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 performed in 2015. Download the full report

Main conclusions from the report:

  • A large proportion of the Belgian population reports to be in good health and to be satisfied with their contacts with the health system, especially in ambulatory care. 
  • While the accessibility of the health care system is pursued by a universal insurance coverage and social security measures, some concerns subsist: the share of out-of-pocket payments is high and the unmet medical needs for financial reasons remains substantial, especially in the lowest income group.
  • Many aspects of the quality of care are rather good, for instance the effectiveness of care. However, the appropriateness of care (for instance, prescription of antibiotics or medical imaging exams) should improve. 
  • Preventive care does not always meet international coverage targets (cancer screening, vaccination) in elderly, and some vaccination in children).
  • Several lifestyle indicators show poor results, inviting for health promotion interventions. The report mentions for instance a stagnation of obesity in adults, the still high prevalence of daily smokers, the low rate of physical activity practice and risky alcohol consumption (binge drinking) in young men.
  • Some of the mental health and mental health care indicators are alarming. Suicide rates remain high, hospitalisation rates in psychiatric wards continue to increase, as does the use of antidepressants. Waiting times for a first contact with mental health centres are long, questioning the accessibility of those services.

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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