Mortality-based indicators for measuring health system performance and population health in high-income countries: a systematic review

Abstract

Objectives: Mortality-based indicators are commonly used as measures of population health but less frequently applied to measuring health system performance. This systematic review aimed to identify and describe mortality indicators relevant to the measurement of population health and health system performance in high-income countries. Methods: We searched peer-reviewed databases (MEDLINE, Embase, CINAHL, Health Business Elite, Health Policy Reference Center, and POPLINE) and grey literature (government agencies, professional associations, and international/non-governmental health organizations). The search was limited to indicators identified for use in high-income countries. We extracted information on indicator characteristics and alignment with dimensions of effectiveness, efficiency, and equity. We assessed the applicability of the indicator to the context of population health, health system, or both settings, alignment with SMART criteria (specific, measurable, actionable, relevant, and timely), and potential for analyses of population subgroups. Health system was defined as encompassing both medical care and public health services and activities. Results: We extracted 385 mortality-based indicators from 240 sources. Indicators were organized into six major domains: all-cause mortality (n = 12), premature mortality (n = 92), life expectancy (n = 23), cause-specific mortality (n = 127), infant, child, and adolescent mortality (n = 50), and hospital-related mortality (n = 81). The majority of indicators (86%) could be applied to measuring health system performance. Premature mortality indicators showed the most potential to measuring both population health and health system performance. Conclusions: This review compiled a wide range of mortality indicators relevant to measuring health system performance in high-income countries. Indicators of premature mortality were most relevant to measuring both population health and health system performance. Key Messages • This systematic review identified 333 mortality-based indicators relevant for measuring health system performance. • About one third of mortality-based indicators could measure health system effectiveness. • Premature mortality indicators showed the most potential as a measure of both population health and health system performance.