Integrating the Population Perspective into Health System Performance Assessment (IPHA): Study Protocol for a Cross-Sectional Study in Germany Linking Survey and Claims Data of Statutorily and Privately Insured

Document Type: Study Protocol

Authors

Department of Health Care Management, Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany

Abstract

Background
Health system performance assessment (HSPA) is a major tool for evidence-based governance in health systems and patient/population-orientation is increasingly considered as an important aspect. The IPHA study aims (1) to undertake a comprehensive performance assessment of the German health system from a population perspective based on the intermediate and final dimensions defined by the World Health Organization (WHO) and (2) to identify differences in HSPA between (a) common user characteristics and (b) user types, which differ in their interactions and patterns of action within the health system.

 
Methods and Analysis
A cross-sectional survey was conducted between October and December 2018 with statutorily and privately health insured to assess the German health system from a population perspective related to the past 12 months. The random sample consists of 32 000 persons insured by AOK Nordost and 20 000 persons insured by Debeka. Data from the survey will subsequently be linked with health insurance claims data at the individual level for each respondent who has given consent for data linkage. Claims data covers the time period January 1, 2017 to June 30, 2018. The combination of the 2 data sources allows to identify associations between insured patient characteristics and differences in the assessment of health system performance. The survey consists of 71 items measuring all final and intermediate health system goals defined by the WHO and user characteristics like health literacy, self-efficacy, the attention an individual pays to his or her health or disease, the personal network, autonomy, compliance and sociodemographics. The claims data contains information on morbidity, care delivery, service utilization, (co)payments and sociodemography.

 
Discussion
The study represents a promising attempt to perform a holistic HSPA using a population perspective. For this purpose, a questionnaire was designed that contains both validated and new items in order to collect data on all relevant health system dimensions. In particular, linking survey data on HSPA with claims data is of high potential for assessing and analysing determinants of health system performance from the population perspective.

