Health system performance assessment (HSPA)

Well-functioning health systems are essential to protect and improve population health. Therefore, the performance of the health care system requires regular assessment,  providing a kind of check-up of their functioning. This assessment process is called Health system performance assessment (HSPA).

Why do health systems need to be performant?

In Belgium, as in Europe, the population is ageing and health care needs are increasing. At the same time, the resources that can be allocated to health care are not extensible. Optimising health systems is therefore crucial, to efficiently enable the best possible health care for citizens.

What is the performance of a health system?

The performance of a health system is defined by a set of dimensions, including at least the quality, the accessibility, the sustainability and the equity of health care. These dimensions can be further subdivided. For instance, in Belgium the ‘quality’ dimension encompasses efficiency, safety, patient-centeredness and continuity of care.

What is a Health System Performance Assessment (HSPA)?

A HSPA is a process aiming to give an overview of the functioning of the health system through a set of indicators. 

Why perform a Health system Performance assessment?

The main goals of the HSPA in Belgium are to:

  • screen for performance problems in the different dimensions constituting the health system and report those to policy makers to support priority setting (warning function)
  • provide transparency and accountability to the citizens. Belgium has actually signed the Tallin Charter in 2008, which is a commitment of all European countries for accountability of health systems.  

How does it work?

Currently, the process of HSPA defined in the Tallin Charter is country-driven, meaning that each country decides on the specific goals and methods for conducting the assessment. The current situation is evolving towards a more standardised approach at European level. 

A set of indicators related to each dimension of the performance of the health system is defined. Indicator values are then measured and monitored over time. Those values are interpreted by comparing them with predefined objectives, or with the values of other (similar) countries. Tendencies over time are also examined.   

Is there a Health System Performance Assessment in Belgium?

Since 2010, the Belgian Health Care Knowledge Centre (KCE), Sciensano and the National Institute for Health and Disability Insurance jointly conduct a HSPA every 3-4 years in Belgium. A set of approximately 80 indicators is measured to assess each dimension of the performance.

How does the Belgian Health system perform?

The most recent HSPA was conducted in 2019. Download the full report

The main conclusions of the report are:

  • With regards to the quality of care, there is a room for improvement for several indicators, and more specifically with regard to appropriateness, safety and continuity of care.

  • Regarding financial accessibility, self-reported unmet needs for medical examination due to financial reasons is higher in Belgium than in the other EU-15 countries.

  • On the availability of workforce, the mean number of patients per nurse in acute hospitals is amongst the highest in Europe, which can have adverse effects on the quality of care.

  • Socioeconomic inequalities persist, with disadvantaged social people facing greater financial barriers to accessing healthcare compared to the most advantaged social group.

  • In terms of preventive care, the rate of influenza vaccination for the 65+ years is below the WHO target and decreasing. The coverage rates of organised breast cancer screening are low and stagnate. Furthermore, the coverage of organised breast cancer screening is too low to be effective. Finally, almost half of the population does not have regular contact with a dentist.

  • In the domain of mental health care, the high suicide rate remains challenging and no significant improvement has been observed over recent years. Waiting times for a first contact in ambulatory mental health centres are long and getting longer, pointing out problems in the accessibility and provision of mental health services in this setting. Finally, more than ten percent of the Belgian adult population is prescribed at least one antidepressant per year, and this consumption is still increasing.

  • In long-term and acute care for the elderly, several indicators show poor results in residential care. For example, almost half of the patients 75 years old and over living in residential care are prescribed antidepressants, the appropriateness of which may be questioned.

  • In the domain of care for mother and newborn, for example, the rate of caesarean sections  is below the EU average but there is important variability between hospitals, and repeated screening for toxoplasmosis during pregnancy is still very common, although the guidelines only state that a single test should be carried out prior to or at the beginning of pregnancy.

The full results can also be consulted on the website Healthy Belgium.  

Sciensano collects healthcare-related data from the general population and from health care providers. Sciensano is a principal partner in the Belgian health system performance assessment, coordinated by the Belgian Health Care Knowledge Centre (KCE). 

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