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DOI: 10.15240/ ul/001/2017-3-009
In oduc ion
Heal hca e sys ems ha e been p o iding
clien s wi h se ices o an inc easingly highe
quali y hanks o many posi i e de elopmen s in
heal hca e, p ima ily he high le el o expe ise
o heal hca e pe sonnel, imp o emen s in
echnology, and speedie app oaches o ea ing
illnesses. Howe e , he heal hca e sys em has
s uggled wi h o he a ious nega i e aspec s:
inapp op ia e s uc u ing, poo managemen , o
ine ec i e i nancing. In ligh o hese nega i e
aspec s and he suppo and de elopmen o
he posi i e, hese sys ems should be managed
p ope ly and hei pe o mance should be
e alua ed (Hejduko á & Ku eko á, 2016b).
Acco ding o Donabedian (1972), he
de i ning goal o he heal hca e sys em is
o imp o e he heal h o he popula ion. I
heal hca e sys ems did no con ibu e o
imp o ing heal h, we would choose no o ha e
hem a all. The heal h o he popula ion should
e l ec he heal h o indi iduals h oughou he
cou se o hei li es and include bo h p ema u e
mo ali y and non- a al heal h ou comes as
key componen s. Many s udies highligh he
ac ha heal h and heal hca e sys ems an
impo an ole in he economy, see S oukal
(2016) and poin o he link be ween social
capi al and public goods (Son, 2016).
In ega d o he sys em o heal hca e as
a whole, esponsibili y o i s e ec i e ope a ion
lies wi h he go e nmen o a gi en coun y.
Public heal hca e policy mus hen de i ne
s a egies and include heal hca e in public
i nances on one hand and suppo p i a e
ins i u ions in he a ea o heal hca e p o ision
on he o he (WHO, 2000).
Measu ing and e alua ing pe o mance in
he i eld o heal hca e mus hen be included in
public policy – o mo e see o example Wou e
e al. (2010) o Ba ák (2010).
In o de o measu e and e alua e
pe o mance on he le el o heal hca e sys ems,
many in e es ing indica o s ha e been c ea ed
by e.g. he WHO, Eu os a , OECD Heal h
S a is ics, o OECD Heal h Policy S udies –
selec ed indica o s a e compa ed in he pape
below.
This pape begins wi h heo e ical esea ch
on he issue and speci i es he basic aspec s
o he selec ed heal hca e sys ems. The pape
hen ocuses on p esen ing goals, me hodology,
and da a, and also p o ides i s own model o
composi e indica o s. The a icle con inues wi h
a chap e de o ed o esul s and discussion on
he opic be o e d awing i s i nal conclusion.
1. Li e a u e Re iew
1.1 Heal hca e Sys ems and Thei
Pe o mance
A high-quali y heal hca e sys em p o ides high-
quali y se ices o all indi iduals who equi e
hem. The basic building blocks o he heal hca e
sys em di e om coun y o coun y; howe e ,
hese sys ems all need sou ces o i nancing,
educa ed pe sonnel, and eliable in o ma ion
(Hejduko á & Ku eko á, 2016a).
Acco ding o Roeme ’s de i ni ion (2002),
he heal hca e sys em is a combina ion
o esou ces, o ganiza ion, i nances and
managemen , which culmina es in he p o ision
o se ices o a gi en popula ion. The Wo ld
Heal h O ganiza ion o e s a di e en de i ni ion,
HEALTHCARE SYSTEMS
AND PERFORMANCE EVALUATION:
COMPARISON OF PERFORMANCE
INDICATORS IN V4 COUNTRIES USING
MODELS OF COMPOSITE INDICATORS
Pa lína Hejduko á, Lucie Ku eko á
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which desc ibes he heal hca e sys em as
“all he ac i i ies whose p ima y pu pose is o
p omo e, es o e and/o main ain heal h.” In
p e ious yea s, his de i ni ion was expanded by
he Wo ld Bank (2007) o include he p e en ion
o domes ic po e y due o illness. Acco ding o
he de i ni ion gi en by Plsek and G eenhalgh
(2001), he heal hca e sys em is a complex
adap i e sys em ha plays a signi i can ole
in in l uencing heal hca e sys ems p ima ily in
p oducing be e esul s in he i eld o heal h.
