Comparative efficiency of national health systems: cross national econometric analysis

Abstract Objective: To improve the evidence base for health policy by devising a method to measure and monitor the performance of health systems. Design: Estimation of the relation between levels of population health and the inputs used to produce health. Setting: 191 countries. Main outcome measure...

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Bibliographic Details
Published in:BMJ 2001-08, Vol.323 (7308), p.307-310
Main Authors: Evans, David B, Tandon, Ajay, Murray, Christopher J L, Lauer, Jeremy A
Format: Article
Language:English
Subjects:
Adult education
Assessment
Biological and medical sciences
Comparative analysis
Crossnational studies
Delivery of Health Care - economics
Delivery of Health Care - standards
Econometric models
Economics
Educational attainment
Educational Status
Efficiency
Efficiency metrics
Efficiency, Organizational
General aspects
Health care
Health care industry
Health Expenditures
Health outcomes
Health policy
Health Status
Health systems. Social services
Humans
Interval estimators
Life Expectancy
Medical sciences
Models, Econometric
National health insurance
Performance appraisal
Point estimators
Population health
Public health. Hygiene
Public health. Hygiene-occupational medicine
Tropical medicine
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Summary:Abstract Objective: To improve the evidence base for health policy by devising a method to measure and monitor the performance of health systems. Design: Estimation of the relation between levels of population health and the inputs used to produce health. Setting: 191 countries. Main outcome measure: Health system efficiency (performance). Results: Estimated efficiency varied from nearly fully efficient to nearly fully inefficient. Countries with a history of civil conflict or high prevalence of HIV and AIDS were less efficient. Performance increased with health expenditure per capita. Conclusions: Increasing the resources for health systems is critical to improving health in poor countries, but important gains can be made in most countries by using existing resources more efficiently. What is already known on this topic Evidence on the effectiveness of health system reforms is scarce Studies have not used a consistent framework for specifying goals or measuring outcomes What this study adds Countries with the best levels of health do not always have efficient health systems Efficiency is related to expenditure on health per capita, especially at low expenditure The methods of measuring performance provide a basis for identifying policies that improve health and for monitoring reforms
ISSN:0959-8138
0959-8146
0959-535X
1468-5833
1756-1833
DOI:10.1136/bmj.323.7308.307