Quality (IOM/NAM Framework)
- Effectiveness – Evidence-based interventions achieving intended outcomes.
- Safety – Freedom from preventable harm.
- Patient-centeredness – Respectful, responsive to preferences, needs, values.
- Timeliness – Reducing waits and harmful delays.
- Efficiency – Avoiding waste (equipment, supplies, ideas, energy).
- Equity – Care quality not varying by gender, ethnicity, geography, SES.
Access
- Availability – Physical and financial accessibility of services.
- Affordability – Ability to pay without catastrophic expenditure.
- Acceptability – Cultural, linguistic, and social appropriateness.
Cost
Total cost of care: direct (clinical services, pharmaceuticals, transportation) + indirect (lost productivity, informal caregiving time).
Health Outcomes
- Mortality – Death rates (age-adjusted, cause-specific).
- Morbidity – Incidence/prevalence of disease and injury.
- Disability – Functional limitation (ADLs, IADLs, work capacity).
- Quality of life – Subjective well-being, HRQoL instruments (SF-36, EQ-5D).
Health Workforce
- Supply, distribution, skill mix (physicians, nurses, pharmacists, allied health).
- Education/training pipeline, continuing competence, burnout/retention.
Health Facilities
- Number, type, service lines, geographic distribution relative to population needs.
Health Financing
- Public funding (tax-based, social insurance).
- Private funding (out-of-pocket, employer-sponsored, individual market).
- Cost-sharing structures (deductibles, copays, coinsurance).
These dimensions form the analytical framework for health system performance assessment globally (WHO, OECD, NAM).
