Defining the problem -- benchmarking and health system performance goals

Roberts et al. discuss the importance of "defining the problem," an issue that takes on particular relevance in light of the recent Oregon Medicaid debate:

The most overlooked, yet one of the most important steps in health-sector reform is defining the problem.  Heath-care systems give rise to hundreds of statistics on their performance.  But which are an appropriate focus for public attention?

The group that succeeds in having its problem definition accepted as the basis for discussion about reform will have a great effect on the solutions pursued and the policies adopted.  

This is basic Public Policy 101 stuff, but a good reminder.  Roberts and Co. also lay out their three main performance goals for health reform: 1) health status; 2) satisfaction (that the health system produces among its citizens); and 3) financial risk protection.  I would argue that 3) is a more worthy goal than 2), but I could be persuaded otherwise.

Within "problem definition" Roberts also discusses the usefulness of "benchmarking," a concept that I like:

In health sector reform, benchmarking means looking at countries similar to one's own in income and spending levels, whose health system performance is particularly effective.  Thus, reformers in Thailand might wonder why Sri Lanka has longer life expectancy while spending less on health care, and use that fact to focus their own problem definition.  Similarly, Latin American countries could look at health statistics from Cuba or Costa Rica for setting their own objectives.