Operational measures: indicators of health system performance

As P.L. 93-641, the National Health Planning and Resources Development Act of 1974 makes clear, Health Systems Agencies (HSAs) were created to improve the costs, availability, accessibility, acceptability, quality, and continuity of the health system. To fulfill this mandate, agencies require clear definitions of these six characteristics and valid measures which can be applied to assess the performance of the existing health system and the impact of proposed modifications. The current state of the planning art does not provide for either of these requirements. This is due to the lack of consensus regarding the definitions of the characteristics and our limited understanding of the variety and validity of measures presently in use. Recognizing these problems, DHEW'S Bureau of Health Planning and Resources Development (BHPRD) initiated a project with The Orkand Corporation in June 1976, to accomplish the following objectives: (1) develop mutually exclusive definitions for the six characteristics; (2) identify and develop model operational measures for each of the characteristics; (3) produce guidelines for the application of these measures; and (4) design a methodology for HSAs to use in appraising the various interrelationships among characteristics. This paper is an introduction to the operational measures project. It describes the operational measures concept and the measures' intended uses. The monograph to be produced by the project is described. Finally, the project findings to date are summarized.