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Indicator Hierarchy

Indicator hierarchy is important because it gives a full picture of relevant indicators per health system performance assessment (HSPA) domain. The following tables display indicator names at headline, operational and explanatory level. The number of indicators per level reflects the ratios as suggested by the indicator framework for monitoring the EU Sustainable Development Strategy. A second set of tables feature the same information, but starts with “super” indicators. A “super” indicator is defined as an indicator given the highest rank in three survey dimensions. These dimensions are the assessment on the level of importance, e.g. headline, on the level of HSPA domain, e.g. access, and according to individual preferences of survey respondents, e.g. top three listed indicator per domain. This illustration serves as a validation for the selection of the respective headline indicators. 

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Access
Efficiency
Quality of Care
Health Status
Health Determinants
Equity

Access

Headline Operational Explanatory
Share of population covered by health insurance        Waiting times for elective surgeries     Rate of patients with colorectal tumour receiving chemotherapy whose treatment started within two months following surgery
Reported waiting times for access to specialist (care) 
Waiting times for admission to public rehabilitation facility and to public long-term care facility
Waiting times for home/social care services
Self-reported unmet need for dental care (total by reason: cost, waiting time, distance)    General practitioner (GP) utilisation: self-reported visits / Number of doctor consultations 
Geographic distribution of doctors: Physicians density in predominantly urban and rural regions
Percentage of households experiencing high levels/catastrophic of out-of-pocket health expenditures

Access with "super" indicators

Headline Operational Explanatory
Share of population covered by health insurance        Waiting times for elective surgeries     Rate of patients with colorectal tumour receiving chemotherapy whose treatment started within two months following surgery
Reported waiting times for access to specialist (care) 
Waiting times for admission to public rehabilitation facility and to public long-term care facility
Waiting times for home/social care services
Self-reported unmet need for dental care (total by reason: cost, waiting time, distance)    General practitioner (GP) utilisation: self-reported visits / Number of doctor consultations 
Geographic distribution of doctors: Physicians density in predominantly urban and rural regions
Percentage of households experiencing high levels/catastrophic of out-of-pocket health expenditures

Efficiency

Headline Operational Explanatory
Total health care expenditure by all financing agents (total, public and private sectors)    Average length of stay (ALOS), total and selected diagnoses Share of GPs in all physicians
Rate of patients with colorectal tumour receiving chemotherapy whose treatment started within two months following surgery
Reported waiting times for access to specialist (care)
Employment in human health and social work activities
Hospital day-cases, total and selected diagnoses General practitioner (GP) utilisation: self-reported visits / Number of doctor consultations
Caesarean section rates
Numbers of people awaiting donor organs

Efficiency with "super" indicators

Headline Operational Explanatory
Total health care expenditure by all financing agents (total, public and private sectors)    Average length of stay (ALOS), total and selected diagnoses Share of GPs in all physicians
Rate of patients with colorectal tumour receiving chemotherapy whose treatment started within two months following surgery
Reported waiting times for access to specialist (care)
Employment in human health and social work activities
Hospital day-cases, total and selected diagnoses General practitioner (GP) utilisation: self-reported visits / Number of doctor consultations
Caesarean section rates
Numbers of people awaiting donor organs

Quality of Care

Headline Operational Explanatory
Vaccination coverage in children Caesarean section rates Rate of patients with colorectal tumour receiving chemotherapy whose treatment started within two months following surgery
30-day in-hospital mortality
Share of long-term care recipients aged 65 years and over receiving care at home
Ambulatory Care Sensitive Conditions (ACSC) Hospitalization Rate
Screening rates for selected cancers (breast, cervical, colon) Prevalence and incidence rate of hospital-acquired infections (% of patients hospitalised)
Incidence rate of end-stage kidney disease
Incidence rate of measles

