Health Reform MonitorMeasuring and managing health system performance: An update from New Zealand

•The System Level Measures Framework (SLMF) was introduced in New Zealand in July 2016.•The SLMF focuses on six health system outcomes, rather than output or process measures.•Local alliances of public and private health organisations are responsible for implementation.•The role of financial incentives in managing performance has been downgraded.

In July 2016, New Zealand introduced a new approach to measuring and monitoring health system performance. This 'Systems Level Measure Framework' (SLMF) has evolved from the Integrated Performance and Incentive Framework (IPIF) previously reported in this journal. The SLMF is designed to stimulate a 'whole of system' approach that requires inter-organisational collaboration. Local 'Alliances' between government and non-government health sector organisations are responsible for planning and achieving improved health system outcomes such as reducing ambulatory sensitive hospitalisation for young children, and reducing acute hospital bed days. It marks a shift from the previous regime of output and process targets, and from a pay-for-performance approach to primary care. Some elements of the earlier IPIF proposal, such as general practice quality measures, and tiered levels of performance, were not included in the SLM framework. The focus on health system outcomes demonstrates policy commitment to effective integration of health services. However, there remain considerable challenges to successful implementation. An outcomes framework makes it challenging to attribute changes in outcomes to organisational and collaborative strategies. At the local level, the strength and functioning of collaborative relationships between organisations vary considerably. The extent and pace of change may also be constrained by existing funding arrangements in the health system.