Competing demands for resources within the health care system require health care providers to ensure the most effective and efficient use of resources. The evidence from the United States, the United Kingdom and other jurisdictions suggests that integrated health delivery systems (IDS) may be a cost-effective way to meet the health care needs of a population. This article introduces a framework for use in monitoring and evaluating the performance of an integrated delivery system. The establishment of a consistently used evaluation framework for integrated delivery systems will provide the government, governing bodies and other evaluators with an effective assessment tool that will enable greater understanding of the impact of the IDS on the health care system. It will also provide information to enable ongoing performance improvements within the system.