In e ms o long- e m sus ainabili y, he
heal hca e sys em mus ha e a clea concep .
Acco ding o Kelley and Hu s (2006a),
he concep ual amewo k o he cu en
heal hca e sys em mus include he ollowing
aspec s: e ec i eness, sa e y, esponsi eness,
accessibili y, equi y and e i ciency.
O he au ho s, e.g. Kacíř (2010), claim ha
he ollowing c i e ia mus be ul i lled in o de
o a heal hca e sys em o p ope ly unc ion:
a ailabili y, quali y, easonable i nancial
bu den, e ec i eness, equal access, and
social accep abili y. Sassi e al. (2002) s a e
ha he pe o mance o heal hca e sys ems
is e alua ed as he pe o mance o indi idual
ac i i ies in a heal hca e sys em.
The WHO (2006) p o ides in e es ing insigh
in o he heal hca e sys em in i s de i ni ion o he
six pilla s o he heal hca e sys em – see Tab. 1.
As is e iden in Tab. 1, he heal hca e
sys em is p ima ily based on economic, social,
legal, and poli ical amewo ks. We can also
summa ize his by s a ing ha public policy
plays he p ima y ole in each o he pilla s
lis ed abo e.
Measu ing and e alua ing he pe o mance
o heal hca e sys ems on a na ional le el
equi es analysis o he ela ionship be ween
pe o mance and public alues – see Hood
(1991) and his discussion o ideas known as
„New Public Managemen “.
Bouckae and Halligan (2008) de i ne
pe o mance on h ee le els: mic o, middle, and
mac o. I we ocus on he mic o le el acco ding
o hese au ho s, he pe o mance o a gi en
Pilla s o he heal hca e sys em Speci i ca ion
1. Se ice deli e y Supply
Demand
In as uc u e
Managemen
P o ec ion and quali y
2. Heal h wo k o ce Na ional employmen policy
Legal amewo k
No ms
S anda ds
3. In o ma ion In o ma ion sys ems
Moni o ing sys ems
Global in o ma ion s anda ds
4. Heal h p oduc s and echnologies Policy
Public ende s
No ms
Acces and quali y
5. Financing S uc u e o public i nance policy in he i eld o
heal hca e
Da a on heal hca e expendi u es
Calcula ions
6. Leade ship/go e nance Sec o policies
Moni o ing and egula ion
In e en ion
Ha moniza ion and uni i ed me hods
Sou ce: own, based on WHO (2006)
Tab. 1: Six basic pilla s o he heal hca e sys em
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si ua ion is e alua ed. On he middle le el,
he au ho s mos ly poin o he pe o mance
o a ce ain b anch (e.g. heal h ca e). On he
mac o le el, discussions a e ypically led on
he pe o mance o a coun y, e.g. coun ies o
he OECD o EU. As s a es K echo ská (2014),
e e y en i y should choose an app oach and
a pe o mance e alua ion me hod ha will bes
co espond o hei needs, goals and cu en
si ua ion.
App oaches o measu ing and e alua ing
pe o mance in heal hca e ha e begun o
expand signi i can ly in connec ion o he
ins a emen and implemen a ion o heal hca e
e o ms and changes in a i udes owa d heal h
in de eloped coun ies (Há a & Maško á-
Hanušo á, 2009a). These new app oaches
and concep s s em p ima ily om sup ana ional
ins i u ions, p ima ily he OECD, WHO,
Eu opean Obse a ion, o he UN.
In e alua ing he pe o mance o heal hca e
sys ems, i is impo an o conside he ac ha
no only he i nancial aspec s a e e alua ed;
simul aneously, a g owing emphasis is also
being placed on non- i nancial cha ac e is ics –
o mo e, see e.g. Robe s e al. (2003), P eke
e al. (2000), Donabenian (1982), o Smi h e
al. (2008).
