HEALTH SYSTEM PERFORMANCE ASSESSMENT - AN ESSENTIAL TOOL FOR HEALTH SYSTEM IMPROVEMENT

Health system performance assessment is a widely recognised tool, which supports the decision-making process in the health system and monitors the progress in achieving its goals. In the last 20 years, many international organisations such as Organisation for Economic Cooperation and Development, World Health Organisation European Region and European Observatory on Health Systems and Policy have undertaken several initiatives for health system performance assessment. At EU level, it is seen as an essential tool to achieve effectiveness, accessibility and resilience of health systems. Different conceptual frameworks for health system performance assessment have been proposed at international and national level. Although there is no uniform dimensions and indicators, all these frameworks have a common starting point – the conceptualisation of the health system, defined in a broader or narrower way. In Bulgaria, over the past decades, comprehensive health system studies have been mainly devoted to the ongoing health reforms and their outcomes. There are numerous studies on specific aspects of the health system, such as effectiveness and access to health services, as well as studies related to the assessment of the health status of the nation. Despite the wide variety of healthcare publications in Bulgaria, there is no a uniform methodology for periodic assessment of the health system. The aim of this study is to review the current state of research on health system performance assessment at international and national level.