematic areas and assess the overall functioning of a health system. Such indicators involve the framing of a clear set of goals that should be eventually achieved and intermediate measures that would serve for benchmarking and diagnosing deficiencies within the system. Following such a concept around the definition of performance measurement indicators, Roberts et al. (2008) proposes a set of goals and intermediate measures which define and evaluate a health system along the performance measurement process; namely:

Population health status: health status as a performance goal embodies the essence of health care provision, which is the population's wellbeing and may include measuring mortality, life expectancy and disease rates.

Citizen satisfaction: this goal refers to how satisfied citizens are with the level of services provided by reflecting their expectations, which may serve as further drivers for reform.

Financial risk protection: protecting the service users from "financial impoverishment" and ensuring that all users are provided a minimum level of economic opportunity is crucial as Roberts et al. (2008) suggests.

Efficiency: efficiency as an intermediate measure implies achieving the most out of the desired outcomes while dealing with limited resources. As very accurately highlighted by Roberts et al. (2008), in healthcare efficiency means "producing the right services in the right way", given the population expectations and demands.

Access: access as an intermediate measure for performance can be perceived in terms of 'physical' availability, which refers to available care provision inputs in comparison to population and in terms of 'effective'