Health System Performance Assessment Framework for the Czech Republic

1. Introduction

Health system performance assessment plays an integral role in ensuring that health systems are delivering quality care and health services to their patients. It is a critical tool for healthcare policy makers and is used to ensure that services are meeting the needs of the general population, patients, and healthcare providers. A health system performance assessment involves a routine assessment of performance of the health system overall – health outcomes, healthcare outputs, processes, and structures – in order to identify areas that need improvement, where resources can be allocated more efficiently, and if policy objectives are being met.

The Czech Republic lacked an HSPA framework, which had been considered by the national authorities a valuable approach for measuring and evaluating their health system. Due to the decentralised nature of the Czech healthcare system, in which healthcare responsibilities are shared across the central government, regions, insurers, and healthcare providers, an agreement on the governance structure of the Czech HSPA, together with a broad stakeholder involvement in the framework development process, was identified as a critical success factor from the very beginning of the project.

In mid‑2021, the EU-supported project on development of HSPA framework for the Czech Republic was launched. The action was funded by the European Union via the Technical Support Instrument, and implemented by the OECD, in co‑operation with the Directorate‑General for Structural Reform Support of the European Commission. The expected project outcome was to develop the Czech HSPA framework to enable the national authorities to implement an institutional framework for reporting health system performance indicators.

The present report is one of the key outputs of the Setting up a Framework for Health System Performance Assessment in the Czech Republic project. It describes in detail the final project version of the Czech HSPA framework, its domains and subdomains, and the indicators that were selected for the implementation of the first the Czech HSPA, which should follow up on this project. In addition, the report outlines the HSPA governance structure, agreed on by the main stakeholders, and details out the next steps in the HSPA implementation roadmap. Finally, the report takes stock of the Czech framework development process and the indicator selection process, which all contributed to the necessary HSPA capacity building in the country.

1.1. The Czech HSPA framework project

The Health System Performance Assessment (HSPA) frameworks have been developed and used across countries and regions in the previous decades and have brought stakeholders in the health sector together to share common health system objectives and support them to work together towards attaining higher health system goals. In its effort to establish a national HSPA, the Czech Republic is joining other countries which have been using, or are developing, their own HSPA frameworks. Most recently, the development of national HSPA frameworks has been systematically supported by the European Union (Albreht et al., forthcoming[1]).

The international experience suggests that to serve its purposes, several steps need to be taken to develop an operational country HSPA framework (for more information on concepts behind HSPA frameworks’ development and international practices, see Annex A). First, clear HSPA objectives must be defined, together with the scope of the HSPA analysis dimensions and units. Data availability should be reviewed, and policy priorities mapped to HSPA objectives. After an HSPA framework is developed, domains must be populated with relevant indicators that enable regular data updates and reporting in a timely manner. The selection should also consider the requirement of data accessibility and indicator usefulness to multiple stakeholders. Furthermore, the framework should be implemented in an objective, transparent, and consistent manner, and include quality assurance mechanisms, such as stakeholder review and consultation. Finally, each HSPA needs to be tailored to the needs of the specific country where it is implemented, so that the framework is relevant and meaningful for national priorities.

The Czech project of setting up an HSPA framework followed this international experience and practice. Moreover, the framework development and the indicator selection processes were managed in an inclusive, highly consultative, and iterative manner to support the feeling of ownership of the developed framework among national authorities and healthcare stakeholders. Figure 1.1 shows the overview of the Czech HSPA framework development project and Figure 1.2 depicts the project teams. The project was launched in September 2021 and ended in June 2023. The official launch event of the newly set the Czech HSPA framework took place on 24 May 2023, in Prague.

Figure 1.1. Overview of the Czech HSPA framework project

Figure 1.2. Project teams and their members

The project was steered by a high-level advisory board (HLAB). Its members included high-level representatives such as deputy ministers, directors, and heads of departments of involved stakeholders. The HLAB overviewed the whole project and oversighted its development. While following the project progress, it provided organisational perspectives and inputs on developed materials, and agreed on project intermediate and final outputs.

The project management team was composed of representatives of the Ministry of Health and the OECD team, and it met regularly during the whole project, prepared meeting agendas and meeting documents, and formulated proposals to be discussed during the working group and HLAB meetings. The OECD team provided the international expertise and knowledge, steered and moderated stakeholders’ discussions, and conducted review of available Czech health and health system data and its infrastructure, inter-institutional data flow and information sharing.

During the project, the total of 9 principal working group meetings took place (Table 1.1). Five of these meetings took the form of a dedicated workshop. As part of the project, the OECD also analysed the current the Czech health data landscape, carried out a series of 4 technical focus group discussions, and supported an international HSPA study exchange. These activities supported the development of the HSPA framework and were part of the inclusive indicator selection process (see Annex C).

Table 1.1. Principal Working Group meetings and workshops

Date	No of participants	Topic of the meeting
1 October 2021	35	The purpose and scope of the HSPA Framework in the Czech Republic
9 November 2021	40	HSPA Elsewhere – experiences with HSPA in other countries
27 January 2022	35	Czech Health Data Infrastructure – review of available health and health system data infrastructure, inter-institutional data flow and sharing
4 April 2022	30	Draft Framework Session 1 – searching for HSPA themes and domains search
5 April 2022	30	Draft Framework Session 2 – HSPA framework drafting
25 January 2023	27	HSPA framework update and next steps
24 March 2023	25	Populating the framework (part I)
27 March 2023	25	Populating the framework (part II)
24 April 2023	25	Finalising the framework

For additional information

Annex A: Concepts behind HSPA framework development and international practices.

Annex C: Process of determining the Czech HSPA framework domains.

• HSPA framework development workshops

• Technical focus groups

• Study visit to Belgium