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This page refers to the Performance and Accountability Framework, an intergovernmental document that assigned various reporting responsibilities to the former National Health Performance Authority. From 1 July 2016, activities related to reporting against the indicators contained in the Framework are the responsibility of the Australian Institute of Health and Welfare.

4.1 - Key conceptual principles

The objectives of the Australian health system are delivered through multiple decision makers, multiple funding streams, multiple service providers and multiple data agencies.

The indicator set included in the Framework is designed to cover this broad spectrum of activity, whilst ensuring that perverse incentives are not created by encouraging activity that addresses the Framework indicators to the exclusion of other important outcomes.

The Framework includes a new accountability regime and therefore, for accountability purposes, it includes a set of indicators that are sufficiently attributable to the organisations that will be held accountable for the relevant outcomes. It also includes some indicators that cannot be used for accountability purposes, but that provide useful contextual or planning information.

Any new indicators that are to be added to the Framework, and that are used to hold hospitals, LHNs or Medicare Locals to account, will need to be clearly attributable to the performance of those organisations.

Across the areas of activity within scope for the Framework, performance will be measured through a combination of service delivery outcomes and population health outcomes. Whilst health performance frameworks can include measures of individual outcomes, such outcomes are not within the scope of the Framework, which is aimed at reporting performance information at an organisational level in a way that supports individual choice rather than focussing on individual outcomes themselves. Figure 2 illustrates the interaction between these outcomes.

Figure 2: Health System Outcomes

PAF section 4 figure 2 - Health Systems Outcomes

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4.2 - The National Health Performance Framework

In 2001, the National Health Performance Framework (NHPF) was developed by the former National Health Performance Committee under AHMAC. The Framework helps Ministers to understand and evaluate the health of Australia’s population from the perspective of three domains: the health status of Australians, the determinants of Australians' health and the performance of the health system. The Framework focuses on the third domain. The other domains are addressed by reports issued by the AIHW, the Australian Bureau of Statistics (ABS) and a range of other bodies.

The Framework draws on the overarching principles of the NHPF in its consideration of health status with regard to the performance of Medicare Local communities, and health system performance with regard to Medicare Locals and hospitals. A key point of difference between the NHPF and the Framework is that the NHPF has been ultimately designed to measure the health status of the population, whilst the primary focus of the Framework is to measure health system performance at the local level.

4.3 - Report on Government Services (RoGS) Framework

The Review of Government Service Provision provides information on the effectiveness and efficiency of government services in Australia. One of the main tasks of the Review is to develop agreed national performance indicators for government services, which are published in the annual Report on Government Services (RoGS).

The RoGS framework is outcomes focused, supplemented by output measures. Indicators are considered under three domains – equity, effectiveness and efficiency – which include assessment of inputs in producing desired outputs and outcomes (see Figure 3 below) to meet the overarching objectives being sought. This ensures that comparative information is available to governments and the public about the equity, effectiveness and efficiency of government services. The RoGS framework aims to present a holistic and balanced picture of performance through a comprehensive suite of indicators but also strives for conciseness, for example, by drawing out headline indicators. The RoGS framework assists in identifying gaps in assessing performance due to an absence of appropriate indicators or where there are potentially too many indicators being used to measure the one domain. This approach has therefore been used to design the initial set of indicators to be included in the Framework. Any future indicators to be added to the Framework are expected to be considered against these domains, as well as the performance indicator selection criteria set out in section 5.

Figure 3: RoGS General Performance Framework

PAF section 4 figure 3 - RoGS General Performance Framework

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The RoGS framework reflects the service process or sequence of steps involved in transforming inputs into outputs and outcomes in order to achieve the desired policy and program objectives. The service process is shown below (Figure 4).

Figure 4: Service Process – underpins the RoGS General Performance Framework

PAF section 4 figure 4 - Service Process – underpins the RoGS General Performance Framework

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The RoGS Framework distinguishes outcomes and outputs by classifying outputs as the actual services delivered whilst outcomes are the impact of a service on the status of an individual or a group and on the success of the service achieving its objectives. This construction provides good fit for assessing the delivery of health services by providers (hospitals, LHNs and Medicare Locals) through the domains of equity, effectiveness and efficiency - the primary focus of performance reporting under the Framework.