Integrating the Population Perspective into Health System Performance Assessment (IPHA): Study Protocol for a Cross-Sectional Study in Germany Linking Survey and Claims Data of Statutorily and Privately Insured

Abstract

Background: Health system performance assessment (HSPA) is a major tool for evidence-based governance in health systems and patient/population-orientation is increasingly considered as an important aspect. The IPHA study aims (1) to undertake a comprehensive performance assessment of the German health system from a population perspective based on the intermediate and final dimensions defined by the World Health Organization (WHO) and (2) to identify differences in HSPA between (a) common user characteristics and (b) user types, which differ in their interactions and patterns of action within the health system. Methods and Analysis: A cross-sectional survey was conducted between October and December 2018 with statutorily and privately health insured to assess the German health system from a population perspective related to the past 12 months. The random sample consists of 32 000 persons insured by AOK Nordost and 20 000 persons insured by Debeka. Data from the survey will subsequently be linked with health insurance claims data at the individual level for each respondent who has given consent for data linkage. Claims data covers the time period January 1, 2017 to June 30, 2018. The combination of the 2 data sources allows to identify associations between insured patient characteristics and differences in the assessment of health system performance. The survey consists of 71 items measuring all final and intermediate health system goals defined by the WHO and user characteristics like health literacy, self-efficacy, the attention an individual pays to his or her health or disease, the personal network, autonomy, compliance and sociodemographics. The claims data contains information on morbidity, care delivery, service utilization, (co)payments and sociodemography. Discussion: The study represents a promising attempt to perform a holistic HSPA using a population perspective. For this purpose, a questionnaire was designed that contains both validated and new items in order to collect data on all relevant health system dimensions. In particular, linking survey data on HSPA with claims data is of high potential for assessing and analysing determinants of health system performance from the population perspective.

A Meta-summarization of Qualitative Findings About Health Systems Performance Evaluation Models: Conceptual Problems and Comparability Limitations

“…It is happened because the patient's perception has been underused to assess performance. 115,116 However, some studies suggest caution in comparing performance between different health systems, emphasizing that in order to be relevant, comparisons require in-depth knowledge of these systems. 117 In this way, the studies aim to identify the set of indicators that can be used in different countries as a comparison parameter.…”

Assessment of health system performance in Germany: Survey‐based insights into the perspective of people with private health insurance

“…This quantitative cross‐sectional study is based on a survey (paper‐ or web‐based), which was conducted between October and December 2018 among 20,000 of a total of 2.4 million people 36 with substitutive PHI from the German health insurance company “Debeka” 35 . The study was approved by the Ethics Committee of the Charité – Universitätsmedizin Berlin.…”

“…The questionnaire was developed along the WHO Health Systems Framework to assess the performance of Germany's health system for all eight intermediate (access, coverage, quality, safety) and final goals (improved health, responsiveness, social and financial risk protection, improved efficiency) (see Figure 1). Survey items (see survey and respective scales in Supporting Information S1: Appendix 1) also included patient characteristics such as socio-demographics as covariates for analysing subgroups (see study protocol 35 for more details). Each intermediate and overall goal was operationalised through at least one item, consisting of validated survey questions (e.g., surveys from the Commonwealth Fund, Eurostat, Robert Koch-Institute, WHO) or accordingly adopted or newly developed questions.…”

“…The present study is part of the larger project “IPHA” (Integrating the Population Perspective in Health System Performance Assessment), which aimed to learn about the population's perception of the German health system and their assessment of the health system performance (see study protocol) 35 …”

Methodische Herausforderungen und Lessons Learned bei der wissenschaftlichen Nutzung von Daten eines privaten Krankenversicherungsunternehmens im Rahmen des Projekts IPHA

“…Im vierten Quartal 2018 fand eine Querschnittserhebung bei 20 000 Vollversicherten der Debeka statt, die zur Teilnahme an einer Befragung (online über SoSciSurvey oder Papierfragebogen) zur Bewertung des deutschen Gesundheitssystems einmalig eingeladen wurden [13]. Die Befragungsdaten enthielten u. a. Angaben zur Soziodemografie, zum subjektiven Gesundheitsstatus sowie zu Haus-oder Facharztbesuchen in den letzten 12 Monaten.…”