About Health System Performance Assessment

Health system performance assessment (HSPA) is a main instrument in the process of health policy decision-making. Its main objective is to support the setting of medium-term strategic goals and monitor their accomplishment by data analysis and evaluation of the results.

The systemic approach taken means that the indicators developed from the data are analysed principally at national level or in higher territorial units (regions, health care regions, counties), therefore health system performance assessment gives a comprehensive overview of the situation of healthcare. This helps to assess whether the health care system is on the right track and which of its areas need to be further developed.

Systemic performance assessment fits into the concept of good government as it contributes to the effective realization of policy objectives and to the increase of transparency.

Hungarian legislation, designates the National Healthcare Service Center (ÁEEK) as the institution responsible for performance assessment. Its activities are carried out with the support of the HSPA Working Group.

The main output of the process is the HSPA Report, in which the analysed and assessed areas of system were determined according to the categories of the framework published by Murray and Frenk in 2000 (one adaptation is shown in the figure below). Besides the final (or intrinsic) and the intermediate (or instrumental) goals of the system, a highlighted horizontal objective to be examined is equity.

In this context, it is necessary to assess whether the distribution of the value of each goal’s indicators according to certain criteria (eg.: gender, age, income, place of residence) is to be justified or considered to be unfair.

In order to put the analysis into context the HSPA Report includes the description of the health reforms and the most important measures of the covered period.

The two focus areas, selected in each reporting period by the Minister responsible for healthcare, ensure that beside consistency (which is essential for the comparability of results) current medium-term priorities of health policy also appear in the assessment.

Source: adapted from Murray-Frenk (2000) and Kutzin (2013)


  • Gaál P.; Szigeti Sz.; Evetovits T.; Lindeisz, F.: Az egészségügyi rendszerek teljesítménymérésének koncepcionális kérdései [Conceptual questions of the health system performance assessment]. Egészségügyi Gazdasági Szemle 50(1): 7–15.; 2012. Available: http://www.weborvos.hu/adat/files/2012_szeptember/egsz21.pdf, downloaded 23. March 2016. 
  • Kutzin, J.: Health financing for universal coverage and health system performance: concepts and implications for policy. Bulletin of the World Health Organisation 91(8): 602-611, 2013 Avaliable: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738310/
  • Murray, CJL.; Frenk, J.: A framework for assessing the performance of health systems. Theme Papers, Bulletin of the World Health Organisation 78(6): 717-731, 2000. Available: http://www.who.int/bulletin/archives/78%286%29717.pdf, dowlnloaded: 23. March 2016.