Evolution of health system performance assessment: The roles of international comparisons and international institutions

Health system performance assessment (HSPA) has become increasingly important nationally and internationally as a way to evaluate whether and to what degree health systems achieve their goals and to hold decision-makers to account. A core challenge remains how to best integrate HSPA in policy processes and to use the findings to contribute meaningfully to health system improvement and health policy development. In this article we review the evolution of HSPA over the past two decades, discuss some of the conceptual and methodological challenges and consider in particular the roles of international comparisons and international institutions.