International Journal for Quality in Health Care 16:i65-i71 (2004)
International Journal for Quality in Health Care vol. 16 Supplement 1 © International Society for Quality in Health Care and Oxford University Press 2004; all rights reserved
Developing a national performance indicator framework for the Dutch health system
1 Department of Social Medicine, Academic Medical Centre, University of Amsterdam,
2 Ministry of Health, Welfare and Sport, The Hague, the Netherlands
Objective. To report on the first phase of the development of a national performance indicator framework for the Dutch health system.
Methods. In January 2002, we initiated an informed interactive process with the intended users—policymakers at the Ministry of Health, Welfare and Sport—and academics to develop both the conceptual framework and its content. Decisions were based on consensus after discussing strategic goals of the health system, information needs of policy makers at the Ministry of Health, Welfare and Sport, and studying existing theory and international experiences with national performance indicator frameworks. We identified objectives and criteria for a framework at the national level, constructed a conceptual model, and selected indicator areas.
Results. As a starting point we chose a balanced scorecard reflecting four perspectives towards health system management information at the national level. These perspectives are consumer orientation, finances, delivery of high quality care, and the ability to learn and grow. We then linked the Lalonde model for population health to a balanced scorecard model. The constructed model makes the relationship between population health and health system management apparent, and facilitates the presentation of performance information from various perspectives. The model reflects the strategic goals of the Dutch health system, i.e. contributing to the production of health by providing necessary health care of good quality that is accessible for all Dutch citizens while simultaneously informing policy makers about the performance of the entire health system in all sectors (care, cure, prevention, and social services). The selected indicator areas for health system management information (20 in total) reflect the policy and management functions of the government and the defined public goals of the health system. The model was formally adopted by the Ministry of Health, Welfare and Sport in February 2003, and since then individual indicator areas have been operationalized by 30 representatives of various departments at the Ministry with continuous external research support.
Conclusion. The merit of linking the balanced scorecard inspired model to public health data is that it facilitates the visualization of the contribution of the health system to the improvement of population health. The method of an intensive interactive indicator development process between policy makers and researchers has so far proven successful.
Keywords: balanced scorecard, health care evaluation mechanisms, health services research, health system, indicator framework, performance indicators, performance measurement, the Netherlands
Address reprint requests to A. H. A. ten Asbroek, Department of Social Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22600, 1100 DD Amsterdam, the Netherlands. E-mail: g.tenasbroek{at}amc.uva.nl
Accepted for publication November 17, 2003.