Peer-reviewed article
Piloting the first health system performance assessment for Germany: key results and learnings
Blümel M, Achstetter M, Hengel P, Schwarzbach M, Busse R ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This paper describes a pilot Health System Performance Assessment tool for Germany, evaluating overall health system performance across nine dimensions including access, quality, efficiency and population health. The assessment analysed 90 indicators over time and compared Germany to eight European countries. While the tool provides a comprehensive picture of Germany's health system performance, it does not focus on children's well-being or child-specific outcomes.
Key points
- 90 indicators were included across nine dimensions of health system performance
- Germany showed good access to healthcare (high insurance coverage, high physician density, low waiting times)
- Quality indicators were mixed, with lower cancer survival rates but positive trends overall
- Population health outcomes were average compared to other European countries despite high resource input
- Data availability was identified as a major challenge for the assessment
Limitations
This is a general health system performance assessment tool not specifically designed to evaluate child well-being or child-focused health outcomes. The document does not provide child-specific mortality, morbidity, or development indicators.
Abstract
Abstract Background Health System Performance Assessment (HSPA) is a tool to monitor and evaluate the performance of health systems and to inform evidence-based policymaking. For the first time, a country specific HSPA is currently being piloted for Germany. Methods The HSPA is based on a newly developed conceptual framework including nine dimensions (e.g., access, quality, efficiency, population health). Indicators were selected based on a systematic search of (inter)national studies and HSPA initiatives. Where possible, indicators were analysed in their development over time (2000-2020), in comparison to eight European countries (e.g., Austria, Denmark, France), and along up to seven equity dimensions (e.g., sex, age, income, education, region). Results Overall, 90 indicators were included in the HSPA. Trend and equity analyses were possible for almost all and country comparisons for most indicators. A few indicators could not be analysed at all due to missing data. The overall HSPA provides an in-detail picture of Germany's health system. Access, for example, can be rated as good in Germany compared to the other countries, as insurance coverage and physician density are high, and unmet needs and waiting times for elective surgery are low. Results for quality are not as good, e.g., cancer survival rates, but most indicators show a positive trend. While population health outcomes are average in country comparison (e.g., fetal and infant mortality), resource input is comparatively high. Consequently, overall efficiency can still be improved (e.g., amenable mortality per total health expenditure). Conclusions This first HSPA for Germany allows new insights to the performance of the German health system which are important for policy and research. While the pilot benefitted a lot from previous HSPA initiatives, data availability remains one of the biggest challenges.