Healthcare access, quality of care and efficiency as healthcare performance measures: A Canadian health service view

While most performance judgements are value-relative, in health systems reform it is important to focus on intermediate performance measures like healthcare access, quality of care and efficiency in healthcare on health status of population, the satisfaction of patients, and the degree to which services are made equi- table. However, to date these concepts are not well-defined, remain fairly ambiguous and, consequently, are also not well-measured. Therefore, such concepts do not provide sufficient information to inform changes to the health system that may improve population level outcomes related to structural factors. Our paper established an argument and from our viewpoints we provide a more conceptual clarification on how these three intermediate variables may shape assessments in health system performance, while drawing from the Canadian healthcare system performance gaps and placing them as evidence. We found an immediate need for patient-centred outcome measures in service and clinical quality instead of surrogate outcome measures, need for improved measures on the rate of service utilization such as in terms of service-orientation and pa- tient satisfaction, and a need for more robust approach in measuring allocative efficiency in healthcare to be the key areas of strengthening performance assessments. These intermediate variables can play an important role in Canadian policy and also would have dominant roles in legislative agenda and outcome, which can be both responsive and influential.