About
European Observatory on Health Systems and Policies
The European Observatory on Health Systems and Policies is a partnership that brings together policy perspectives to identify and generate the evidence that Europe’s decision-makers need. The Observatory shares this evidence on health systems and policies in print, in person and online – acting as a knowledge broker and bridging the gap between academia and policy. The Observatory has four core functions:
- Country monitoring: providing analytic and evaluative descriptions of country health systems and systematically monitoring developments;
- Analysis: exploring how health systems ‘work’ through secondary and comparative research, multi-disciplinary studies and policy briefs on key and emerging challenges;
- Health systems performance assessment: supporting the development and interpretation of indicators for practical policy use and to help improve performance;
- Knowledge brokering: making Observatory evidence visible and useful to its target audiences by unpacking and sharing it in a range of formats.
Health Systems and Policy Monitor (HSPM) network
The Observatory's HSPM network convenes an international group of around 50 national health systems researchers from over 40 institutions in more than 30 high-income countries. The countries include all EU countries, Canada, Israel, the UK and the US. The HSPM network participates in a wide range of collaborations keeping the health policy community up to date on health system developments and contributing their expertise on the dynamics of health systems to reports, studies, and knowledge transfer exercises for a variety of audiences, including ministries of health and international organizations. The HSPM network also informs the HSPM website, an innovative platform that provides a detailed description of health systems and provides up-to-date information on reforms and changes that are particularly policy-relevant.
History of the tool and the Reform Round-up
The HSPM network brings together prestigious academic institutions with a strong track record in health systems and policy analysis. The network meets annually to exchange knowledge and experiences from the various health system activities across Europe and beyond. It fosters comparative research collaborations and generates evidence to inform policymaking.
Every year since 2018, the Observatory has asked the network members to share what they understand to be the current year's “top three” health reforms in their respective countries. This exercise is called the Reform Round-up and has resulted in a repository of over 620+ reforms in the Health Reform Tracker. The assessment exercise also informs cross-country comparative studies and supports HSPM members and health policy makers.
Methodology
HSPM national experts are asked via e-mail to identify the “top three” recent reforms in their respective countries in a standardized survey in English. This survey asks for the name of each reform, a short description, including details on what it addresses and how, as well as the type of reform (e.g., legislation, a directive, a strategy or plan), and the originator of the reform (e.g., executive government, parliament/legislature, health insurance). The implementation status of each reform is also tracked over time.
No limitations are imposed on HSPM experts' choice of reforms, i.e. experts were free to select whatever they felt were the most important in their country in that year. From 2018-2020, reforms were iteratively organized across nine pre-defined clusters. These clusters were derived from the template for the Observatory's Health Systems in Transition series and the WHO Health Systems Framework (2007), and then aligned with the OBS and WHO HSPA framework (2023). Information on the implementation status of reported reforms is also solicited. Since 2021, the experts themselves are asked to do an initial clustering, which is then checked and validated by researchers at the Observatory. Given the complex and multifaceted nature of health reforms, a second cluster allocation was also introduced in 2021. As the exercise evolved, two additional clusters were added, bringing the total to 11. The reforms from 2018-2021 were subsequently re-clustered across these 11 areas. Most reforms are now included in two distinct clusters to give users different entry points for understanding reforms.
Latest literature
Polin K, Hjortland M, Maresso A, van Ginneken E, Busse R, Quentin W. “Top-Three” health reforms in 31 high-income countries in 2018 and 2019: an expert informed overview. Health Policy 2021;125 (7): 815-832 https://doi.org/10.1016/j.healthpol.2021.04.005.