Challenges of Measuring the Performance of Health Systems

Living reference work entry
Part of the Health Services Research book series (HEALTHSR)


Improving the measurement of the performance of health systems is a wise policy option for federal, provincial, and territorial governments because it provides essential information for understanding the inevitable trade-offs involved in trying to reduce costs while striving to improve quality of care, access, and the health of the population. Performance measurement – monitoring, evaluating, and communicating the degree to which health-care systems address priorities and meet specific objectives – is also garnering increased attention from many stakeholders at other levels of the system.


Canada Health care systems Health technology assessment Measurement Performance measurement 



This chapter is reprinted from Levy, Adrian R., and Boris G. Sobolev. “The Challenges of Measuring the Performance of Health Systems in Canada.” Health Care Federalism in Canada. Eds. Katherine Fierlbeck and William Lahey. Montreal: McGill-Queen’s University Press, 2013. Print.


  1. Alkin M. Evaluation roots: tracing theorists’ views and influences. Thousand Oaks: CA Sage; 2004.CrossRefGoogle Scholar
  2. Canadian Institute for Health Information (CIHI). Health indicators 2012.
  3. Evans DB, Edejer TT, Lauer J, et al. Measuring quality: from the system to the provider. Int J Qual Health Care. 2001;13:439–46.CrossRefPubMedGoogle Scholar
  4. Goeree R, Levin L, Chandra K, et al. Health technology assessment and primary data collection for reducing uncertainty in decision making. J Am Coll Radiol. 2009;6:332–42.CrossRefPubMedGoogle Scholar
  5. Health Canada – Health Technology Assessment Task Group on behalf of the Federal/Provincial/Territorial Advisory Committee on Information and Emerging Technologies Technology Strategy 1.0. 2004. Available at
  6. Hutton J, McGrath C, Frybourg JM, et al. Framework for describing and classifying decision-making systems using technology assessment to determine the reimbursement of health technologies (fourth hurdle systems). Int J Technol Assess Health Care. 2006;22:10–8.CrossRefPubMedGoogle Scholar
  7. Ibrahim JE. Performance indicators from all perspectives. Int J Qual Health Care. 2001;13:431–2.CrossRefPubMedGoogle Scholar
  8. Jacob R, McGregor M. Assessing the impact of health technology assessment. Int J Technol Assess Health Care. 1993;13:68–80.CrossRefGoogle Scholar
  9. Klazinga N, Stronks K, Delnoij D, Verhoeff A. Indicators without a cause. Reflections on the development and use of indicators in health care from a public health perspective. Int J Qual Health Care. 2001;13:433–8.CrossRefPubMedGoogle Scholar
  10. Lafortune L, Farand L, Mondou I, et al. Assessing the performance of health technology assessment organizations: a framework. Int J Technol Assess Health Care. 2008;24:76–86.CrossRefPubMedGoogle Scholar
  11. Levin L, Goeree R, Sikich N, et al. Establishing a comprehensive continuum from an evidentiary base to policy development for health technologies: the Ontario experience. Int J Technol Assess Health Care. 2007;23:299–309.CrossRefPubMedGoogle Scholar
  12. Levy AR. Categorizing outcomes of health care delivery. Clin Invest Med. 2005;28:347–50.PubMedGoogle Scholar
  13. Levy AR, McGregor M. How has extracorporeal shock-wave lithotripsy changed the treatment of urinary stones in Quebec? Can Med Assoc J. 1995;153:1729–36.Google Scholar
  14. Levy AR, Terashima M, Travers A. Should geographic analyses guide the creation of regionalized care models for ST-segment elevation myocardial infarction? Open Med. 2010;1:e22–5.Google Scholar
  15. Manitoba, Minister of Health and Healthy Living. Manitoba’s comparable health indicator report. Winnipeg: Manitoba Health; 2004.Google Scholar
  16. McGregor M, Brophy JM. End-user involvement in health technology assessment (HTA) development: a way to increase impact. Int J Technol Assess Health Care. 2005;21:263–7.PubMedGoogle Scholar
  17. Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harv Sch Public Health/WHO/World Bank; 1996; Report No. 1.Google Scholar
  18. Osbourne D, Gaebler T. Reinventing government. Lexington: Addison-Wesley; 1992.Google Scholar
  19. Raftery J, Roderick P, Stevens A. Potential use of routine databases in health technology assessment. Health Technol Assess. 2005;9:1–iv.CrossRefGoogle Scholar
  20. Roberts MJ, Hsiao W, Berman P, Reich M. Getting health reform right – a guide to improving performance and equity. Oxford, UK: Oxford University Press; 2008.CrossRefGoogle Scholar
  21. Roos LL, Gupta S, Soodeen RA, Jebamani L. Data quality in an information-rich environment: Canada as an example. Can J Aging. 2005;24 Suppl 1:153–70.CrossRefPubMedGoogle Scholar
  22. Roski J, Gregory R. Performance measurement for ambulatory care: moving towards a new agenda. Int J Qual Health Care. 2001;13:447–53.CrossRefPubMedGoogle Scholar
  23. Shepherd RP. In search of a balanced Canadian federal evaluation function: getting to relevance. Can J Program Eval. 2012;26:1–45.Google Scholar
  24. Snowdon A, Schnarr K, Hussein A, Alessi C. Measuring what matters: the cost vs. values of health care. Ivey International Centre for Health Innovation.
  25. Sobolev B, Sanchez V, Kuramoto L. Health care evaluation using computer simulation: concepts, methods and applications. New York: Springer; 2012; 480 pages ISBN: 978-1-4614-2232-7.Google Scholar
  26. Suissa S, Henry D, Caetano P, et al. CNODES: the Canadian network for observational drug effect studies. Open Med. 2012;6, e134.PubMedPubMedCentralGoogle Scholar
  27. Tu JV, Bowen J, Chiu M, et al. Effectiveness and safety of drug-eluting stents in Ontario. N Engl J Med. 2007;357:1393–402.CrossRefPubMedGoogle Scholar
  28. Velasco GM, Gerhardus A, Rottingen JA, Busse R. Developing health technology assessment to address health care system needs. Health Policy. 2010;94:196–202.CrossRefGoogle Scholar
  29. Weintraub WS, Grau-Sepulveda MV, Weiss JM, et al. Comparative effectiveness of revascularization strategies. N Engl J Med. 2012;366:1467–76.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Community Health & EpidemiologyDalhousie UniversityHalifaxCanada
  2. 2.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada

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