Abelson Julia, Allin Sara, Grignon Michel, Pasic Dianna, Walli-Attaei Marjan
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario L8S 4K1, Canada.
Canadian Institute for Health Information, 4110 Yonge Street, Suite 300, Toronto, Ontario M2P 2B7, Canada.
Health Policy. 2017 Jan;121(1):9-16. doi: 10.1016/j.healthpol.2016.10.007. Epub 2016 Oct 25.
Although a wide range of health system performance indicators are commonly reported on, there has been little effort to establish their relevance to the objectives that health systems actually pursue.
The aim of this study was to identify, explore and better understand health policy makers' views regarding the objectives and outcomes for their health systems, how they are prioritized, and the underlying processes that yield them to inform the development of health system efficiency measures.
A descriptive, qualitative methodology was employed using key informant interviews with 17 current and former senior health ministry officials in 8 Canadian provinces and 2 territories.
Health ministries have clearly stated objectives for health systems focused on the achievement of health system delivery and population health goals and, increasingly, public, patient and financial accountability. Acute care objectives are routinely prioritized over population health objectives and viewed as resulting from challenges associated with difficult trade-off decisions shaped by organized interests and the media rather than explicit, evidence-based processes.
This study provides insights beyond publicly available documents to explore the processes that underlie simple statements of health system objectives. Our findings suggest that despite respondents giving priority to improving individual and population health, it is more commonly portrayed as an ideal objective than as a realistic one. By understanding what lies behind statements about what health systems are striving for, we offer a more robust avenue for increasing the uptake of future studies of health system performance.
尽管人们普遍报告了广泛的卫生系统绩效指标，但几乎没有努力去确定这些指标与卫生系统实际追求的目标之间的相关性。
本研究的目的是识别、探索并更好地理解卫生政策制定者对其卫生系统的目标和成果的看法，了解这些目标如何确定优先次序，以及产生这些目标的潜在过程，以为卫生系统效率衡量标准的制定提供参考。
采用描述性定性方法，对加拿大8个省和2个地区的17名现任和前任卫生部高级官员进行关键信息人访谈。
卫生部对卫生系统有明确的目标，重点是实现卫生系统服务提供和人群健康目标，以及日益强调的公共、患者和财务问责制。急性护理目标通常比人群健康目标更受优先重视，并且被认为是由有组织的利益集团和媒体所形成的艰难权衡决策所带来的挑战导致的，而非明确的、基于证据的过程。
本研究提供了公开文件之外的见解，以探索构成卫生系统目标简单陈述基础的过程。我们的研究结果表明，尽管受访者优先考虑改善个人和人群健康，但这更常被描绘为一个理想目标而非现实目标。通过了解关于卫生系统所追求目标的陈述背后的情况，我们为增加未来卫生系统绩效研究的接受度提供了一条更有力的途径。
