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Health systems’ responsiveness and its characteristics: a cross-country comparative analysis


  • Robone, S
  • Rice, N
  • Smith, P


This paper investigates the influence of aggregate country-level characteristics on health system responsiveness, using data on 62 countries present in the World Health Survey. While evidence exists on variations in reported levels of health system responsiveness across countries, the literature is sparse on the determinants of responsiveness, particularly of system wide characteristics (World Health Report, 2000). We attempt to bridge this gap in the literature by considering simultaneously several plausible country-level characteristics as potential determinants of health system responsiveness. These characteristics refer to the way health care systems are organised and funded, the socio-demographic traits of the populations served and the economic, cultural and institutional characteristics of countries. We pay particular attention to the role of health care expenditures per capita while controlling for potential confounding factors. Data on responsiveness and socio-demographic characteristics of respondents are taken from the World Health Survey, a survey launched by the World Health Organization in 2001. Information on the country-level characteristics are obtained from the United Nations Development Program (UNDP), the World Value Survey and the Polity IV Project database. The empirical analysis is performed by adopting a two step procedure. First, we increase the crosscountry comparability of the data by adjusting for variation in the way survey respondents rate an objective level of responsiveness using the hierarchical ordered probit (hopit) model. Secondly, we investigate the influence of health spending per capita and other country characteristics on the adjusted country-level measures of responsiveness. Our results suggest that the most relevant determinants of responsiveness appear to be health expenditure per capita, health care expenditure in the public sector and population levels of education.

Suggested Citation

  • Robone, S & Rice, N & Smith, P, 2010. "Health systems’ responsiveness and its characteristics: a cross-country comparative analysis," Health, Econometrics and Data Group (HEDG) Working Papers 10/29, HEDG, c/o Department of Economics, University of York.
  • Handle: RePEc:yor:hectdg:10/29

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    References listed on IDEAS

    1. Owen O'Donnell & Eddy van Doorslaer & Ravi P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Deni Harbianto & Charu C. Garg & Piya Hanvoravongchai & Mohammed N. Huq & Anup Karan & Gabriel M., 2007. "The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia," The World Bank Economic Review, World Bank, vol. 21(1), pages 93-123.
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    1. Gianluca Fiorentini & Silvana Robone & Rossella Verzulli, 2018. "How do hospital‐specialty characteristics influence health system responsiveness? An empirical evaluation of in‐patient care in the Italian region of Emilia‐Romagna," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 266-281, February.
    2. Fiorentini, Gianluca & Ragazzi, Giovanni & Robone, Silvana, 2015. "Are bad health and pain making us grumpy? An empirical evaluation of reporting heterogeneity in rating health system responsiveness," Social Science & Medicine, Elsevier, vol. 144(C), pages 48-58.

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    More about this item


    Health systems responsiveness; Anchoring vignettes; Health care expenditures;
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