Grech, Kenneth (2018) he development of health system performance assessment frameworks in Malta and beyond and their impact upon policy making. PhD thesis, University of Warwick.

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Abstract

Introduction and aims: Following the 2008 financial crisis, performance monitoring and evaluation in the form of Health System Performance Assessment (HSPA) received heightened attention and is now used by policy makers and health service leaders for decision taking. However, despite its increased importance and relevance, there is, as yet, no common internationally recognised standardised methodology for its development and implementation. Moreover, whilst there is ample evidence linking HSPA with service improvement, the literature on the impact of HSPA upon health policy-making is limited. The research questions aim at addressing these two research gaps, looking into the most appropriate method for developing a health system performance assessment framework for Malta and examining the role, if any, that national health system performance assessment frameworks play in the development of national health policy. These two facets of HSPA are the focus of this research, where a methodology for implementing HSPA in a small state (Malta) is developed and the relationship between HSPA and policy development at national and European level is thoroughly investigated.
Methods: The study consisted of three phases. A comprehensive document analysis was first carried out. This was followed by the development and implementation of a HSPA framework and performance assessment report for Malta. The final phase consisted of a three-year ethnographic study across Europe’s capitals, resulting in the collection and analysis of data on the relationship between HSPA and health policy development in the European region.
Results: HSPA methodology must combine scientific robustness with policy constraints to take into account the political exigencies of the health system it is purported to assess. This is deemed both important and appropriate for HSPA, especially for small states like Malta. The research also reveals the unique role HSPA plays in policy development, as one of the many variables that influences health policy. However, the study also goes on to highlight the mismatch between the evidence generated by HSPA and a more evidence-based approach to policy making.
Conclusions: The study concludes by proposing a new model for policy making, incorporating HSPA as a central tenet of this process. Several options are then suggested to better align the disparate agendas of policy makers and researchers, such as matching the research and policy priorities closely at the start of the research and policy process.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RA Public aspects of medicine
Library of Congress Subject Headings (LCSH):	Medical care -- Malta -- Evaluation, Medical care -- Malta -- Quality control, Hospital care -- Malta -- Evaluation, Medical policy -- Malta, Malta -- Statistics, Medical
Official Date:	September 2018
Dates:	Date Event September 2018 Submitted
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Spurgeon, P.(Peter)
Sponsors:	Malta Government Scholarship Scheme
Extent:	xxiv, 433 leaves : charts
Language:	eng

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