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Accountability in the Health Sector – Part 1


Provincial and territorial governments are experiencing unprecedented pressure to provide necessary and mandated services in a financially responsible manner while meeting quality requirements and managing risk.

Nationally, health care expenditures are increasing at a rate that most industry observers consider to be unsustainable. To ensure the sustainability of a publicly funded health care system, improving the accountability within the system is critical. There is increasing interest across Canada in moving towards consistent, pan-Canadian indicators to monitor and report on health and social services system performance and outcomes.

Accountability and Answerability

Accountability is a popular term, yet the concept is often ill-defined and misunderstood. As stated in a report on accountability prepared for Partners for Health Reformplus, "The essence of accountability is answerability; being accountable means having the obligation to answer questions regarding decisions and/or actions."

There are two aspects to answerability:

  • An informing aspect, or transparency, to report the activities and outputs of what was done; and
  • A justification aspect to explain the reasons for activities and outputs.

Three Critical Elements of Accountability

Accountability in the Canadian health care context is challenging, as it is not always clear who is being held accountable, to whom, for what and to what end.

For there to be genuine accountability, three elements must be present. There must be:

  • Clearly defined responsibilities and performance targets;
  • Accurate and timely reporting of performance measures; and
  • The power and authority for an overseeing actor to impose consequences for achieving or not achieving performance targets. Accountability with no sanctions is typically considered to be weak accountability.

Accountability Language

To understand accountability, one must first understand the language of accountability. In a 2012 report entitled "Measuring and Reporting on Health System Performance in Canada: Opportunities for Improvement," the Health Council of Canada outlined four terms that are commonly used when discussing accountability in the health sector.

  • Transparency — The open sharing of information on health care. Transparent reporting of goals, health indicator results and performance is considered essential for driving quality improvement and should be the foundation of quality-focused health care systems.
  • Performance Measurement — The extent to which the delivery of health care services or health system activity achieves specific standards, benchmarks or targets.
  • Health Indicators — Summary measures of health and the factors that affect health. Given the appropriate context, health indicators can provide a basis for comparison and performance measurement.
  • Benchmarks — Standards or reference points against which health indicators are measured and compared.

In Part 2 of "Accountability in the Health Sector," coming next month, we will talk specifically about the value of a good health indicator.