Context: As evidence-based medicine grows in influence and scope, its applicability to health policy prompts two questions: Can the principles and, more specifically, the tools used to bring research into the clinical world apply to civil servants offering advice to politicians? If not, what approach should the evidence-oriented health policy organization take to improve the use of research?
Growing interest in pay-for-performance and the level of chief executive officers' (CEOs') pay raises questions about the link between performance and compensation in the health sector. This study compares the compensation of nonprofit hospital CEOs in Ontario, Canada to the three longest reported and most used measures of hospital financial performance. Our sample consisted of 132 CEOs from 92 hospitals between 1999 and 2006. Unbalanced panel data were analyzed using fixed effects regression. Results suggest that CEO compensation was largely unrelated to hospital financial performance. Inflation-adjusted salaries appeared to increase over time independent of hospital performance, and hospital size was positively correlated with CEO compensation. The apparent upward trend in salary despite some declines in financial performance challenges the fundamental assumption underlying this article, that is, financial performance is likely linked to CEO compensation in Ontario. Further research is needed to understand long-term performance related to compensation incentives.
ABSTRACT
IntroductionThere is little argument that integrated data can provide a valuable resource for improved health system management, planning, and accountability as well as discovery and commercial use, but policies to enable and support integrated data fall short of the potential represented by integrated data. To understand the current level of progress on policy for integrated data, we looked at two successful and two unsuccessful efforts to support the creation and use of integrated data in health systems.
Methods/ApproachWe used document and literature analysis to develop descriptions of the Icelandic Health Sector Database Act, the creation of the Institute for Clinical Evaluative Sciences in Ontario (Canada), the care.data initiative in the United Kingdom, and the Health Datapalooza initiative in the US and used an Ideas, Institutions and Actors framework to compare the experience with integrated data policy and politics.
Results and discussionOur analysis suggests that institutions around integrated data remain under-developed and largely focused on specific aspects of integrated data policy or use. There are at least two sets of dominant ideas around integrated data – data as a tool for economic development and health system performance and data as a threat to privacy and liberty – that are often diametrically opposed in different jurisdictions. To a great extent, powerful actors remain disengaged from integrated data discussions and leadership engaged in integrated data policy and politics remains isolated from larger policy and political discussions. The medical profession along with civil society groups can mount effective opposition to integrated data initiatives, although potentially for different reasons (accountability and privacy concerns respectively).
ConclusionsOur analysis suggests several key issues around successful integrated data policy and politics that support the importance of strong leadership, an incremental approach to institution building that focuses on public benefits, strongly alignment to missions that are congruent with societal values, and stronger attention to effective and rapid implementation of policy. In addition to the cases studied here, the success of smaller sub-national (e.g. state or provincial) efforts suggests that smaller efforts tend to work better although their success may not receive the attention that could support larger efforts to integrate data on the national level. Further work should focus chiefly on the extension of these arguments to non-health sectors to realize the full value of integrated data.
SummaryNational Ministries of Health in low‐ and middle‐income countries (LMICs) have a key role to play as stewards of the quality agenda in their health systems. This paper uses a previously developed six‐point framework for stewardship (strategy formulation, intersectoral collaboration, governance and accountability, health system design, policy and regulation, and intelligence generation) and identifies specific examples of activities in LMICs in each of these domains, pitfalls to avoid, and possible solutions to these pitfalls. Many LMICs now have quality strategies with clear vision statements. There are good examples of quality agencies and donor collaboration councils to coordinate activities across different sectors. There are multiple options for accountability, including public reporting, community accountability structures, results‐based payment, accreditation, and inspection. To improve health system design, available tools include decision support tools, task‐shifting models, supply chain management, and programs to train quality improvement staff. Policy options include legislation on disclosure of adverse events, and regulations to ensure skills of health care providers. Lastly, health information tools include patient registries, facility surveys, hospital discharge abstracts, standardized population and patient surveys, and dedicated agencies for reporting on quality. Policy‐makers can use this article to identify options for driving the quality agenda and address anticipated implementation barriers.
