National Health Performance Framework report: August 2001

The National Health Performance Committee (NHPC) was formed at the request of the Australian Health Ministers' Conference to develop and maintain a national performance measurement framework for the health system. The NHPC is also required to establish and maintain appropriate national performance indicators within the national performance measurement framework for the purpose of its reporting.

In February 2000, the NHPC embarked on the development of a new Australian health performance framework. A Discussion Paper was disseminated widely for comment to jurisdictions, government and non-government providers, and consumers in the health system. An NHPC workshop to refine and improve the proposed framework was held in July 2000. The new framework has been adapted from the Canadian Institute for Health Information framework as part of the Canadian Roadmap Initiative that was established in 1999.¹

The NHPC undertook a scan of high level goals and objectives of the Commonwealth and State health systems and determined that the framework would provide relevant information on the attainment of those goals.

The framework has not been developed as a model of the health system. Rather it is designed to provide structure as to how we approach an appraisal of how well the health system is performing. The framework is expected to support benchmarking for health system improvement and to provide information on national health system performance. Through the promotion of the framework, the NHPC also aims to facilitate the use of data at the health service unit level for benchmarking purposes.

The framework consists of three tiers: Health Status and Outcomes, Determinants of Health and Health System Performance. These tiers do not represent a hierarchy but reflect the fact that health status and health outcomes are influenced by the impacts of health determinants and health system performance. Questions are posed for each tier and dimension and it is anticipated that performance indicators will be chosen or developed to provide answers to the questions that will give us a guide as to how well the health system is doing.

Four dimensions are presented in the Health Status and Outcomes section and include health conditions, human function, life expectancy and wellbeing, and deaths. The second tier includes the Determinants of Health and these are grouped into environmental factors, socioeconomic factors, community capacity, health behaviours and person-related factors.

Health System Performance has been grouped into nine dimensions of performance. A single indicator may provide information across one or more of the nine dimensions. For example an indicator relating to an intervention might additionally be considered across different populations and also within the context of the time taken to receive that intervention. Therefore the indicator reflects the effectiveness, accessibility and responsiveness of the intervention.

Quality in the performance framework is considered to be an integral part of the framework. The dimensions considered in determining the quality of the system are very similar to those measuring performance. A system will only perform well if it is delivering high quality interventions in a cost- effective manner.

In developing the framework, equity was explicitly mentioned as one measure of health system performance. However, it was clear that equity was integral to the entire framework, hence the question 'Is it the same for everyone?' in all three tiers. This approach will guide how the data is broken down and interpreted. Data will be considered at a national and state level, as well as by age, sex, place of residence, and socioeconomic status. Specific populations, groups or communities may be considered and may include Aboriginal and Torres Strait Islander peoples and non-English speaking people. Health status will be considered and then specific issues related to health determinants and system delivery will be explored to provide information on performance, as well as possible scope for improvement.

In this report, criteria for the selection and evaluation of performance indicators are proposed. Examples of performance measures relevant to each of the tiers are provided to illustrate dimensions of the tiers and to show how the NHPC will be using the framework for its annual performance report to Ministers. These examples do not represent the final selection of indicators for the 2001 or subsequent Performance Reports.

This report concludes with a discussion on indicator development and the nature of the annual reporting to Ministers.

In its Fourth National Report on Health Sector Performance Indicators (July 2000), the Committee set itself three key goals in addition to continuing the work of the National Health Ministers' Benchmarking Working Group, which had initially concentrated on the acute health sector. These goals are:

• to extend the national performance indicator framework for services other than acute inpatient
• services. This would include not only indicators of the overall health system's performance, but also for services such as community health, general practice and public health;
• to establish good links with, and take advantage of, the vast range of work being undertaken on performance indicator development across the nation; and
• to improve the timeliness of reporting of performance information.

The performance framework provides a valuable tool to identify trends and patterns, inform decision making, and evaluate progress of efforts to address health challenges.

1. Canadian Institute for Health Information and Statistics Canada (2000), Canadian Health Information Roadmap Initiative Indicators framework, Ottawa.