Health System Performance Assessment Framework for the Slovak Republic

Annex D. The Slovak HSPA: Contextualising indicators and alternative indicator sources

Annex D contains two types of information to supplement information provided in Section 3.2 about indicators in the Slovak HSPA. First, it lists contextualising indicators in the Slovak HSPA Contextualising indicators are measures outside the HSPA core set that help contextualise or complement analyses of HSPA indicators. Secondly, it explains how in the case of several indicators in the framework, the same dataset and methodology are used by another organisation than that marked in the Indicator production and dissemination column to produce the same indicator. These alternative indicator sources can be drawn from for additional breakdowns or comparisons that add value to interpretation of the indicator in the context of the Slovak Republic (e.g. regional or district-level comparisons in addition to international data).

Table A D.1 lists all cases in the Slovak HSPA where a contextualising indicator is used in addition to a main HSPA indicator. These are different indicators from the indicator included in the HSPA, but add context or further information relevant to interpret the indicator. In total, the Slovak HSPA includes 25 such indicators.

Table A D.1. Contextualising indicators in the Slovak HSPA

Domain	HSPA indicator	Contextualising indicator	Contextualising indicator source
Workforce	Physicians	Number of doctors by regions, density	NCZI
Workforce	Physicians	Share of doctors (all professions) aged 55 and older	OECD
Workforce	Average age of general practitioners	Share of GPs beyond retirement age (63 and older)	ÚDZS
Workforce	Remuneration of salaried health professionals	Average healthcare wage (inpatient, per person)	NCZI
Financing	Health expenditure	Health Expenditure by financing type	OECD
Financing	Pharmaceutical costs of health insurers (including hospital-administered)	National data by type of pharmaceutical reimbursement (% of A&AS-reimbursed pharmaceuticals in public expenditure on pharmaceuticals)	NCZI
Research and Innovation	Number of publications from research projects in healthcare organisations funded from public sources	Number of organisations involved in biomedical research and clinical trials	IZA [Inštitút výskumu a vývoja]
Prevention	Childhood vaccination rates among eligible children	Diphtheria, Tetanus, Pertussis (DTP) immunisation (% of children less than 1 year)	OECD
Prevention	Childhood vaccination rates among eligible children	Measles immunisation (% of children less than 1 year)	OECD
Prevention	HPV vaccination among girls aged up to 15	HPV vaccination in boys aged 15	WHO/UNICEF
Prevention	Mammography screening within the past two years (women 50‑69)	Self-reported last breast examination by X-ray among women	Eurostat/ŠÚ SR
Prevention	Colorectal cancer screening	Self-reported last colorectal cancer screening test	Eurostat/ŠÚ SR
Prevention	Cervical cancer screening	Self-reported last cervical smear test among women	Eurostat/ŠÚ SR
Behavioural Determinants	15‑year‑olds who have smoked cigarettes at least once over the last 30 days	% of 15‑year‑olds who have used e‑cigarettes at least once over the last 30 days	WHO (HBSC survey)
Behavioural Determinants	Frequency of alcohol consumption	Alcohol consumption in adults [litres per person]	ŠÚ SR
Environment and AMR	Percentage (%) of WHO “Access” group antibiotics consumed out of total AWaRe consumption (community and hospital sectors combined)	Volume of cephalosporines and quinolones (second line antibiotics) as a proportion of all systemic antibiotics prescribed	OECD
Access	Average time from national application-to-reimbursement inclusion (categorisation) for innovative medicines (within a given period)	Time from central approval to availability	EFPIA
Quality and Safety	Incidence of nosocomial infections in inpatient facilities	Hospital incidence density of healthcare‑associated Clostridioides difficile infection by year	ECDC/ÚVZ
General Health Outcomes	Life expectancy at birth	Healthy life years at birth	Eurostat
General Health Outcomes	Life expectancy among men and women at 65	Healthy life years at 65	Eurostat
General Health Outcomes	Self-perceived health	Self-reported health status and life expectations (limitations due to health problems, opinion on life expectancy, life evaluation, belief in a better future)	ÚVZ
Disease‑Specific Outcomes	Five‑year survival: Colon cancer five‑year	Five‑year survival for other cancer sites (breast, cervical, lung, pancreas, etc.)	CONCORD
Care Provision Efficiency	Hospital average length of stay (curative care beds)	Average length of stay in days by area of permanent residence of the patient	NCZI
Care Provision Efficiency	Number of consultations with a physician per person	Number of outpatient clinic visits by patients per 100 000 inhabitants, by age, region, district and specialty	NCZI
Care Provision Efficiency	Visits to general practitioners, specialists and dentists	Medical doctor consultations per person; in-person; teleconsultations; total	OECD

Source: Developing HSPA framework for the Slovak Republic project.

Table A D.2 flags 15 indicators for which, although the specification cites a particular source, further disaggregation (e.g. by region or population group) can be produced from the same national dataset using the same methodology. For example, this can enable regional analyses even when only country‑level data is available internationally.

Table A D.2. Indicators where an additional source adds relevant breakdowns or comparisons

Workforce	Indicator	Indicator production and dissemination (Main source in HSPA)	Source of additional breakdowns or information	Information added by additional source
Workforce	Physicians	OECD	NCZI	Region
Workforce	General practitioners	OECD	NCZI	Region
Workforce	Medical graduates	OECD	CVTI	Nationality
Infrastructure	Hospital beds	OECD	NCZI	Region
Prevention	Mammography screening within the past two years (women 50‑69)	OECD	NCZI	District, region
Prevention	Colorectal cancer screening	OECD	NCZI	District, region
Prevention	Cervical cancer screening	OECD	NCZI	District, region
General health outcomes	Causes of mortality	Eurostat	ŠÚ SR	District, region
General health outcomes	Mortality rates for children under five years of age	Eurostat	ŠÚ SR	Region
Disease‑specific health outcomes	Cardiovascular disease mortality	Eurostat	ŠÚ SR	Region
Disease‑specific health outcomes	Respiratory system diseases mortality	Eurostat	ŠÚ SR	Region
Care provision efficiency	Number of one‑day surgery, by region of healthcare provider	NCZI	OECD	International comparison
Care provision efficiency	Hospital average length of stay (curative care beds)	OECD	NCZI	Region
Care provision efficiency	All-bed occupancy rate in inpatient healthcare facilities by specialisation	OECD	NCZI	Region
Care provision efficiency	Number of consultations with a physician per person	OECD	NCZI	Age, region, district, medical specialty

Source: Developing HSPA Framework for the Slovak Republic project.