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

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  • Jeff Richardson
  • John Wildman
  • Iain K. Robertson

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.

Suggested Citation

  • Jeff Richardson & John Wildman & Iain K. Robertson, 2003. "A critique of the World Health Organisation's evaluation of health system performance," Health Economics, John Wiley & Sons, Ltd., vol. 12(5), pages 355-366, May.
    • Handle: RePEc:wly:hlthec:v:12:y:2003:i:5:p:355-366
    DOI: 10.1002/hec.761
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    References listed on IDEAS

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    1. 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.
    2. Greene, William, 2001. "New Developments in the Estimation of Stochastic Frontier Models with Panel Data," Efficiency Series Papers 2001/06, University of Oviedo, Department of Economics, Oviedo Efficiency Group (OEG).
    3. 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.
    4. Alan Williams, 2001. "Science or marketing at who? Rejoinder from Alan Williams," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 283-285, June.
    5. 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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    2. Mário Amorim Lopes & Carlos Soares & Álvaro Almeida, 2015. "Comparing Comparables: An Approach To Accurate Cross-Country Comparisons Of Health Systems For Effective Healthcare Planning And Policy Guidance," FEP Working Papers 563, Universidade do Porto, Faculdade de Economia do Porto.
    3. Nigel Rice & Silvana Robone & Peter C. Smith, 2012. "Vignettes and health systems responsiveness in cross‐country comparative analyses," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 175(2), pages 337-369, April.
    4. Sharon Hadad & Yossi Hadad & Tzahit Simon-Tuval, 2013. "Determinants of healthcare system’s efficiency in OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 253-265, April.
    5. 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.
    6. Wilbroad Mutale & Peter Godfrey-Fausset & Margaret Tembo Mwanamwenge & Nkatya Kasese & Namwinga Chintu & Dina Balabanova & Neil Spicer & Helen Ayles, 2013. "Measuring Health System Strengthening: Application of the Balanced Scorecard Approach to Rank the Baseline Performance of Three Rural Districts in Zambia," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-11, March.
    7. Asrul Shafie & Mohamed Hassali, 2011. "Is There a Role for Pharmacoeconomics in Developing Countries?," PharmacoEconomics, Springer, vol. 29(1), pages 83-84, January.
    8. Wente, Tobias & Vauth, Christoph, 2003. "Internationales Benchmarking von Gesundheitssystemen - Ansatz zur Problemlösung?," Hannover Economic Papers (HEP) dp-286, Leibniz Universität Hannover, Wirtschaftswissenschaftliche Fakultät.
    9. Richard Gearhart, 2016. "No theory: an explanation of the lack of consistency in cross-country health care comparisons using non-parametric estimators," Health Economics Review, Springer, vol. 6(1), pages 1-12, December.
    10. Costa -Font, Joan & Forns, Joan Rovira & Sato, Azusa, 2015. "Participatory health system priority setting: Evidence from a budget experiment," Social Science & Medicine, Elsevier, vol. 146(C), pages 182-190.
    11. Constantin Ogloblin, 2023. "Health care financing and productivity of health care in OECD countries: a stochastic frontier analysis," Eurasian Economic Review, Springer;Eurasia Business and Economics Society, vol. 13(2), pages 259-283, June.
    12. Ahmed Mandil, 2009. "Commentary: Mosaic Arab world, health and development," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 54(5), pages 361-362, October.
    13. Kjeld Møller Pedersen, 2002. "The World Health Report 2000: dialogue of the deaf?," Health Economics, John Wiley & Sons, Ltd., vol. 11(2), pages 93-101, March.

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