Health System Performance Assessment Framework for Estonia

The Health System Performance Assessment (HSPA) framework for Estonia acts as a tool for stakeholders and policy makers to guide health reforms in an evidence-based and targeted manner. This report outlines the Estonian HSPA framework and documents its development through a highly inclusive and consultative process. It also reports on indicators that were selected to populate the first Estonian HSPA report, their selection criteria and core methodologies, and describes the HSPA governance structure, implementation plan, and HSPA capacity building. The report provides a guideline to embed the HSPA in Estonian governance processes in a sustainable manner. Implementing the HSPA will improve systematised public reporting on the health system performance in Estonia, thus increasing transparency and accountability of stakeholders and public awareness and involvement in the health system policy making.

Published on June 15, 2023

The ESTONIAN HSPA framework project

The HSPA framework for Estonia acts as a tool for policy makers to guide health reforms in an evidence-based and targeted manner. It resulted from close co operation between the Estonian Ministry of Social Affairs and health system stakeholders, supported by the technical assistance from the OECD and the support of the European Commission.

The purpose of the Estonian HSPA is to guide the establishment of common objectives between health stakeholders, to allow for targeted and evidence based change management, and to improve the collection and utilisation of health data. Furthermore, the HSPA aims to contribute to raising public awareness of the population health status through regular HSPA reporting and to improve the transparency and accountability of healthcare stakeholders. The implementation of the Estonian HSPA will address the need to monitor policy objectives and strategic goals outlined in various national strategies in a comprehensive and continuous manner.

The Estonian HSPA framework is composed of 18 domains grouped into 5 areas of health status, outcomes, processes, structures, and cross-cutting themes. The domains are further detailed into 62 subdomains, covering different aspects of the Estonian health system to align with the defined HSPA scope and purpose. The visualisation of the HSPA framework displays the domains in a circular diagram, with population health status as the main health policy target in the centre, encircled by the areas of processes, outcomes, and structures, while the three cross-cutting themes surround the diagram. The framework thus highlights the main policy direction of the Estonian health system to become more person-centred, and embeds equity, efficiency, and resilience into all domains. In total, 212 indicators populate the Estonian HSPA framework, which were selected via a comprehensive multi-stage selection procedure and further clarified with health system stakeholders and custodians by means of individual consultations.

EST-HSPA-Framework

Source: The Estonia HSPA framework project, April 2023.‌