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A critique of the World Health Organisation's evaluation of health system performance

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Author Info

  • Jeff Richardson

    (Health Economics Unit, Centre for Health Program Evaluation, Monash University, Victoria, Australia)

  • John Wildman

    (Department of Economics, University of Newcastle Upon Tyne, UK)

  • Iain K. Robertson

    (Centre for Health Program Evaluation, Monash University, Australia)

Abstract

The World Health Organisation's (WHO) approach to the measurement of health system efficiency is briefly described. Four arguments are then presented. First, equity of finance should not be a criterion for the evaluation of a health system and, more generally, the same objectives and importance weights should not be imposed upon all countries. Secondly, the numerical value of the importance weights do not reflect their true importance in the country rankings. Thirdly, the model for combining the different objectives into a single index of system performance is problematical and alternative models are shown to alter system rankings. The WHO statistical analysis is replicated and used to support the fourth argument which is that, contrary to the author's assertion, their methods cannot separate true inefficiency from random error. The procedure is also subject to omitted variable bias. The econometric model for all countries has very poor predictive power for the subset of OECD countries and it is outperformed by two simpler algorithms. Country rankings based upon the model are correspondingly unreliable. It is concluded that, despite these problems, the study is a landmark in the evolution of system evaluation, but one which requires significant revision. Copyright © 2002 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.761
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 12 (2003)
Issue (Month): 5 ()
Pages: 355-366

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Handle: RePEc:wly:hlthec:v:12:y:2003:i:5:p:355-366

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References

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  1. Wagstaff, Adam, 2001. "Measuring equity in health care financing - reflections on (and alternatives to) the World Health Organization's fairness of financing index," Policy Research Working Paper Series 2550, The World Bank.
  2. Bruce Hollingsworth & P.J. Dawson & N. Maniadakis, 1999. "Efficiency measurement of health care: a review of non‐parametric methods and applications," Health Care Management Science, Springer, vol. 2(3), pages 161-172, July.
  3. Cornwell, Christopher & Schmidt, Peter & Sickles, Robin C., 1990. "Production frontiers with cross-sectional and time-series variation in efficiency levels," Journal of Econometrics, Elsevier, vol. 46(1-2), pages 185-200.
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Cited by:
  1. Nigel Rice & Silvana Robone & Peter Smith, 2009. "Vignettes and health systems responsiveness in crosscountry comparative analyses," Health, Econometrics and Data Group (HEDG) Working Papers 09/29, HEDG, c/o Department of Economics, University of York.
  2. Wente, Tobias & Vauth, Christoph, 2003. "Internationales Benchmarking von Gesundheitssystemen - Ansatz zur Problemlösung?," Diskussionspapiere der Wirtschaftswissenschaftlichen Fakultät der Leibniz Universität Hannover dp-286, Leibniz Universität Hannover, Wirtschaftswissenschaftliche Fakultät.
  3. Kjeld M�ller Pedersen, 2002. "The World Health Report 2000: dialogue of the deaf?," Health Economics, John Wiley & Sons, Ltd., vol. 11(2), pages 93-101.
  4. Franken, Margreet & Koolman, Xander, 2013. "Health system goals: A discrete choice experiment to obtain societal valuations," Health Policy, Elsevier, vol. 112(1), pages 28-34.
  5. Sharon Hadad & Yossi Hadad & Tzahit Simon-Tuval, 2013. "Determinants of healthcare system’s efficiency in OECD countries," The European Journal of Health Economics, Springer, vol. 14(2), pages 253-265, April.
  6. Asrul Shafie & Mohamed Hassali, 2011. "Is There a Role for Pharmacoeconomics in Developing Countries?," PharmacoEconomics, Springer, vol. 29(1), pages 83-84, January.

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