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Health Systems in Transition: Template for analysis

Allin S, Busse R, Dixon A, Figueras J, Grosse-Tebbe S, Kutzin J, McDaid D, Mossialos E, Nolte E, Rico A, Riesberg A, Thomson S
Copenhagen/ Brussels: European Observatory on Health Systems and Policies



The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. They are produced by country experts in collaboration with the Observatory staff. The profiles are based on a template which, revised periodically, provides detailed guidelines and specific questions, definitions and examples needed to compile HiTs. However, there might be cases where certain information may not be available in a specific country, or where the template may be too restrictive in terms of how the information and analysis are presented. It is important to highlight that this template is intended to be used in a flexible way to allow authors and editors to adapt it to their particular national context.

This edition of the template and questionnaire is a more comprehensive version of the 1999 template and incorporates the many useful comments and suggestions from users and contributors.

The HiTs are building blocks that can be used to:

  • examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems;
  • describe the institutional framework, process, content and implementation of health and health care policies;
  • highlight challenges and areas that require more in-depth analysis;
  • provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries;
  • assist other researchers in more in-depth country-based and comparative health policy analysis.

Compiling the HiT profiles poses a number of methodological problems.
In many countries, there is relatively little information available on the health
system and the impact of policies and reforms. Owing to the lack of a uniform
data source, quantitative data on health services are based on a number of
different sources, including Eurostat, the World Health Organization (WHO)
European Health for All database, the World Bank, national statistical offices,
Organisation for Economic Co-operation and Development (OECD) Health
Data, InternationalMonetary Fund, and any other relevant sources considered
useful by the authors. We acknowledge that data collection methods and
definitions vary, but authors are encouraged to identify differences and report

A standardized profile has certain disadvantages because the institutional
framework, and the financing and delivery of health care differ across countries.
However, it also offers advantages, because it raises similar issues and questions.
If the template is used in a flexible way, it is likely that some differences will
be seen across country profiles in content and comprehensiveness.

Unfortunately we have not been able to accommodate some suggestions to
revise the template; there are always trade-offs between comprehensiveness and
what can be covered in an already-detailed template. We understand that this
type of exercise in which we try to address several aspects of the health system
has many limitations. While the HiTs may not always be up to date, other
Observatory publications, Eurohealth, Euro Observer, and reports by other
organizations are available on our web site (www.euro.who.int/observatory)
under “country information”. We hope to update the template periodically to
reflect changes in the health system environment.

Comments and suggestions for the further development and improvement of
the HiTs are most welcome and can be sent to info@obs.euro.who.int. HiTs
and HiTs in brief are available on the Observatory’s web site. A glossary of
terms used in the HiTs can be found at: www.euro.who.int/observatory/


The authors and editors are grateful to the following individuals for comments
made on previous drafts of this template: Nina Schwalbe, Noah Simmons and
Karen Plafker (Open Society Institute, New York), Monica Ciupagea and
Kasia Malinowska-Sempruch (International Harm Reduction Development,
Open Society Institute, New York), Charles Shaw, Peter van Son (EUCOMP), Stephen Wright (European Investment Bank), Peter Achterberg (National Institute for Public Health and Environment, the Netherlands), Besim Nuri (World Bank), Ceri Thompson (European Commission) and Mila Garcia-
Barbero (WHO).

The authors and editors would also like to thank the two external reviewers of this template, Professor Peter Smith (University of York, UK) and Professor Karsten Vrangbaek (University of Copenhagen, Denmark), for their constructive contributions.

Special thanks are also extended to Shirley and Johannes Frederiksen for their support of Observatory staff in production of the HiTs.

Finally, the authors and editors would like to thank all the Observatory partners, institutions and individuals that have contributed to work on country monitoring.

Any errors in this template are solely those of the authors and editors.

Elias Mossialos
Sara Allin
Josep Figueras

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