such as "Introduction", "Conclusion"..etc
Ali R Tawfik-Shukor1,2, Niek S Klazinga1 and Onyebuchi A Arah1,3
of Social Medicine, Academic Medical Center, University of Amsterdam,
PO Box 22700, 1100 DE Amsterdam, The Netherlands
2Netherlands Institute for Health Sciences, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
for Prevention and Health Services Research, National Institute of
Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The
BMC Health Services Research 2007,
7:25doi:10.1186/1472-6963-7-25. [Open Access]
Given the proliferation and the growing complexity of performance
measurement initiatives in many health systems, the Netherlands and
Ontario, Canada expressed interests in cross-national comparisons in an
effort to promote knowledge transfer and best practise. To support this
cross-national learning, a study was undertaken to compare health
system performance approaches in The Netherlands with Ontario, Canada.
We explored the performance assessment framework and system of each
constituency, the embeddedness of performance data in management and
policy processes, and the interrelationships between the frameworks.
Methods used included analysing governmental strategic planning and
policy documents, literature and internet searches, comparative
descriptive tables, and schematics. Data collection and analysis took
place in Ontario and The Netherlands. A workshop to validate and
discuss the findings was conducted in Toronto, adding important
insights to the study.
Both Ontario and The Netherlands conceive health system performance
within supportive frameworks. However they differ in their assessment
approaches. Ontario's Scorecard links performance measurement with
strategy, aimed at health system integration. The Dutch Health Care
Performance Report (Zorgbalans) does not explicitly link performance
with strategy, and focuses on the technical quality of healthcare by
measuring dimensions of quality, access, and cost against healthcare
needs. A backbone 'five diamond' framework maps both frameworks and
articulates the interrelations and overlap between their goals, themes,
dimensions and indicators. The workshop yielded more contextual
insights and further validated the comparative values of each
constituency's performance assessment system.
To compare the health system performance approaches between The
Netherlands and Ontario, Canada, several important conceptual and
contextual issues must be addressed, before even attempting any future
content comparisons and benchmarking. Such issues would lend relevant
interpretational credibility to international comparative assessments
of the two health systems.
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