I we s a e he basic goals o he ins i u ions
and au ho s lis ed abo e, we can claim ha he
WHO (2000) de i nes h ee goals in e alua ing
he pe o mance o a heal hca e sys em.
These a e: heal h, esponsi eness, and ai
i nancing. On he con a y, he OECD (2004)
and Kelly and Hu s (2006a; 2006b) app oach
he issue o heal hca e sys em e alua ion in
a b oade sense and ci e addi ional ac o s,
e.g. sa is ac ion o he pa ien , adequacy, o
imeliness o ca e.
In e na ional compa isons o he
pe o mance o heal hca e sys em discuss
many au ho s – see Ba ák (2012), Dlouhý
(2009), Hadad e al. (2013) o Lawson e al.
(2012). The e exis many indica o s which a e
used o measu e and e alua e he pe o mance
o heal hca e sys ems. The WHO lis s one le el
o e alua ion as “be e heal h” linked o he i s
o he h ee goals lis ed abo e (WHO, 2000).
Acco ding o he Uni e si y o Ljubljana (2015),
wo ypes o indica o s exis on his le el:
indica o s o chances o li ing a ull li e and
indica o s o los yea s o li e. O he app oaches
use he ollowing indica o s: numbe o doc o s
and nu ses, educa ion o he heal hca e
pe sonnel, in an mo ali y, o e weigh ness
and obesi y, o consump ion o alcohol (OECD,
2016). In he a icle, Hejduko á (2015) uses
o he indica o s o e alua ing pe o mance, o
ins ance heal h ca e expenses o he numbe o
gi en de ices o equipmen used in medicine.
1.2 Heal hca e Sys ems in V4 Coun ies
As was no ed abo e, e o ms play an impo an
ole in cu en heal hca e policy and hus in
heal hca e sys ems. Among V4 coun ies, hese
e o ms a e simila o one ano he and show
coope a ion be ween he e o ming ins i u ions,
law i ms, and en i ies on he i nancial ma ke
p ima ily in a eas o mode nizing heal hca e
acili ies wi h a s ong ocus on he ma ke
(P eke & Ha ding, 2004; 2007). All ou V4
coun ies sha e simila i ies, such as ecen
his o ical e en s, bu he e a e also di e en
socio-economics and poli ical di e ences in
Viseg ad G oup (Pio owicz, 2015).
The heal hca e sys em in he Czech
Republic is cha ac e ized by ex ensi e
u iliza ion o heal hca e goods and se ices
(Ma in, 2016). The Czech Republic is a V4
coun y ha has gone h ough many e o ms in
ecen yea s in he i eld o heal hca e. These
e o ms ha e deal no only wi h he heal hca e
sys em i sel , bu also wi h he i elds o public
i nance and p i a e law. The OECD (2008b)
desc ibes he heal hca e sys em o he Czech
Republic in a wholly posi i e manne , bu poin s
ou some possible isks: “c eam skimming”
by heal h insu ance companies, asymme ic
in o ma ion be ween he managemen o
heal hca e companies and poli icians, possible
de e io a ion in he quali y o heal hca e as
a esul o he g owing numbe o heal hca e
acili ies, o issues wi h he ins a emen and
subsequen cancella ion o doc o ees.
Simila ly o o he V4 coun ies, he
Hunga ian heal hca e sys em has been
in l uenced by he coun y’s ans o ma ion om
a ansi i e o ma ke economy. Acco ding o
he OECD (2008c), isks linked o economic,
i scal, o ma ke -o ien ed e o ms (co-pays,
compe i ions in public heal hca e) can ha e
e y nega i e impac s on he heal hca e
sys em. “On he o he hand, Hunga y is
a a ge coun y o c oss-bo de heal h ca e,
mainly o den al ca e bu also o ehabili a i e
se ices, such as medical spa ea men . The
heal h indus y can hus be a po en ial s a egic
a ea o economic de elopmen and g ow h.”
