BMJ 2001;323:307-310 ( 11 August )

Papers

Comparative efficiency of national health systems: cross national econometric analysis

Editorial by McKee

David B Evans, director ad interim, ^a Ajay Tandon, fellow, ^a Christopher J L Murray, executive director ad interim, ^b Jeremy A Lauer, economist. ^a

^a Global Programme on Evidence for Health Policy, World Health Organization, 1211 Geneva 27, Switzerland, ^b Evidence and Information for Policy, World Health Organization

Correspondence to: D B Evans evansd{at}who.int

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

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