Assessing the responsiveness of chronic disease care - is the World Health Organization's concept of health system responsiveness applicable?
The concept of health system responsiveness is an important dimension of health system performance assessment. Further efforts have been made in recent years to improve the analysis of responsiveness measurements, yet few studies have applied the responsiveness concept to the evaluation of specific health care delivery structures. The objective of this study was to test the World Health Organization's (WHO's) responsiveness concept for an application in the evaluation of chronic disease care. In September and October 2012 we conducted four focus groups of chronically ill people (n = 38) in Germany, in which participants discussed their experiences and expectations regarding health care. The data was analyzed deductively (on the basis of the WHO responsiveness concept) and inductively using directed content analysis. Ten themes related to health system responsiveness and one theme (finances) not directly related to health system responsiveness, but of high importance to the focus group participants, could be identified. Eight of the ten responsiveness themes are consistent with the WHO concept. Additionally, two new themes were identified: trust (consultation and treatment are not led by any motive other than the patients' wellbeing) and coordination (treatment involving different providers is coordinated and different actors communicate with each other). These findings indicate the suitability of the WHO responsiveness concept for the evaluation of chronic disease care. However, some amendments, in particular an extension of the concept to include the two domains trust and coordination, are necessary for a thorough assessment of the responsiveness of chronic disease care.
Berlin Centre for Health Economics Research and Department of Health Care Management, Technische Universität Berlin, Strasse des 17, Juni 135, 10623 Berlin, Germany. Electronic address: Julia.Roettger@tu-berlin.de.
Julia
J
Röttger
Berlin Centre for Health Economics Research and Department of Health Care Management, Technische Universität Berlin, Strasse des 17, Juni 135, 10623 Berlin, Germany.
Miriam
M
Blümel
Berlin Centre for Health Economics Research and Department of Health Care Management, Technische Universität Berlin, Strasse des 17, Juni 135, 10623 Berlin, Germany.
Sabine
S
Fuchs
Berlin Centre for Health Economics Research and Department of Health Care Management, Technische Universität Berlin, Strasse des 17, Juni 135, 10623 Berlin, Germany.
Reinhard
R
Busse
D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D005858:Germany; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards*; D014944:World Health Organization; D055815:Young Adult
Chronic disease care; Client orientation; Focus groups; Germany; Health system responsiveness; Patient expectations; Patient experiences; Respect for persons