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Ekonomika a managemen
(Eu opean Obse a o y on Heal h Sys ems and
Policies, 2011, p. 20)
As Wóyciska and G abowski (2007) no e,
Poland is a V4 coun y ha has no been
success ul in making a sa is ac o y shi o mee
wel a e-s a e ends and in doing so c ea e
a model o mode n social secu i y. In he a ea o
heal hca e, Poland’s la ges p oblems lie in i s
o e all expendi u es on heal hca e and he s a e
o i s ci izens’ heal h (Wa son, 2006; Kuszewski
& Ge icke, 2005). Acco ding o a s udy c ea ed
by Há a and Maško á-Hanušo á (2009a),
p oblems in Polish heal hca e a e also e iden
in he i eld o medical ees, a na ional heal h
insu ance und, disag eemen s in poli ics, and
o he s. Acco ding o he OECD (2008a), one
o Poland’s majo p oblems lies in he ac ha
he coun y has one o he highes deg ees
o income inequali y in he OECD; o o he
in o ma ion see – Pa olini and Guillén (2013) o
Cos a-Fon and G ee (2016).
Slo akia is he i s V4 coun y o ha e
ins a ed wide-scale e o ms in he i eld
o heal hca e. Despi e his ac , howe e ,
Slo akia s ill lags behind i s V4 pa ne s in
he e ec i eness o i s heal hca e. He e we
can men ion he highe mo ali y o i s sys em,
which is 15% highe in compa ison o o he V4
coun ies. Cha ac e is ic o Slo akia is also he
high use o medicine and high a es o medical
isi s. Highe cos s in compa ison wi h he o he
V4 coun ies in he a ea o diagnos ics and
labo a o y wo k a e also e iden (Zd a o nický
deník, 2016). Despi e i s ini ial e o ms, Slo akia
has been s ongly in l uenced by disag eemen s
in poli ics, o example he es ablishmen and
cancella ion o medical ees, a mo a o ium
on ans o ming he legal s a us o heal hca e
ins i u ions, and so on. (Ve hoe en e al., 2007).
Acco ding o he OECD (2016a), all V4
coun ies show less expendi u e on heal hca e
han he OECD a e age, which is also con i med
by conclusions in he s udies by Há a and
Maško á-Hanušo á (2009b) o OECD (2016b).
We can also claim ha he V4’s heal hca e
sys ems con inued o be unde i nanced in
compa ison o he OECD a e age (OECD,
2016b; 2015).
In addi ion o he ac ha hese coun ies a e
s ill acing challenges wi h hei ans o ma ion
om a ansi i e economy o a ma ke economy,
he s uc u e o heal hca e sys ems in V4
coun ies is also in l uenced by demog aphic
de elopmen s, i scal p oblems, e o s owa d
cons an economic g ow h, and globaliza ion.
Basic p oblems in he heal hca e sys ems o he
V4 can be ound in he o ien a ion o indi idual
sys ems on p ima ily economic goals, whe eas
in e na ional ends a e mo e ocused on non-
economic and non- i nancial aspec s.
Measu ing and e alua ing he pe o mance
o heal hca e sys ems can be seen as one o he
mos impo an aspec s o e ec i e heal hca e
managemen . In s uc u ing and c ea ing
a me hod o he pe o mance e alua ion o
heal hca e sys ems, i is necessa y (i a all
possible) o ocus on objec i ely measu able
indica o s. Thus, i is impo an o de e mine
and e alua e he capabili y o in e p e ing
esul s o measu emen . Such measu emen
p o ides o compa isons o pe o mance o be
made in ime and in e ms o selec ed egional
uni s (e.g. on he le el o a coun y’s indi idual
egions, o on a na ional le el). Scien i i c
s udies ha e paid only li le a en ion o hese
measu able/quali a i e o ms o pe o mance
e alua ion o heal hca e sys ems, hus p o iding
an oppo uni y o us o ca y ou esea ch and
c ea e a composi e indica o o pe o mance
e alua ion in his a ea.
