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Since the fall of 2019, Lebanon has been facing an economic crisis that has imposed many challenges on its healthcare system in its entirety. In this review, we propose a methodology to inform healthcare policy and apply it on cardiovascular disease (CVD) healthcare with emphasis on ischemic heart disease (IHD). The main goal of this methodology is reducing unnecessary expenditure while maintaining quality and access. CVD, and particularly IHD, is the most common reason for hospitalizations in Lebanon. Lebanon also has a high density of catheterization labs, higher than countries with higher prevalence of disease. Additionally, we found coronary to be are more expensive in comparison to other countries. To reduce healthcare costs without compromising quality and access we propose solutions targeting healthcare financing, payment for services, healthcare organizations, behaviors of providers, payers, and patients, and above all government regulation.

In the fall of 2014, Health Quality Ontario released A Primary Care Performance Measurement Framework for Ontario. Recognizing the large number of recommended measures and the limited availability of data related to those measures, the Steering Committee for the Primary Care Performance Measurement (PCPM) initiative established a prioritization process to select two subsets of high-value performance measures - one at the system level and one at the practice level. This article describes the prioritization process and its results and outlines the initiatives that have been undertaken to date to implement the PCPM framework and to advance primary care performance measurement and reporting in Ontario. Establishing a framework for primary care measurement and prioritizing system- and practice-level measures are essential steps toward system improvement. Our experience suggests that the process of implementing a performance measurement system is inevitably non-linear and incremental., (Copyright © 2020 Longwoods Publishing.)

A systematic approach to Primary Care Performance Measurement is needed to provide useful information on a regular basis to inform planning, management and quality improvement at both the practice and system levels. Based on an environmental scan, a summit of primary care stakeholders and a stakeholder survey and supported by Measures and Technical Working Groups, the Ontario Primary Care Performance Measurement Steering Committee, representing 20 stakeholder organizations, identified system- and practice-level measurement priorities and related specific performance measures across nine domains of primary care performance. This initiative addressed measures' selection and technical specification. It did not include data collection. Lessons learned in Ontario can assist other jurisdictions developing frameworks for monitoring and reporting on primary care performance. Cross-country alignment could lead to a coordinated approach to measure and target areas for primary care performance improvement in Canada., (Copyright © 2017 Longwoods Publishing.)