title: Comparing health system performance assessment and management approaches in the Netherlands and Ontario, Canada.
abstract: BACKGROUND
  Given the proliferation and the growing complexity of performance measurement initiatives in many health systems, the Netherlands and Ontario, Canada expressed interests in cross-national comparisons in an effort to promote knowledge transfer and best practise. To support this cross-national learning, a study was undertaken to compare health system performance approaches in The Netherlands with Ontario, Canada.
  
  
  METHODS
  We explored the performance assessment framework and system of each constituency, the embeddedness of performance data in management and policy processes, and the interrelationships between the frameworks. Methods used included analysing governmental strategic planning and policy documents, literature and internet searches, comparative descriptive tables, and schematics. Data collection and analysis took place in Ontario and The Netherlands. A workshop to validate and discuss the findings was conducted in Toronto, adding important insights to the study.
  
  
  RESULTS
  Both Ontario and The Netherlands conceive health system performance within supportive frameworks. However they differ in their assessment approaches. Ontario's Scorecard links performance measurement with strategy, aimed at health system integration. The Dutch Health Care Performance Report (Zorgbalans) does not explicitly link performance with strategy, and focuses on the technical quality of healthcare by measuring dimensions of quality, access, and cost against healthcare needs. A backbone 'five diamond' framework maps both frameworks and articulates the interrelations and overlap between their goals, themes, dimensions and indicators. The workshop yielded more contextual insights and further validated the comparative values of each constituency's performance assessment system.
  
  
  CONCLUSIONS
  To compare the health system performance approaches between The Netherlands and Ontario, Canada, several important conceptual and contextual issues must be addressed, before even attempting any future content comparisons and benchmarking. Such issues would lend relevant interpretational credibility to international comparative assessments of the two health systems.
authors.affiliation: Department of Social Medicine, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands. shukor@gmail.com <shukor@gmail.com>
authors.forename: Ali R
authors.initials: AR
authors.lastname: Tawfik-Shukor
authors.forename: Niek S
authors.initials: NS
authors.lastname: Klazinga
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
mesh_terms: D019985:Benchmarking / Q000379:methods*; D003695:Delivery of Health Care / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D009426:Netherlands; D009864:Ontario; D011787:Quality of Health Care