Health System Performance Assessment Framework for the Czech Republic

3. The Czech HSPA framework

This section presents the Czech HSPA framework and describes its domains and subdomains. While taking account of the development process that led to establishing and recognising common HSPA framework across health sector stakeholders, the stock of this project’s activities is described in Annex C.

3.1. The process

The Czech HSPA framework was developed in several iterations. The first draft was the output of interactive sessions of workshops 4 and 5, held in April 2022 (see Annex C). The working group members generated themes and ideas that were then grouped into common domains.

The framework was further elaborated on and refined throughout the next project phases, following the discussions and suggestions raised during the focus group meetings, the project management team meetings, the indicator selection process consultations, and the inputs from the High-Level Advisory Board members. The later took regular note of the framework development and approved the final version of the Czech HSPA framework on its meeting in April 2023.

3.2. The Czech HSPA framework domains, and subdomains

The Czech HSPA framework is composed of 12 domains grouped into 4 areas: Outcomes, Outputs, Processes, and Structures (Figure 3.1). The domains are further detailed out by 28 subdomains, covering different aspects of the Czech health system to align with the defined HSPA purpose and scope (see Sections 2.2 and 2.3).

Figure 3.1. The Czech HSPA framework

Source: The Czech HSPA project.

The ultimate Outcomes of the health system are covered within the Health Status domain, looking at life expectancy and mortality, avoidable mortality, people’s experienced health, and burden of disease. The domain of the Health Risks is placed a little aside because it focuses on people’s lifestyle and environment, which is not a direct outcome of a health system, but can be influenced, to some degree, for instance by prevention campaigns and improved health literacy. This domain thus covers topics grouped into lifestyle habits such as smoking and alcohol consumption, healthy diet, physical exercise, and risks imposed by the living environment.

The three domains in the Output area include measurements of the direct outputs of the health system, focusing on healthcare accessibility and quality and health system financial stability. The Access domain involves the three dimensions of accessibility of health services, along the definitions of healthcare financial affordability, geographical accessibility, and waiting times. Complementarily, the Quality domain features topics of healthcare safety, clinical effectiveness, people‑centredness, and care appropriateness. Finally, the Financial Stability domain looks at health system revenues, fiscal sustainability, and the public health insurance system functioning.

The area of Processes describes what is happening in the health system to reveal strengths and weaknesses related to healthcare organisation and delivery. Under the Integrated Care Delivery domain, the co‑ordination of health services is described as processes involving interactions of various healthcare providers, which are usually required to care for chronically ill people. Simultaneously, the Continuity of Care subdomain describes patient pathways and the smoothness of care delivery for a single diagnose or health event, and the Long-Term Care and Prevention subdomains complement the Care Integration domain. The second domain of Processes involves Cost-effective Care Delivery, focusing on areas where cost-effectiveness measurement is feasible: prescriptions, treatment costs, length of hospitalisations, and avoidable admissions. The Equitable Care Delivery aims to describe the inequalities in healthcare consumptions based on socio‑economic status, looking in particular at unmet healthcare needs due to specific reasons and for specific groups of population.

The last area of the Czech HSPA framework covers structures of the healthcare system, ranging from domains focusing on health workforce, to those focusing on eHealth and technologies, financing, and health system resilience.

The detailed description of subdomains of the Czech HSPA framework is provided in Table 3.1.

Table 3.1. Description of the Czech HSPA domains and subdomains

Area	Domain	Subdomain	Description
Outcomes	Health status	Life expectancy	The “life expectancy” area analyses life expectancy, healthy life expectancy and the main causes of death.
Outcomes	Health status	Avoidable mortality	The area of “avoidable mortality” aims at monitoring deaths from preventable or treatable causes.
Outcomes	Health status	Experienced health	The patients subjective experience of their own health
Outcomes	Health status	Burden of disease	The “burden of disease” area analyses the incidence and prevalence of the most common diseases and the occurrence of comorbidities.
Outcomes	Health Risks	Habits	Monitoring of behaviour related to risky lifestyle (i.e. substance abuse)
Outcomes	Health risks	Diet, nutrition	Monitoring of behaviour related to eating habits and diet
Outcomes	Health risks	Physical exercise	Monitoring of behaviour related to active lifestyle (i.e. physical exercise)
Outcomes	Health risks	Environmental risks	Monitoring of environmental risks for health.
Outputs	Access	Financial affordability	Financial affordability of healthcare services for the patients
Outputs	Access	Geographical accessibility	Geographical accessibility of healthcare services
Outputs	Access	Waiting times	Accessibility of health services in time
Outputs	Quality	Safety	Safety of care may be defined as “the degree to which the system does not harm the patient”
Outputs	Quality	Clinical effectiveness	Effectiveness of care is ’the degree of achieving desirable outcomes and the degree to which care is provided according to evidence (EBM).
Outputs	Quality	People‑centredness	The patients’ subjective experience with the health system
Outputs	Quality	Care appropriateness	Appropriate care is healthcare that is relevant with regard to the patient’s health status, clinical needs and current knowledge (i.e. care provided by a provider with the right expertise or level of specialisation, in the right time)
Outputs	Financial stability		Analysis of the income side of the system, analysis of the financial resources of the system and their stability (and sufficiency) over time.
Processes	Integrated care delivery	Coordination of care	Ongoing co‑ordination of multiple providers in the care of a chronically ill patient, including measurement of the consequences of insufficient co‑ordination (e.g. avoidable hospitalisations). (E.g., care of an ophthalmologist, diabetologist and GP for a patient with diabetes)
Processes	Integrated care delivery	Continuity of care	It measures the patient’s journey through the system (patient pathway), the continuity of patient care between individual providers within a single diagnosis (e.g. early rehabilitation after a heart attack)
Processes	Integrated care delivery	Long-term care	Indicators describing the functioning of long-term care and home care.
Processes	Integrated care delivery	Prevention	Ability of the system to avoid the occurrence of a disease (primary prevention, e.g. using vaccination), or to identify a disease as early as possible in order to initiate treatment without delay (secondary prevention, e.g. screening programmes).
Processes	Cost-effective care delivery		The indicators measure ways of providing healthcare that are considered cost-effective. It also measures the consequences of care failure, such as avoidable admissions.
Processes	Equitable care delivery		Availability of healthcare services to patients regardless of their sex, age, education or income
Structures	Workforce	Current Capacity	Current availability and capacity of medical personnel
Structures	Workforce	Future Capacity	Future availability and capacity of medical personnel
Structures	eHealth and technologies	Health information infrastructure	How fast and how easily are health-information accessible for the patient and for relevant providers
Structures	eHealth and technologies	Innovative treatments and technologies	Availability of hi-tech equipment and innovation in the healthcare sector
Structures	Financing		Analysis of the expenditure side of the healthcare system (e.g. by types of care, diagnoses)
Structures	Resilience		Ability of the healthcare system to absorb, respond to and adapt to unexpected events.

Source: The Czech HSPA project.

For additional information:

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

• HSPA framework development workshops

• Technical focus groups

• Study visit to Belgium