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[:en]Measures and Methodology for Worldwide Comparisons of Well being Care System Efficiency: Closing Report[:]



Analysis Questions

  1. What measures of well being system efficiency can be utilized for worldwide comparisons?
  2. How a lot consensus was there amongst specialists on the significance, scientific acceptability, perceived feasibility, and value of measure constructs?
  3. Which of those measures may finally be proposed to OECD for consideration?

The Instant Workplace of the Secretary of the Division of Well being and Human Companies (HHS) is searching for to determine measures that might enhance the flexibility of the US and different nations to be taught from worldwide comparisons of well being system efficiency. To tell the identification of measures for worldwide comparability that might finally be proposed to the Organisation for Financial Co-operation and Growth (OECD), RAND Company researchers labored with a various group of 15 specialists in high quality measurement, scientific care, and well being economics to generate and prioritize potential measure constructs that align with HHS priorities and are notably promising for worldwide comparisons. Eight measure constructs had been recognized as having probably the most promise for worldwide comparability, however they’ll require extra growth work to determine their operational definitions and specs to make sure that any measure developed is legitimate and possible for worldwide comparisons of well being system efficiency. This report is designed to put a powerful basis for these future refinements by noting the diploma of consensus amongst specialists concerning the significance, scientific acceptability, perceived feasibility, and value of measure constructs; summarizing the strengths and limitations of the measure constructs; and offering extra context that may be helpful for informing the collection of measure constructs that may finally be developed into measures and proposed to OECD for consideration.

Key Findings

  • Of the 25 measure constructs included within the professional score course of, eight had been rated as having probably the most promise for worldwide comparisons: remedy and management of hypertension; entry to and protection for telehealth; quality-adjusted life expectancy; insurance coverage protection for psychological well being, behavioral well being, and substance abuse companies; receipt of preference-concordant end-of-life care; care continuity or constant supplier; entry to psychological well being suppliers; and knowledge switch and interoperability.
  • Ten measure constructs had been decided by specialists to carry promise however would require extra refinements previous to transferring towards the event of an operational definition: self-reported ache, entry to major palliative care, costs for brand-name and generic medication, diffusion of and entry to new pharmaceuticals, avoidable emergency division use, the proportion of sufferers with an opioid use dysfunction who had been referred to or prescribed medication-assisted remedy, estimates of administrative complexity and price, disadoption of ineffective medical companies, wholesome days at house, and availability of emergency medical companies to stop opioid demise.
  • Seven measure constructs weren’t mentioned due to their decrease preliminary rankings: clinician workforce who can prescribe medication-assisted remedy or naloxone, entry to opioid remedy facilities, the proportion of sufferers with a follow-up go to inside 4 weeks of beginning an opioid for power ache, time to regulatory approval for brand new pharmaceuticals, journey time to supplier workplace, well being care spending within the final 12 months of life, and spending on psychological well being (share of whole well being spending).


  • Pursue measure specification for promising measure constructs. In lots of instances, specialists pointed to present measures that could possibly be leveraged.
  • Develop tips for assessing well being care system efficiency. Some specialists felt that if a measure assemble could possibly be influenced by components outdoors of the well being system, that assemble was much less helpful for worldwide comparisons of well being care system efficiency given variations in populations, cultural preferences, and social situations throughout nations. Different specialists famous, nonetheless, that there could possibly be methods to account for these variations in evaluation to isolate the impact of well being system efficiency on the end result of curiosity.
  • Disentangle and prioritize associated constructs of entry, protection, utilization, and outcomes. A number of measure constructs targeted on problems with entry or protection, however specialists identified that protection for or entry to companies doesn’t essentially equate to applicable utilization of these companies or end in enhancements in well being outcomes.
  • Put money into creating novel measure constructs. Consultants supplied a variety of concepts that had been deemed not particular sufficient to advance to the score stage. These could possibly be good candidates for measurement growth work by HHS or different federal companies.
  • Provide refinements to present OECD measures. In Section 1, specialists nominated measure ideas for consideration. Many of those had been refinements to or expansions of present OECD measures, with options for extra specification or suggestions to additional parse out the info by key subgroups.

Desk of Contents

  • Chapter One


  • Chapter Two

    Measure Constructs That Maintain the Most Promise for Worldwide Comparisons

  • Chapter Three

    Measure Constructs That Obtained Decrease or Inconsistent Scores After Professional Dialogue

  • Chapter 4

    Measure Constructs That Have been Not Mentioned by Consultants

  • Chapter 5

    Beneficial Modifications to Current OECD Measures

  • Chapter Six

    Measure Constructs Requiring Growth

  • Chapter Seven

    Suggestions and Conclusion

  • Appendix A

    Proof Tables

This analysis was funded by the Workplace of the Assistant Secretary for Planning and Analysis and carried out by the Fee, Value, and Protection Program inside RAND Health Care.

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