2. Me hodology and Resea ch Da a
The goal o his pape is o compa e and
e alua e he pe o mance o heal hca e sys ems
in V4 coun ies using selec ed indica o s o
heal hca e sys ems and de e mine he s a e
o he Czech Republic’s heal hca e sys em in
compa ison o o he V4 coun ies.
This pape will a emp o answe he
ollowing ques ions: Wha is he Czech
Republic’s posi ion in e ms o heal hca e
indica o s in compa ison o o he V4 coun ies?
Wha esul s do he selec ed indica o s show
and how can we in e p e hem? Resea ch o
li e a u e and selec ed s a is ical indica o s
p o ided he answe s o hese ques ions.
Da a o his pape was mainly aken om
OECD Heal h Policy S udies. The heal hca e
sys ems s udied in his pape we e chosen
due o he ac ha V4 coun ies a e ansi i e
economies o he CEE wi h a poo e s a e
o heal h among o hei gene al popula ion
han in de eloped coun ies o he OECD o
EU. In addi ion, hese coun ies sha e ce ain
cha ac e is ics – hei sys ems ha e long been
unde i nanced and e o ms in hese coun ies
ha e mos ly been gea ed owa d economic
goals. As Há a and Maško á-Hanušo á (2009b)
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Business Adminis a ion and Managemen
poin ou , howe e , in e na ional discou se has
helped o de elop b oade concep s o long-
e m sus ainabili y wi h an emphasis on o e all
e ec i eness, quali y o p o ided se ices, and
human igh s wi h ega d o heal h.
The calcula ion o composi e indica o s is
some solu ion ha p o ides he abili y o cap u e
a complex phenomenon. The au ho s ealize
ha a ce ain le el o abs ac ion will always
occu when ying o quan i y phenomena
using composi e indica o s. In composi e
indica o , he deg ee o abs ac ion is mul iplied
because i is based on mul iple indica o s. This
disad an age, howe e , is balanced by he ac
ha he composi e indica o e l ec s ac by
means o se e al sub-indica o s and includes
di e en , o en con adic o y, aspec s o he
phenomenon.
The e is no only one co ec CI app oach,
so he e is no one igh solu ion o his ask, so
he au ho s o e h ee me hods (models) o CI
calcula ion. Th ea s associa ed wi h he use o
composi e indica o s a e (i) he isk o inco ec
calcula ion, and (ii) he possibili y o simple
in e p e a ion can lead o oo simpli i ed and
hus inco ec conclusions. The au ho s ied o
elimina e hese h ea s by s udying app op ia e
li e a u e and using hei expe ience wi h
s a is ics and indica o s.
The au ho s a e awa e ha using he same
weigh s o componen s he e is a isk ha
ce ain a eas (one pilla o componen ) will be
assigned a g ea e weigh by being ep esen ed
by a la ge numbe o indica o s in CI. This may
ha e a s onge impac on o e all CI han i
does wi h he in ended CI and i s heo e ical
amewo k. The same weigh s a e app op ia e
i he co ela ion be ween he indica o s does
no indica e he double coun ing o he same
aspec o he measu ed phenomenon due
o he edundan sub-index. The use o he
same weigh s as e idenced by he p esence
o a la ge numbe o pa ial indica o s, i.e.
50-100 pa ial indica o s (Gulliksen, 1950). In
he case o a la ge numbe o indica o s, i is
di i cul o adequa ely de e mine he weigh s o
each indica o , and he mo e complex weighing
scheme would make i di i cul o in e p e he
impac o he indi idual sub-indica o s. Simila ly,
i we ha e only a small se o da a ha consis s
o less han 30 obse a ions, he same weigh s
a e app op ia e (Raju e al., 1999). Hopkins
(1991) says ha i i is impossible o ob ain
a gene al consensus o weigh de e mina ion,
he simples solu ion is he bes . The au ho s
e en ually applied linea weighing, his p ocess
is u he suppo ed by he esul s in he
empi ical pa , he esul s a e consis en wi h
esul s in o he s udies (see Dlouhý, 2016a;
Dlouhý, 2016b).
