Health System Performance Assessment Framework for the Czech Republic

Annex B. Defining the HSPA scope and purpose in line with national health priorities

Operationalising the Czech HSPA scope and purpose

Table A B.1. Practical applications of the Czech HSPA scope and purpose

HSPA purpose statement	Potential practical applications
Assessing health status development	Indication whether development is going in the desired direction, i.e. leading to the ultimate goal of improving the population health For policy and decision makers (incl. Ministry of Health, SZÚ, health insurance funds, Parliament) and professional public to feed public debate on policy priorities For media and general public to gain better understanding of population health status development
Evaluation of changes in health sector performance	Increasing accountability of principal stakeholders, namely healthcare providers and health insurance funds Supporting stakeholders to know what to focus on in their agendas Enabling stakeholders to evaluate implemented measures
Assessment of healthcare quality development	Increasing accountability of principal stakeholders, namely healthcare providers and health insurance funds Supporting stakeholders to know what to focus on in their agendas Enabling benchmarking among healthcare providers that will lead to higher quality of care Improved international benchmarking, leading to further boost of care quality increases.
Evaluation of outcomes and impacts of health policy measures and health system investments	Tracking progress on reaching goals stated in the National Strategy document Health 2030 Assessing the performance of investments to improve health system, including access, efficiency, and resilience Strengthening the public reporting function
Assessment of healthcare accessibility for everyone (geographical, timely, and financial dimension)	Increasing accountability of health insurance funds Enabling evidence‑based decisions for workforce planning Improving equity in access to healthcare Strengthening financial protection in healthcare consumption

Source: The Czech HSPA project, HLAB meeting in June 2022.

The Health 2030 strategy goals

The Strategic Framework for Developing Healthcare in the Czech Republic to 2030 (Health 2030) focuses on three strategic goals, which are broken down into seven specific objectives (see Figure A B.1).

Figure A B.1. The Health 2030 strategic goals cover population health, health system performance and science and research

Source: MZČR (2020[2]).

The HSPA framework contributes to the goals and sub-goals mentioned in the strategy, particularly in relation to analytical assessments and by including health status and health risk indicators. Details of indicators cited in the Health 2030 are described in Table A B.2; many of these were also selected to populate the Czech HSPA framework (see Annex D).

Table A B.2. Indicators discussed in Health 2030 in relation to specific objectives

Specific Objective	Indicator cited in Health 2030
1.1. Primary care reform	Total number of physicians Average age of general practitioners Ratio of outpatient specialists to general practitioners Doctors per 1 000 inhabitants Number of outpatient visits (to specialists) Number of outpatient visits (to GPs) Preventive examination of children Preventive examination in adults
1.2 Disease prevention health promotion and improvement of health literacy	Vaccination coverage Ratio of antimicrobial resistance Health literacy (using a standardised scale) Obesity rates (for children and adults) Physical activity rate Fruit and vegetable consumption (by income level) Adolescent tobacco and cannabis use Current daily smokers Alcohol consumption (for children and adults) Illegal drug use Breast cancer mortality Cervical cancer mortality Colon cancer mortality Rectal cancer morality
2.1 Integration of care models and of health and social care, mental health care reform	Life expectancy Chronic illness Chronic illness in older adults # of diagnosed cancers # of patients treated for chronic respiratory disease # of patients with hypertension # of LTC recipients (older adults) # of LTC recipients (disability) Hospitalisations in the last three months of life for seriously ill patients Cause of death from chronic conditions Integration of health and social care # of recipients of community based mental health care
2.2 Healthcare workforce retention and strengthening 2.3 Digitisation 2.4 Optimisation of the payment system	# of working hours of active doctors, dentists and pharmacists per 1 000 inhabitants # of doctors in the hospital per 100 000 inhabitants Average age of physicians Outpatient surgical care w/ digital infrastructure Share of inpatient expenditure of total health budget # of medical graduates # of outpatient doctors # of dentists # of nurses per 1 000 inhabitants # of nurses in hospital care Average physician salary (public setting) Average physicians wage (private setting) Average nurse salary Access to LTC Percentage GDP on healthcare (international comparison) Effectiveness of health expenditure
3.1 Improvement of science and research in addressing the health sector priority objectives	Impact of research on productivity Research on health status Impact of technology on productivity Use of innovative technologies and medicines