Quality of Care with "super" indicators

Headline Operational Explanatory
Prevalence and incidence rate of hospital-acquired infections (% of patients hospitalised) Caesarean section rates Rate of patients with colorectal tumour receiving chemotherapy whose treatment started within two months following surgery
30-day in-hospital mortality
Share of long-term care recipients aged 65 years and over receiving care at home
Ambulatory Care Sensitive Conditions (ACSC) Hospitalization Rate
Screening rates for selected cancers (breast, cervical, colon) Prevalence and incidence rate of hospital-acquired infections (% of patients hospitalised)
Incidence rate of end-stage kidney disease
Incidence rate of measles

Equity

Headline Operational Explanatory
Share of population covered by health insurance Private household out-of-pocket expenditure as a proportion of total health expenditure Percentage of households experiencing high levels/catastrophic of out-of-pocket health expenditures 
Out-of-pocket payments as percentage of GDP, per capita
Rate of patients with colorectal tumour receiving chemotherapy whose treatment started within two months following surgery
Self-reported unmet need for dental care (total by reason: cost, waiting time, distance)
Waiting times for elective surgeries Waiting times for admission to public rehabilitation facility and to public long-term care facility
Gap in life expectancy at age 30 by sex and educational level
Practising physicians

Equity with "super" indicators

Headline Operational Explanatory
Private household out-of-pocket expenditure as a proportion of total health expenditure Private household out-of-pocket expenditure as a proportion of total health expenditure Percentage of households experiencing high levels/catastrophic of out-of-pocket health expenditures 
Out-of-pocket payments as percentage of GDP, per capita
Rate of patients with colorectal tumour receiving chemotherapy whose treatment started within two months following surgery
Self-reported unmet need for dental care (total by reason: cost, waiting time, distance)
Waiting times for elective surgeries Waiting times for admission to public rehabilitation facility and to public long-term care facility
Gap in life expectancy at age 30 by sex and educational level
Practising physicians

Health Status

Headline Operational Explanatory
Life expectancy Incidence rate of tuberculosis (TB) Incidence rate of end-stage kidney disease
Incidence rate of occupational diseases
Potential years of life lost (PYLL) Fetal mortality rate by gestational age, birth weight, plurality
Prevalence rate of COPD
Long-term activity limitations
Incidence rate of sexually transmitted infections and blood-borne viruses Multiple birth rate by number of fetuses
Prevalence rate of Diabetes

Health Status with "super" indicators

Headline Operational Explanatory
Life expectancy Incidence rate of tuberculosis (TB) Incidence rate of end-stage kidney disease
Incidence rate of occupational diseases
Potential years of life lost (PYLL) Fetal mortality rate by gestational age, birth weight, plurality
Prevalence rate of COPD
Long-term activity limitations
Incidence rate of sexually transmitted infections and blood-borne viruses Multiple birth rate by number of fetuses
Prevalence rate of Diabetes

Health Determinants

Headline Operational Explanatory
Share of population covered by health insurance Prevalence of smoking among pregnant women Incidence rate of occupational diseases
At risk of poverty or social exclusion rate
Percentage of households experiencing high levels/catastrophic of out-of-pocket health expenditures 
Incidence rate of tuberculosis (TB) Distribution of gestational age by vital status, plurality
Incidence rate of road traffic accidents resulting in injuries
Distribution of parity 
Mean and median income

Health Determinants with "super" indicators

Headline Operational Explanatory
Prevalence of different smoking status, self-reported Prevalence of smoking among pregnant women Incidence rate of occupational diseases
At risk of poverty or social exclusion rate
Percentage of households experiencing high levels/catastrophic of out-of-pocket health expenditures 
Incidence rate of tuberculosis (TB) Distribution of gestational age by vital status, plurality
Incidence rate of road traffic accidents resulting in injuries
Distribution of parity 
Mean and median income

Headline indicators

Headline indicators are important because they provide a focused system overview at a glance and they give overall early warnings of policy impacts.

An indicator has headline quality if it monitors the overall performance in defined domains related to key objectives in public health and in health systems. Other criteria include being robust, widely used with high communicative and educational values, and available for most EU Member States, generally for a minimum of five years.

The following tables present headline indicators per HSPA domain. They contain indicator name, explanatory information, information about the availability of each indicator in EU Member States, and the availability in key databases such as Eurostat, OECD health statistics, and WHO-EUR health information gateway.