A composi e indica o o he pe o mance o
he heal hca e sys em was c ea ed. The main
ad an age o using composi e indica o s is
ha hey allow us o summa ize and exp ess
complex phenomena in o one indica o . In ou
case, he indica o exp esses he pe o mance
o he heal hca e sys em. The composi e
indica o enables us o c ea e a ela i ely simple
compa ison o a selec ed uni (e.g. coun y,
egion, company, e c.) in ime o be ween
indi idual uni s. Acco ding o Booysen (2002),
ano he ad an age o composi e indica o s is
hei l exibili y in he sense ha compu a ions o
me hodology can be easily changed (selec ion
o indica o s, no maliza ion, weigh ing sys ems,
agg ega ion). These changes, howe e , a e
made a he expense o he compa abili y o
indica o s in ime. This p oblem can be pa ially
deal wi h ia e ospec i e e ision acco ding
o new me hodology.
Da a om he OECD Heal h Policy S udies
was used o cons uc he composi e indica o .
The pe iod o ime chosen o he s udy was en
yea s, i.e. om 2005 o 2014. Based on expe
selec ion, en indica o s we e chosen and he
assump ion was made ha indica o s and hei
alues e l ec he pe o mance o heal hca e
sys ems in he indi idual membe s a es o
he V4. Indica o s we e di ided in o wo pilla s
(Pilla I and II) based on how posi i ely o
nega i ely hey con ibu e o heigh ening he
pe o mance o heal hca e sys ems. Six o en
selec ed indica o s we e included in Pilla I and
a e in di ec dependence on he pe o mance
o he heal hca e sys em. The emaining ou
ha e been included in Pilla II, which a e in
indi ec dependence on he pe o mance o he
heal hca e sys em. A summa y o he selec ed
a iables is lis ed in Tab. 2.
A mean was calcula ed o each indica o
du ing he gi en pe iod. Indica o ID_8 shows
a ailable da a o e he cou se o he whole
pe iod only o he Czech Republic. The mean
o indica o ID_8 o he emainde o coun ies
was calcula ed only o 2009 and 2014. As
ega ds indica o ID_10, comple e da a was
a ailable only in he case o Poland; in he
Czech and Slo ak Republic’s case, in o ma ion
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138 2017, XX, 3
Ekonomika a managemen
was published in wo-yea in e als. Missing
alues we e hus subs i u ed by he alue o he
a i hme ic mean and, in Hunga y’s case, da a
was a ailable only o he pe iod be ween 2005
and 2009. The me hod o linea eg ession was
selec ed o he impu a ion o absen alues.
Values we e impu ed based on an es ima e o
he eg essi e axis by using he leas squa es
me hod. Mean alues o indi idual indica o s
a e p esen ed in Tab. 3.
Based on he selec ed indica o s,
composi e indica o s we e cons uc ed. These
indica o s a e mean o e l ec he pe o mance
o heal hca e sys ems o he V4 membe s a es.
Th ee me hods o modeling hese indica o s
we e used in o de o es ablish he compa ison
o heal hca e sys em pe o mance. These h ee
me hods a e: (i) using he a ea o a ada cha ,
(ii) de e mining pe o mance based on o de ,
and (iii) de e mining pe o mance based on
dis ance om he e e ence uni . These h ee
me hods o de e mining he pe o mance o
heal hca e sys ems allow us o compa e he
si ua ions o indi idual heal hca e sys ems in
e ms o pe o mance.
3. Models o Composi e Indica o s
The i s model is p ima ily based on a g aphic
ep esen a ion o he composi e indica o . Fo
hese pu poses, a ada o “spide web” cha
is used. This cha is a basic analy ical ool
ha allows us o isualize se e al indica o s in
one cha and hus o e s a isualiza ion o he
a iable’s a ea (in ou case he pe o mance o
he heal hca e sys em). Based on he size o
he web’s a ea, we can hen easily compa e he
heal hca e sys ems be ween gi en coun ies.
