How to Evaluate the Performance of Health Care Systems

The annual open enrollment period for health benefits at workplaces is underway, and cost increases are expected to be steep again this year. A key concern is that rising medical costs threaten the solvency of state, local, and federal governments, as well as employers. It also imperils the economic security of tens of millions of workers and their families. And it is seen as one of the biggest barriers to expanding access to affordable, quality care for people who need it.

The term health care covers a wide range of actions and treatments to promote or maintain physical or mental wellness. It can include services such as hospital stays, surgery, physician visits, nursing care, home health aides, or pharmaceuticals. Health care can also refer to the larger system that delivers these services, including all of its policies and infrastructure.

Health care is different from other goods and services because it is considered to have a special social and moral dimension. It embodies not just the technical and practical aspects of preventing or curing illness but also a symbolic aspect, reflecting values such as mutual empathy and caring. Moreover, because the need for health care arises from events that are beyond people’s control, it has a disproportionately large impact on society.

For these reasons, it is more complicated to measure and evaluate the performance of health care systems than it is to measure and evaluate the performance of other goods and services. In addition, the impact of health care differs widely among people and between countries.

Despite these challenges, there are some measures that can help identify areas of potential improvement. These include the Organization for Economic Cooperation and Development’s “Mirror, Mirror 2024” report, which ranks 31 OECD countries by their performance on a variety of indicators. Those include access to care, cost, quality of care, efficiency, and equity.

The report’s methodology relies primarily on survey measures from patients and physicians. It finds that most of the highest-ranked countries, such as Australia and the Netherlands, perform less well on measures related to accessibility and quality of care than they do on other indicators. But the United States is an outlier in both of these dimensions, despite spending more than 16 percent of its GDP on health care.

In assessing the performance of health care systems, it is important to recognize that health outcomes are not solely determined by the quality of medical interventions. A number of other factors, called the social drivers of health, play a critical role in people’s susceptibility to disease and in their ability to benefit from available health care. The most influential of these factors are rooted in a person’s social circumstances, which extend far beyond the walls of a hospital or exam room. These factors, which vary between countries, are sometimes referred to as the “other health care gap.”1

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