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Arch Hellen Med, 24(1), January-February 2007, 7-21


Health services and health systems evaluation

Center for Health Services Research, Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens, Greece

This article reviews the concept and methods of evaluation in health care. Evaluation should be considered a necessary component in the planning, organization and administration of every health service or health system, and it can be made at four levels: inputs, processes, outputs and outcomes. Evaluation should use specific, widely accepted criteria, of which effectiveness, efficiency and equity are considered the most important. Equity is rated first on the priority list of those who view health as a public good. Comprehensive evaluation should cover all levels and include a combination of different criteria. Health service evaluation usually attempts to assess the extent of accomplishment of the objectives of either the service as a whole or its individual health programs. This can be achieved by selection of specific indices and application of suitable methods. Many methods are available, of which randomized controlled trials play the major role in health services research methodology. As far as health systems are concerned, appropriate evaluation of their inputs, outputs and outcomes is based on specific indicators and includes comparison with accepted standards, while evaluation of the intermediate processes is usually based on data from representative aspects of clinical and administrative procedures. Complex interventions and reforms are usually evaluated by social evaluation methods.

Key words: ┼ffectiveness, ┼fficiency, ┼quity, ┼valuation, ăealth.

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