Universidade Federal de São Paulo, São Paulo, Brazil.
Universidade de São Paulo, São Paulo, Brazil.
Inquiry. 2020 Jan-Dec;57:46958020962650. doi: 10.1177/0046958020962650.
Due to the replacement of the issue of performance measurement in health policies worldwide this study identifies and analyzes the models for evaluating health systems performance. For this purpose, a systematic review of the literature on the topic "health systems performance evaluation" is done, making it compatible with a qualitative meta-synthesis of the type "meta-summarization." It works with all databases related to the theme (PubMed, Scopus, EMBASE, PubAdm and Lilacs/Scielo). Portuguese, English, and Spanish are elected as language limit. Of the total number of articles (n = 32), 23 articles (71.8%) do not have a definition on "performance." In those who have a definition, "performance" could be summed up in 6 central ideas. Among the most frequent subsidiary concepts that makes up the performance idea are the concepts of "efficiency" (11.9%), "quality" (9.5%) and "effectiveness" (7.1%). Six models were found in this review: "dashboard," "balanced scorecard," "open system model," "PCATool," "analyze dimension and performance indicators" and "standardized checklist and interview." The "dashboard" was the most frequent performance evaluation model, found in 35.7% of studies. Only 25% of the reviewed studies presented the performance evaluation model applied specifically to health systems. Far from being configured as management tools useful to comprehension of health systems, these performance evaluation models have shortcomings that compromise their systemic evaluative power. This reinforces the inversion of reality in the relationship between quality and performance. Also, the performance evaluation models used try to adapt to the object, however in most them with relevant analytical problems compromising the specificities in depth of the health system under analysis. This generates inaccuracies and replaces the question about its use and their limitations to compare health systems.
由于全球卫生政策中绩效衡量问题的更替，本研究确定并分析了评估卫生系统绩效的模型。为此，对主题为“卫生系统绩效评估”的文献进行了系统回顾，使其与“元综合”类型的定性荟萃分析兼容。它与所有与主题相关的数据库（PubMed、Scopus、EMBASE、PubAdm 和 Lilacs/Scielo）都兼容。选择葡萄牙语、英语和西班牙语作为语言限制。在总共（n=32）的文章中，有 23 篇（71.8%）文章没有对“绩效”进行定义。在那些有定义的文章中，“绩效”可以概括为 6 个核心思想。在构成绩效概念的最常见的次要概念中，包括“效率”（11.9%）、“质量”（9.5%）和“效果”（7.1%）等概念。在本次综述中发现了 6 种模型：“仪表板”、“平衡计分卡”、“开放系统模型”、“PCATool”、“分析维度和绩效指标”和“标准化检查表和访谈”。“仪表板”是最常见的绩效评估模型，在 35.7%的研究中发现。在审查的研究中，只有 25%的研究提出了专门针对卫生系统的绩效评估模型。这些绩效评估模型远未被配置为有助于理解卫生系统的管理工具，它们存在缺陷，从而损害了其系统评估能力。这加剧了质量与绩效之间关系的颠倒。此外，所使用的绩效评估模型试图适应对象，然而在大多数情况下，它们存在相关的分析问题，从而损害了被分析的卫生系统的深度特殊性。这会导致不准确性，并取代了关于其使用及其局限性的问题，以比较卫生系统。