Pilla Indica o
I
ID_1 Numbe o doc o s pe 1,000 people (in %)
ID_2 Numbe o nu ses pe 1,000 people (in %)
ID_3 Li e expec ancy a bi h in e ms o he o e all popula ion (in yea s)
ID_4 Heal hca e expendi u es in e ms o GDP (in %)
ID_5 P e alence o examina ion echnology: Magne ic esonance imaging
machines pe 1,000,000 people (numbe o machines)
ID_6 P e alence o examina ion echnology: Compu ed omog aphy scanne s pe
1,000,000 people (numbe o machines)
II
ID_7 Alcohol consump ion pe pe son among people o e 15 yea s o age (in li e s)
ID_8 Consump ion o obacco p oduc s, % o popula ion o e 15 yea s o age who
a e daily smoke s (%)
ID_9 In an mo ali y, numbe o dea hs pe 1,000 li e-bo n indi iduals (in numbe
o dea hs)
ID_10 Thi y-day mo ali y a e admission o hospi al o AMI based on admission
da a (Age-sex s anda dized a e pe 100 pa ien s)
Sou ce: own based on OECD (2016a)
Tab. 2: Selec ed indica o s o he pe o mance o heal hca e sys ems
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Based on he ada cha , he heo e ical
exp ession o pe o mance can be exp essed
as he di e ence be ween he sizes o he
indi idual a eas o he web.
(1)
whe e Aj ep esen s he di e ence be ween he
a ea o he spide web eached in Pilla I (PI)
and Pilla II (PII). The size o he a eas PI and
PII is depic ed in he ollowing wo i gu es.
Loga i hmic ans o ma ion o he mean alues
o indi idual indica o s ( ) was used o he
isualiza ion. I is o mally possible o alues Aj
o calcula ed pe o mance based on he ada
cha o ake on nega i e alues, bu de e mining
pe o mance in his manne in ou case me ely
allows us o compa e he selec ed uni s. I is
no possible o s a e whe he a nega i e alue
indica es a dec ease in pe o mance in ime
and ice e sa. The i gu es hemsel es a e
a pa o he ollowing chap e on Resul s and
Discussions. I should also be s a ed ha he
cha s in Fig. 1 encompass six indica o s whose
ising alues should ha e a posi i e e ec on
he pe o mance o he heal hca e sys em o , in
o he wo ds, he highe he pe o mance o he
heal hca e sys em, he la ge he a ea o he
“spide web”. On he con a y, Fig. 2 shows ou
indica o s whose ising alues should dec ease
he pe o mance o he heal hca e sys em. In
o he wo ds, a smalle a ea o he web can be
expec ed among heal hca e sys ems o highe
pe o mance.
The second model o compa ing he
pe o mance o he heal hca e sys em is he
model o a calcula ed sco e based on o de . In
o he wo ds, his is a si ua ion in which da a was
no malized using o de in e ms o indi idual
coun ies (j).
(2)
whe e is he o iginal alue o he indica o
i o he compa ed uni j exp essed as he mean
o e he selec ed pe iod o ime. This means
ha , o he nex analysis, i is possible o use
only o dinal in o ma ion on he o de o he
gi en uni . Thus, no conclusions can be d awn
on he ela i e di e ence be ween uni s. On he
o he hand, he me hod is easy o comp ehend,
i is no in l uenced by emo e obse a ion, and i
uni i es he a iance and ange o all indica o s.
The mean om he o de uses a a ing om The
Medica e S udy on Heal hca e Pe o mance
ac oss he Uni ed S a es (Jencks e al., 2003).
In Pilla I, indica o s wi h he highes
alues eached he bes placing. Con a y o
his, in Pilla II he index alues we e placed
in descending o de , i.e. coun ies wi h he
lowes indica o alue eached he bes placing.
