Health System Performance Assessment Framework for the Slovak Republic

Annex C. Technical sheet example

C.1 Technical information for the Slovak HSPA indicator sheets

Indicator technical information forms a vital component of the HSPA by clearly defining each indicator and ensuring methodological soundness and transparency. The technical information for the Slovak HSPA draws on international best practices from other HSPA frameworks and adapts them to the Slovak national context. The technical information serves as an indicator “passport”, setting out key information such as identification, rationale, calculation methods, and data sources. By systematically documenting methodologies, the technical information supports accurate interpretation of results and builds confidence in the robustness of the HSPA process.

Table A C.1 presents the proposed structure and content of The Slovak Republic’s indicator technical information, developed jointly by the PMT and the OECD. For each indicator, 24 information fields would be provided.

Table A C.1. Proposal for definitions of technical details for the Slovak HSPA indicator sheets

Name of detail (column)	Description
Area	HSPA area the indicator is in
Domain	HSPA domain the indicator is in
Indicator ID	ID assigned earlier in indicator selection
Name of indicator (ENG)	The name of the indicator in English
Name of indicator (SVK)	The name of the indicator in Slovak
Indicator breakdown	Based on data availability, which disaggregation of the indicator are possible for analysis (e.g. by age, sex, region, socio-economic status etc.)
Definition	A description of what the indicator measures
Unit	The measurement unit used to express the indicator, including where relevant the base population or standardisation applied (e.g. count, percentage, rate per 1 000 inhabitants, EUR, PPP, years, days, score, FTE).
Rationale	Provides a reasoning for monitoring the indicator and its connection to the HSPA purpose and/or logics of the framework, or can be also to broader health objectives or outcomes. Particularly important for indicators that are a proxy of the phenomenon (e.g. avoidable hospital admissions ~ PHC performance, # pf publications ~ research activity).
Responsibility in HSPA (HSPA indicator custodian)	Organisation that would be responsible for drafting the indicator sheet, including structuring its technical information and providing the data analysis descriptions [i.e. this organisation may not necessarily provide, i.e. collect and process, indicator’s data]
Custodian producing or disseminating the original indicator	Where the data could be taken from.
Indicator collection or publication name	Survey or data collection to generate the indicator (publication/collection of indicator)
Custodian of dataset	Changed name from “data custodian.” Organisation(s) managing the primary dataset(s) used to calculate the indicator figures/data.
Custodian dataset name (if different from the row before)	Dataset collection type and name that the indicator is calculated from (e.g. annual activity report of hospitals, cancer registry, national survey). Where relevant include frequency of dataset generation/update
Type of dataset data	The general type of underlying data used to calculate the indicator (e.g. administrative, survey, claims/reimbursement, estimated/modelled, or mixed data).
Data collection frequency	How often is the indicator generated/updated
Data Availability	Describes whether the indicator is readily available, or alternatively whether the data required to calculate the indicator is available.
Comparability	Describes whether international or national comparisons are available, and on what level (which countries/what level of regional disaggregation), time trend availability
Data coverage	Scope of the data (geographic coverage, population coverage, etc.)
Calculation	Methodology and technical formula, including descriptions of numerator and denominator / survey question if relevant
Limitations	Describes the constraints affecting use and interpretation of the indicator, such as data quality, methodological or comparability issues, etc.
Additional information	Any relevant details that help interpret or complement the indicator (notes about data collection, complementary findings, links to related analyses, or other remarks)
Supplementary indicators	Identifies data and indicators outside of the HSPA framework that can be used to contextualise or complement the selected indicator.
URL	Link to the indicator source (if available)

Source: Developing the HSPA framework for the Slovak Republic project.

C.2 Technical information – International practice

Countries typically compile technical information on HSPA indicators during the HSPA implementation phase. The technical information is assumed to remain relatively stable over time, as the underlying methodologies change infrequently.

