27 September 2017
Why compare healthcare in NSW internationally?
One of BHI’s core functions in supporting the accountability of the healthcare system in NSW is to benchmark performance with comparable health systems. Looking at what is being achieved in other systems or countries can help identify and prioritise performance gaps and potentially to focus resources where they are likely to have the greatest impact. Comparisons also help us to recognise and better understand where NSW performs well.
Choosing countries to compare our health system with is not without challenges. Healthcare in each country and region is based on a wide range of histories, economies and amidst changing cultures and populations. Organisation for Economic Co-operation and Development (OECD) and the Commonwealth Fund International Health Policy Survey, are reliable sources of health care information, based on peer countries with developed economies and comparable levels of resources devoted to healthcare.
What do we see when we compare?
NSW does perform relatively well. Healthcare in Focus 2016, BHI’s annual performance report, shows the NSW result is among the top quarter of countries for nearly 40% of the 37 internationally comparable measures focused on appropriate and effective hospital care, continuity of care and access to care. NSW performance is strong on measures of hospital processes and patient centeredness, medication management, and care management, but weaker relative to other countries on measures of waiting times for elective surgery and patient safety following surgery.
Comparisons are an important part of the picture, but don’t tell us everything.
‘Better than others’ doesn’t necessarily mean good enough. NSW is among the top 25% of countries for the percentage of people with chronic conditions saying they have a written plan to manage their condition, however only 50% have a plan. Further, some population groups don’t fare as well. The report shows people experiencing emotional distress have higher levels of unmet need in NSW relative to comparator countries.
Methods, summary methods, and developing better ways to turn data into information can help broaden the picture.
Performance is commonly assessed across several domains using a variety of survey and administrative sources. One benefit of using international survey data is that the same question is asked across all countries, which adds a valuable patient perspective to international comparisons. A challenges in summarising international comparisons is to bring several measures information together. Using standardised scores, which are representing the relative difference to the country average, we can place measures of safety incidents per 100,000 surgeries beside median waiting times for surgery and measures of the percentage of people who said they had foregone healthcare due to cost, and see where NSW stands out.
Beyond methods and measures, how can we better turn data into actionable information, accessible to those who can act on it?
There is a growing requirement and expectation to produce suites of data products that meet several needs: to share findings in a publicly accessible way; to generate summary statements and discussions of the performance healthcare in NSW; to bring high quality performance results to a wider audience, while being transparent and statistically sound. Towards this end, BHI is developing tools such as chart packs (below) to present high level findings in a clear manner and to better support healthcare providers and decision makers in performance improvement. To ensure transparency, we also provide data tables and technical supplements to help those who want to drill down and see more detail. All of this data for Healthcare in Focus 2016 is available here
CHART PACK - Commonwealth Fund International Health Policy Survey 2016
NSW healthcare compared to 10 countries across 56 survey questions
One in 10 NSW adults said they skipped care due to cost
Most NSW patients experienced courteous and respectful care
Seven in 10 NSW patients were 'definitely' involved in decisions about their care
One in five NSW adults who experienced emotional distress could not get help
Compare, and then consider further.
In sports, benchmarking tells us how many games our home team is behind the leader but not how to can catch up. In healthcare performance, it is more difficult to tell ‘how far behind’ we are in a meaningful way. Benchmarking and making fair comparisons is just the start of a conversation towards performance improvement ideas regarding ‘how to catch up.
TagsAccessibility and timeliness 4 Admitted patients 1 Ambulance services 3 Appropriateness of healthcare 2 BHI - general 6 Challenging ideas 1 Chartpack 2 Data 8 Effectiveness of healthcare 3 Efficiency 1 Elective surgery 2 Emergency department 2 Healthcare services 6 Hospital care 6 Hospital performance 1 Patient experience 6 Patient survey 1 Safety and risk 2
Dr Diane Watson is the Chief Executive of the Bureau of Health Information. She has 20 years of senior management experience measuring, monitoring and reporting on the performance of healthcare systems in Australia and internationally.
Lisa Corscadden is a senior researcher at the Bureau of Health Information. She has experience in healthcare research in Australia and Canada, with an interest in measuring equity in healthcare.
Lilian Daly is the Lead for Strategy and Engagement at the Bureau of Health Information. She holds a Master’s degree in public health from the University of New South Wales and has extensive experience as a healthcare clinician, researcher and educator.
Hilary is our Senior Director, Communications and Strategic Relations. She has extensive experience in developing policy and strategy around the role of information in improving healthcare.
Renee Carter is a former senior analyst at the Bureau of Health Information. She holds a Masters degree in health and social policy from the London School of Economics and a Doctorate in epidemiology from McGill University.
Jean-Frederic is the former Chief Executive of BHI. He is now Chief Executive of the Agency for Clinical Innovation.
Kim is the former Senior Director, Performance Measurement & Reporting at BHI. She has extensive experience in health services research in Australia and internationally.