Fu he mo e, he mean o de o he lis was also
calcula ed:
CZ HU PL SK
ID_1 3.61 3.02 2.20 3.30
ID_2 8.04 6.19 5.26 6.02
ID_3 77.56 74.52 76.24 75.47
ID_4 6.80 7.47 6.21 7.32
ID_5 5.70 2.82 4.13 6.20
ID_6 14.03 7.36 12.63 14.20
ID_7 11.81 11.78 10.21 10.46
ID_8 22.92 26.15 23.25 21.20
ID_9 2.84 5.31 5.27 5.92
ID_10 7.41 13.27 6.22 9.02
Sou ce: own based on OECD (2016a)
Tab. 3: Summa y o mean alues o indi idual indica o s
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Ekonomika a managemen
(3)
Fo he hi d model o compa ing pe o mance
o heal hca e sys ems, sco e calcula ion based
on dis ance om he e e ence uni was selec ed.
The dis ance om he e e ence uni was used o
no malize da a, and he bes uni was used as
a e e ence uni in Pilla I and he wo s uni as
a e e ence uni in Pilla II. A e e ence alue was
selec ed in each indica o and an indica o alue
was exp essed as he a io o he e e ence
alue (which is 100%).
(4)
whe e is he o iginal mean alue o he
indica o and he compa ed uni j and is
he alue o e e ence uni o indica o i. I
is clea ha i he maximum alue is chosen
as he e e ence uni , hen he alues o he
no malized indica o s a e lesse o equal o
one – his applies o Pilla I. I he wo s uni is
chosen as he e e ence alue, he no malized
da a is always g ea e o equal o one – his
applies o Pilla II. This me hod p ese es he
ela i e di e ences be ween uni s.
In o de o es ablish ou own composi e
indica o , a so-called “linea composi e
indica o ” ela ed o expendi u es on heal hca e
was used – o mo e see OECD (2002). The
ma hema ical exp ession o his selec ed
indica o is shown in he ollowing equa ion:
(5)
exp esses he pe o mance o he
heal hca e sys em o he compa ed uni j.
Fu he mo e, ep esen s he mean
alue o expendi u es on heal hca e o he
compa ed uni j. In addi ion, α ep esen s he
weigh o he pilla in he composi e indica o
o pe o mance . The e a e many ways
o de e mine weigh s o indi idual sepa a e
indica o s c ea ing an agg ega ed indica o . In
ou case, symme ic weigh s we e c ea ed, i.e.
α akes on he alue o 0.5. In he e en ha we
only ha e a small se o da a, Raju e al. (1999)
chooses o use he same weigh s. Hopkins
(1991) also claims ha i i is impossible o gain
common ag eemen o de e mining weigh s,
he simples solu ion is he bes solu ion, i.e.
also se ing he same weigh s.
4. Resul s and Discussion
Fo all h ee sugges ed me hods o
de e mining he composi e indica o , hei
alues (Aj, Sj
a g; Ej
a g) we e calcula ed wi h
esul s p esen ed in Tab. 4. These show ha
he Czech Republic eaches he bes esul s
in all cases in compa ison wi h o he membe
s a es o he Viseg ad Fou . Acco ding o esul s
o composi e indica o s, he second highes -
pe o ming heal hca e sys em is he Slo ak
Republic, while he wo s is Hunga y.
I we compa e coun ies based on he
alues o indi idual Pilla s I and II, we each
almos exac ly he same conclusions as in he
case o compa ing alues based on composi e
indica o s. Fig. 1 shows ha he Czech Republic
akes up he la ges a ea in Pilla I, wi h Slo akia
in second place, Poland in hi d, and Hunga y in
las . I we compa e a eas eached in Pilla II, we
CZ HU PL SK
PI13.59 10.79 10.67 13.04
PII 9.02 12.10 9.91 10.84
Aj4.57 -1.30 0.75 2.20
Sj
a g 1.90 3.20 2.70 2.20
II
ij 5.82 4.54 4.63 5.62
III
ij 6.02 4.12 5.54 4.83
Ej
a g 3.09 2.15 2.78 2.62
Sou ce: own calcula ion
Tab. 4: Summa y o esul s o composi e indica o s
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Fig. 1: Visualiza ion o Pilla I
Sou ce: own
Fig. 2: Visualiza ion o Pilla II
Sou ce: own
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