Comparative efficiency of national health systems: cross national econometric analysis

TLDR

Evidence on health system reform effectiveness is scarce and consistent frameworks for goals and outcomes are lacking, yet efficient health systems are not always associated with the best health levels, and performance relates to per‑capita health spending, especially at low levels. The study aims to develop a method to measure and monitor health system performance to strengthen the evidence base for health policy. Using data from 191 countries, the authors estimated the relationship between population health levels and health system inputs to assess health system efficiency. Efficiency ranged from nearly fully efficient to nearly fully inefficient, with lower efficiency in countries experiencing civil conflict or high HIV prevalence, and higher performance associated with greater per‑capita health spending, indicating that resource increases and efficiency improvements can enhance health outcomes.

Abstract

<h3>Abstract</h3> <b>Objective:</b> To improve the evidence base for health policy by devising a method to measure and monitor the performance of health systems. <b>Design:</b> Estimation of the relation between levels of population health and the inputs used to produce health. <b>Setting:</b> 191 countries. <b>Main outcome measure:</b> Health system efficiency (performance). <b>Results:</b> 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. <b>Conclusions:</b> 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. <h3>What is already known on this topic</h3> Evidence on the effectiveness of health system reforms is scarce Studies have not used a consistent framework for specifying goals or measuring outcomes <h3>What this study adds</h3> 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