title: Correlates of health and healthcare performance: applying the Canadian Health Indicators Framework at the provincial-territorial level.
abstract: BACKGROUND
  Since, at the health system level, there is little research into the possible interrelationships among the various indicators of health, healthcare performance, non-medical determinants of health, and community and health system characteristics, we conducted this study to explore such interrelationships using the Canadian Health Indicators Framework.
  
  
  METHODS
  We conducted univariate correlational analyses with health and healthcare performance as outcomes using recent Canadian data and the ten Canadian provinces and three territories as units of the analyses. For health, 6 indicators were included. Sixteen healthcare performance indicators, 12 non-medical determinants of health and 16 indicators of community and health system characteristics were also included as independent variables for the analysis. A set of decision rules was applied to guide the choice of what was considered actual and preferred performance associations.
  
  
  RESULTS
  Health (28%) correlates more frequently with non-medical determinants than healthcare does (12%), in the preferred direction. Better health is only correlated with better healthcare performance in 13% of the cases in the preferred direction. Better health (24%) is also more frequently correlated with community and health system characteristics than healthcare is (13%), in the preferred direction.
  
  
  CONCLUSIONS
  Canadian health performance is a function of multiple factors, the most frequent of which may be the non-medical determinants of health and the community characteristics as against healthcare performance. The contribution of healthcare to health may be limited only to relatively small groups which stand to benefit from effective healthcare, but its overall effect may be diluted in summary measures of population health. Interpreting multidimensional, multi-indicator performance data in their proper context may be more complex than hitherto believed.
authors.affiliation: Department of Social Medicine, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, the Netherlands. o.a.arah@amc.uva.nl
authors.forename: O A
authors.initials: OA
authors.lastname: Arah
authors.forename: G P
authors.initials: GP
authors.lastname: Westert
mesh_terms: D002170:Canada / Q000453:epidemiology; D003659:Decision Making, Organizational; D017598:Efficiency, Organizational; D006302:Health Services Research; D006305:Health Status Indicators; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018802:Patient-Centered Care; D019984:Quality Indicators, Health Care; D012040:Regional Health Planning / Q000458:organization & administration* / Q000592:standards; D013219:State Government