A New Approach for Constructing a Health Care Index including the Subjective Level

Abstract

Until now, health care systems have been compared by means of macro criteria, an approach that might have its shortcomings in assessing the actual benefits that health care systems may provide for people. Therefore, a new health care index is presented which combines individual assessments of health care systems with objective macro health care system criteria. Two steps are taken for furthering this approach: First, a data-driven procedure is used to determine the influence of self-rated health on confidence in the health care system through macro criteria of health care systems. The macro indicators are weighted accordingly and created into an index, which adds to the subjective level of the link. In a second step, the constructed health care index is tested in a multilevel model with self-rated health being the dependent variable, to avoid tautological conclusions. The index is able to reduce country differences, decrease explained variability and has a statistically significant effect without affecting other estimates.

The Search for an Outcome Variable That Measures Both Quality and Processes in Cardiac Surgery: Comparing the Quality Process Index and Mortality

“…Indices for quality and process improvement are common in the manufacturing industry and in improvement methodologies such as Lean and Six Sigma [17,18]. In healthcare, indices are used to objectively measure and compare a variety of dimensions [13][14][15][16][17]. The difference the QPI has is that it is specifically designed for quality and processes in a hospital's department.…”

“…Many customers ask their suppliers to record capability indices of their product or process characteristics on a regular basis to ensure the right quality, measured as the percentage of non-conformities. There is a wide range of indices that cover multiple dimensions of healthcare [7,[13][14][15][16][17]. In quality and process improvement methodologies, such as Lean Six Sigma, capability indices are used for diagnosing the current process and redefining the business case of the improvement project [18].…”

Beyond objective metrics: A comparative analysis of health care systems incorporating subjective dimensions to improve comparability of access and equity in healthcare assessments

“…Often, the correlations at least headed in the same direction. However, there are indicators where deviations occur and the sign of the correlation changes accordingly, which is the case for (11) government financing arrangements, (12) compulsory health insurance, (13) social health insurance, (21) transfers from government domestic revenue, (22) international transfer and grants, (23) transfers by government on behalf of specific groups, (25) other transfers from government domestic revenue, (27)(28)(29)(30)(31) all social insurance contributions, (41) government schemes, (42) compulsory contributory health insurance schemes, (43) social health insurance schemes and (48) enterprise financing scheme.…”

“…The weighting chosen here is generated by a subjective attitude on the micro level. The used database contains roughly 50 different macro indicators of the Global Health Expenditure Database–GHED [ 10 ], and weighted by subjective importance [ 11 ]. For this purpose, the macro indicators were merged to the ‘International Social Survey Programme–ISSP 2011 [ 12 ]: Health and Health Care’ dataset and examined how relevant each indicator is to the link between self-rated health and confidence in the health care system.…”

“…In this way, the subjective level is placed on top of the objective health care expenditure, thus linking the two levels. The result is an index which has been shown to be robust and reduces country differences when comparing several multilevel models [ 11 ].…”