The technical information serves four main purposes:

• Standardise indicator definitions and measurement approaches

• Ensure transparency, enabling users to understand data sources and calculation methods

• Guide analysis and reporting, supporting results that are interpretable and credible

• Support cross-country comparability

Countries adopt different approaches to documenting technical information for HSPA indicators. They vary in the types of elements included, the level of detail provided, and the structure and presentation of the information. Some countries integrate technical information alongside the indicator results, while others present it separately. Unlike results, which are updated regularly, technical information is updated only when necessary, for example following methodological revisions or the identification of new limitations.

To compare international practices in presenting technical information across HSPAs and related frameworks, the analysis reviewed four HSPAs and one additional example used in Luxembourg: Belgium’s HSPA (Belgian Healthcare Knowledge Centre, 2025[1]), Ireland (AMC, 2021[2]), Canada (CIHI, 2025[3]) and Italy (Ministero della Salute Italy, 2019[4]); and Luxembourg’s ObSanté indicators (ObSanté, 2025[5]).

The table below summarises the elements included in the technical information sections across these countries. These findings highlight the variation in selected elements and supported the reflection process caried out by the PMT on which components may be most relevant for inclusion in their respective HSPAs.

Figure A C.1. Overview of international practice in HSPA indicator technical detail provision across national HSPAs

Note: The indicators developed by Luxembourg are not part of an HSPA framework and were used to explore different formats for presenting technical information. This refers to the health indicators developed by the Observatoire national de la santé (National Health Observatory).

Source: Based on the Belgian Healthcare Knowledge Centre (2025[1]); Academic Medical Centre of the University of Amsterdam (2021[2]); Canadian Institute for Health Information (CIHI, 2025[3]); Ministero della Salute Italy (2019[4]); and ObSanté Luxembourg (2025[5]).

Although the specific elements differ across HSPA frameworks, most organise their technical information around a similar set of categories. In practice, the technical sections of nearly all HSPAs cover the following core areas:

• Identifying information: This typically includes a unique indicator ID, the official indicator name and a brief description.

• Background and context: This section commonly outlines the rationale for inclusion, links to related domains or indicators, and considerations for international comparability.

• Indicator calculation: Describes how the indicator is constructed. This includes the calculation method, measurement type, data sources, available breakdowns and the frequency of updates.

• Quality statement: Assesses the robustness of the indicator. This section usually documents data limitations and provides additional notes to support interpretation and assess reliability.

Countries also differ in how they present technical information for HSPA indicators. In practice, each country adopts a format that reflects its institutional needs and aligns with the overall design of its HSPA platform. Belgium and Luxembourg provide a separate technical document for each indicator, typically in PDF format, with technical details presented in a structured table (Belgian Healthcare Knowledge Centre, 2025[1]; ObSanté, 2025[5]). Italy, by contrast, consolidates the technical information for all indicators into a single PDF document containing all technical sheets (Ministero della Salute Italy, 2019[4]).

Canada also presents technical information at the indicator level, but uses individual web pages rather than downloadable files (CIHI, 2025[3]). In addition, Canada integrates key indicator results directly into the technical tables. Belgium presents results separately from the technical information, although both appear within the same document (Belgian Healthcare Knowledge Centre, 2025[1]).

Ireland adopts a different approach, compiling technical information for all indicators across domains in a single Excel file (AMC, 2021[2]). This file is published separately from the online interactive platform used to present indicator result.

References

[2] AMC (2021), Methodological report: The development of the Irish Health System Performace Assessment Framework and its relation to the Health Information System, Academic Medical Centre of the University of Amsterdam, https://assets.gov.ie/static/documents/methodological-report.pdf.

[1] Belgian Healthcare Knowledge Centre (2025), Performance of the Belgian Health System: Report 2024, Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE), https://doi.org/10.57598/R376C.

[3] CIHI (2025), Health system performance measurement, Canadian Institute for Health Information, https://www.cihi.ca/en/access-data-and-reports/health-system-performance-measurement.

[4] Ministero della Salute Italy (2019), Schede tecniche degli indicatori NSG.

[5] ObSanté (2025), Indicateurs, Observatoire national de la santé, https://obs.gouvernement.lu/fr/indicateurs-sante.html?utm_source.