Improving the evaluation of large-scale health reforms
Countries worldwide are investing in major health reforms. Effective evaluation is essential. This project examined reform evaluation approaches in six countries, identifying lessons for large-scale system transformation.
Full project name: Health reform evaluation models: A comparative case study of Australia, Denmark, Canada, England, Norway and Sweden
About the project
Health systems around the world are undertaking major reforms to move towards more universal, integrated and people-centred care. These reforms are not small tweaks: they reshape core parts of the system, such as how primary and hospital care work together, how digital information is shared and how funding models shift towards paying for outcomes rather than activity.
This project responds to a recurring problem: reform ambitions are high, but evaluation often does not keep pace. Without rigorous, transparent and long-term evaluation of both implementation and outcomes, it is difficult to know whether reforms are delivering better outcomes, better experiences, lower costs and improved clinician wellbeing, or whether unintended consequences are emerging.
Project goals
This project examined how large-scale national health reforms are evaluated in six countries: Australia, England, Canada, Denmark, Norway and Sweden. Guided by the World Health Organisation Health System Performance Assessment framework, it mapped what reforms say they aim to achieve against what evaluation models actually measure.
Utilising a mixed-methods document review and policy analysis, the project identified where reform measurement is strong and where it is missing, particularly for people-centredness, health improvement, financial protection, system efficiency and system equity.
The report argues that a more comprehensive, whole-of-system approach to reform evaluation is needed, to better connect what systems actually do with what they aim to achieve, strengthening accountability, learning and trust over time.
Project leads: Professor Jeffrey Braithwaite and Dr Samantha Spanos
From Macquarie University:
From Aalborg University Danish Center for Health Services Research:
- Dr Kathrine Hald
- Professor Søren Paaske Johnsen
- Dr Julie Mackenhauer
- Dr Freja Sønderby Severinsen