Keywords


  1. World Health Organization Regional Office for Europe. Pathways to health system performance assessment: a manual to conducting health system performance assessment at national or subnational level. Copenhagen: WHO Regional Office for Europe; 2013.
  2. Nuti S, Vola F, Bonini A, Vainieri M. Making governance work in the health care sector: evidence from a 'natural experiment' in Italy. Health Econ Policy Law. 2016;11(1):17-38. doi:10.1017/s1744133115000067
  3. Organisation for Economic Co-operation and Development (OCED). Health at a Glance: Europe 2018. Paris: OECD; 2018.
  4. Tawfik-Shukor AR, Klazinga NS, Arah OA. Comparing health system performance assessment and management approaches in the Netherlands and Ontario, Canada. BMC Health Serv Res. 2007;7:25. doi:10.1186/1472-6963-7-25
  5. World Health Organization (WHO). Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: WHO; 2007.
  6. World Health Organization (WHO). The world health report 2000: health systems: improving performance. Geneva: WHO; 2000.
  7. World Health Organization (WHO). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: WHO; 2010.
  8. Dorota BE. So what? Strategies across Europe to assess quality of care: report by the expert group on health systems performance assessment. Luxembourg: Publications Office of the European Union; 2016.
  9. Organisation for Economic Co-operation and Development (OCED). Health at a Glance 2017: OECD Indicators. Paris: OECD; 2017.
  10. Cylus J, Papanicolas I, Smith PC, eds. Health system efficiency: how to make measurement matter for policy and management. Copenhagen: WHO Regional Office for Europe; 2016.
  11. Valentine NB, Prasad A, Rice N, Robone S, Chatterji S. Health systems responsiveness: a measure of the acceptability of health-care processes and systems from the user’s perspective. In: Smith PC, Mossialos E, Papanicolas I, Leatherman S, eds. Performance measurement for health system improvement: experiences, challenges and prospects. 1st ed. Cambridge: Cambridge University Press; 2009:138-186.
  12. Busse R. Understanding satisfaction, responsiveness and experience with the health system. In: Papanicolas I, Smith PC, eds. Health system performance comparison: An agenda for policy, information and research. European Observatory on Health Systems and Policies series. Maidenhead, England: Open University Press; 2013:255-279.
  13. Coulter A, Cleary PD. Patients' experiences with hospital care in five countries. Health Aff (Millwood). 2001;20(3):244-252. doi:10.1377/hlthaff.20.3.244
  14. Weldring T, Smith SM. Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs). Health Serv Insights. 2013;6:61-68. doi:10.4137/hsi.s11093
  15. Fujisawa R, Klazinga NS. Measuring patient experiences (PREMS): progress made by the OECD and its member countries between 2006 and 2016. OECD Health Working Papers. No. 102. Paris: OECD; 2017.
  16. Sirven N, Santos-Eggimann B, Spagnoli J. Comparability of health care responsiveness in Europe. Soc Indic Res. 2012;105(2):255-271. doi:10.1007/s11205-011-9880-z
  17. Bleich SN, Ozaltin E, Murray CK. How does satisfaction with the health-care system relate to patient experience? Bull World Health Organ. 2009;87(4):271-278. doi:10.2471/blt.07.050401
  18. Anzahl der Krankenkassen im Zeitverlauf- Konzentrationsprozess durch Fusionen (Angaben zum Stichtag 1.1). GKV-Spitzenverband; 2018.
  19. Versicherte je System in Prozent. GKV-Spitzenverband; 2019.
  20. Zahlen und Fakten. Verband der Privaten Krankenversicherung; 2018.
  21. Röttger J, Blümel M, Engel S, et al. Exploring health system responsiveness in ambulatory care and disease management and its relation to other dimensions of health system performance (RAC) - study design and methodology. Int J Health Policy Manag. 2015;4(7):431-437. doi:10.15171/ijhpm.2015.97
  22. Brooks R, Rabin R, de Charro F. The Measurement and Valuation of Health Status Using EQ-5D: A European Perspective: Evidence from the EuroQol BIOMED Research Programme. Dordrchet: Kluwer Academic; 2003.
  23. Statistische Ämter des Bundes und der Länder. Leben in Europa 2013 Personenfragebogen; 2013.
  24. Valentine N, Darby C, Bonsel GJ. Which aspects of non-clinical quality of care are most important? Results from WHO's general population surveys of "health systems responsiveness" in 41 countries. Soc Sci Med. 2008;66(9):1939-1950. doi:10.1016/j.socscimed.2007.12.002
  25. Üstün TB, Sonmath C, Abdelhay M, Murray CJL, WHS Collaborating Group. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health systems performance assessment: debates, methods and empiricism. Geneva: WHO; 2003.
  26. de Silva A. A framework for measuring responsiveness. GPE Discussion Paper Series: No. 22 32. Copenhagen: World Health Organization; 2000.
  27. Röttger J, Blümel M, Fuchs S, Busse R. Assessing the responsiveness of chronic disease care - is the World Health Organization's concept of health system responsiveness applicable? Soc Sci Med. 2014;113:87-94. doi:10.1016/j.socscimed.2014.05.009
  28. Alvarez-Galvez J, Salvador-Carulla L. Perceived discrimination and self-rated health in Europe: evidence from the European Social Survey (2010). PLoS One. 2013;8(9):e74252. doi:10.1371/journal.pone.0074252
  29. Böcken J, Braun B, Meierjürgen R. Gesundheitsmonitor 2016: Bürgerorientierung im Gesundheitswesen. Gütersloh: Verlag Bertelsmann Stiftung; 2016.
  30. Statistische Ämter des Bundes und der Länder. Leben in Europa 2017 Personenfragebogen; 2017.
  31. Organisation for Economic Co-operation and Development (OCED). Tackling Wasteful Spending on Health. Paris: OECD; 2017.
  32. Schoen C, Davis K, Stremikis K. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update. The Commonwealth Fund; 2010.
  33. Perić N, Hofmarcher MM, Simon J. Headline indicators for monitoring the performance of health systems: findings from the european Health Systems_Indicator (euHS_I) survey. Arch Public Health. 2018;76:32. doi:10.1186/s13690-018-0278-0
  34. Osborn R, Squires D, Doty MM, Sarnak DO, Schneider EC. In new survey of eleven countries, US adults still struggle with access to and affordability of health care. Health Aff (Millwood). 2016;35(12):2327-2336. doi:10.1377/hlthaff.2016.1088
  35. Böcken J, Braun B, Meierjürgen R. Gesundheitsmonitor 2014: Bürgerorientierung im Gesundheitswesen. Gütersloh: Verlag Bertelsmann Stiftung; 2014.
  36. Braun B, Böcken J, Landmann J. Gesundheitsmonitor 2010: Bürgerorientierung im Gesundheitswesen. Gütersloh: Verlag Bertelsmann Stiftung; 2011.
  37. Himmel K, Schneider U. Ambulatory Care at the End of a Billing Period. Research Paper 14. Hamburg Center for Health Economics; 2017.
  38. Sørensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80. doi:10.1186/1471-2458-12-80
  39. The HLS-EU Consortium. HLS-EU-Q - Measurement of health literacy in Europe: HLS-EU-Q47, HLS-EU-Q16, and HLS-EU-Q86; 2012.
  40. Sørensen K, Pelikan JM, Röthlin F, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015;25(6):1053-1058. doi:10.1093/eurpub/ckv043
  41. Bandura A. Self-efficacy and health behaviour. In: Baum A, Newman S, Wienman J, West R, McManus C, ed. Cambridge Handbook of Psychology, Health and Medicine. Cambridge: Cambridge University Press; 1992:160-162.
  42. Glanz K, Rimer BK, Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice. John Wiley & Sons; 2008.
  43. Beierlein C, Kovaleva A, Kemper CJ, Rammstedt B. Ein Messinstrument zur Erfassung subjektiver Kompetenzerwartungen: Allgemeine Selbstwirksamkeit Kurzskala (ASKU). GESIS-Working Papers 17. GESIS - Leibniz-Institut für Sozialwissenschaften; 2012.
  44. Altenhöner T, Philippi M, Böcken J. Health behaviour and changes in health behaviour - are education and social status relevant? (German).  Gesundheitswesen. 2014;76(1):19-25. doi:10.1055/s-0033-1333729
  45. Koch-Institut R. Fragebogen zur Studie “Gesundheit in Deutschland aktuell”: GEDA 2014/2015-EHIS. Journal of Health Monitoring. 2017;2(1):105-135.
  46. Coulter A. Can patients assess the quality of health care? BMJ. 2006;333(7557):1-2. doi:10.1136/bmj.333.7557.1