Table 3.
Health system governance assessment instrument
| YES | SOMEWHAT | NO | |
|---|---|---|---|
| 1. Transparency | |||
| 1.1. Is the population entitled to services under the statutory health system clearly defined in legislation, and is it clearly communicated to the public? | Clearly defined and clearly communicated to the public | Partially defined and/or poorly communicated to the public | Not defined or very poorly defined/only in a few cases |
| 1.2. Is the list of services, to which patients are/are not entitled under the statutory health system, clearly defined in legislation, and clearly communicated to the public? | Clearly defined and clearly communicated to the public | Partially defined and/or poorly communicated to the public | Not defined or very poorly defined/only in a few cases |
| 1.3. Are quality and waiting time guarantees under the statutory health system clearly specified in legislation, and clearly communicated to the public? | Clearly specified and clearly communicated to the public | Partially specified and/or poorly communicated to the public | Not specified or very poorly specified/only in a few cases |
| 1.4. Is the information on performance (quality, waiting time) of health care legal entities (e.g., hospitals, clinics, individual practices) collected and publicly available? | Regularly and comprehensively collected and publicly available | Partially collected and/or not publicly available | Not collected at all or only in a few cases |
| 1.5. Is obligatory patient cost-sharing under the statutory health system clearly specified in legislation, and clearly communicated to the public? | Clearly defined and clearly communicated to the public | Partially defined and/or poorly communicated to the public | Not defined or very poorly defined/only in a few cases |
| 1.6. Are patient payments under the statutory health system, other than obligatory cost-sharing (e.g., gratitude payments, payments to foundations, balance/extra billing), clearly regulated, and clearly communicated to the public? | All are clearly regulated and clearly communicated to the public | Some are regulated and/or poorly communicated to the public | None or almost none are regulated |
| 2. Accountability | |||
| 2.1. Are there any laws or regulations, and are they enforced in practice, to penalize individual health professionals for demanding or accepting informal patient payments? | There are laws or regulations, and they are generally enforced in practice | There are some laws or regulations, but they are occasionally enforced in practice | There are no laws or regulations |
| 2.2. Are there any laws or regulations, and are they enforced in practice, to penalize health care legal entities (e.g., hospitals, clinics, individual practices) for demanding or accepting informal patient payments or for their employees demanding or accepting informal patient payments? | There are laws or regulations, and they are generally enforced in practice | There are some laws or regulations, but they are occasionally enforced in practice | There are no laws or regulations |
| 2.3. Are there any laws and regulations, and are they enforced in practice, to penalize patients (or individuals acting on their behalf) for giving informal payments? | There are laws or regulations, and they are generally enforced in practice | There are some laws or regulations, but they are occasionally enforced in practice | There are no laws or regulations |
| 2.4. Are there any mechanisms within the health system (e.g., internal whistleblowing, complaint mechanisms) to enable people to report cases of informal patient payments and be protected against reprisal? | There are mandatory/widely implemented mechanisms | There are some mechanisms, but they are partially implemented | There are no mechanisms, or they are very rarely implemented |
| 2.5. Are there any watchdogs (e.g., committees, Ombudsman) at the national, regional, local or individual level, which are responsible specifically for protecting patients’ rights. | There are institutions at all or most levels of the system | There are institutions at some levels of the system | There are no institutions, or they are not specifically dedicated to patients |
| 2.6. Are there established and effectively implemented mechanisms to hold health care legal entities accountable for providing adequate quality and access to care (e.g., accreditation, monitoring of errors and compliance with quality standards, quality-based payment mechanisms, etc.)? | There are mandatory/widely implemented mechanisms | The are some mechanisms, but they are partially implemented | There are no mechanisms, or they are very rarely implemented |
| 2.7. Are there established and effectively implemented mechanisms to ensure adequate financing of the benefit package by public payer/s (e.g., cost-based price setting, population needs assessment, etc.)? | There are mandatory/widely implemented mechanisms | The are some mechanisms, but they are partially implemented | There are no mechanisms, or they are very rarely implemented |
| 3. Participation | |||
| 3.1. Is there a rule and practice of involving relevant stakeholders (including patients) in health care decision making at the local, regional, or national levels? | There is a rule which is always or almost always followed, and patients are involved | There is a rule, but it does not always apply or is partly followed, and patients’ involvement might be limited | There is no rule, or the rule is very rarely followed |
| 3.2. Are there any monitoring and evaluation mechanisms in place that enable citizens to provide feedback on the quality of care? | There are mandatory/widely implemented mechanisms | The are some mechanisms, but they are partially implemented | There are no mechanisms, or they are very rarely implemented |
| 3.3. Are there any mechanisms and policy initiatives to foster patient involvement in decisions regarding their health (allowing the choice of providers, promoting shared decision-making, patient empowerment, and person-cantered care)? | There are mandatory/widely implemented mechanisms as well as various policy initiatives | There are some mechanisms, but they are partially implemented, and policy initiatives are occasional | There are no mechanisms or policy initiatives, or both are very rare |
| 3.4. Has the participatory and consensus-based approach been applied to policy on obligatory patient cost-sharing in the statutory health system? | Participatory and consensus-based approach has been applied (policy is accepted by all stakeholders) | Participatory and consensus-based approach has been partly applied | Participatory and consensus-based approach has not been applied |
| 4. Integrity | |||
| 4.1. Are there any specific missions, strategies, codes of conduct to fight/prevent informal patient payments, which authorities and institutions are committed to? | There are missions, strategies, codes of conduct, and authorities and institutions demonstrate commitment to implementing them | There are some missions, strategies, codes of conduct, but they are generally focused on corruption and/or authorities and institutions demonstrate little commitment to implementing them | There are no missions, strategies, or codes of conduct |
| 4.2. Are the public sector and private sector well separated, i.e., are health care legal entities allowed to provide both public and private services, and are medical professionals allowed to work in both the public and private sectors? | They are well separated | They are partly separated | There are not separated or very poorly separated |
| 4.3. Are there any regulations and mechanisms to take into account the performances of health professionals when hiring, promoting, and remunerating them? | There are regulations and mandatory/widely implemented mechanisms | The are some regulations and mechanisms, but they are partially implemented | There are no regulations and mechanisms, or they are very rarely implemented |
| 5. Capacity | |||
| 5.1. Are there any specific institutions that provide evidence and support health policymaking, including policy on patient payments (e.g., HTA agency, research institutes)? | There are institutions, and they provide evidence for policy making on a regular basis | There are some institutions, but they do not provide evidence on a regular basis | There are no institutions dedicated to this purpose |
| 5.2. Is there a mechanism and practice of relying on evidence in health policymaking? | There is a mandatory mechanism and/or it is a common practice | There is a mechanism, but it is partially put into practice | There is no mechanism, or it is an uncommon practice |
| 5.3. Are reliable data (e.g., from national household surveys) on informal patient payments systematically collected and available for policymakers? | Reliable (complete and accurate) data are systematically collected and readily available | Reliable data are collected but not systematically, or data are only partially reliable | Data are not collected, or they are not reliable |