Researchers at the World Health Organisation estimated the efficiency of health systems in 191 countries, using data from 1993-1997. After taking account of the level of education in the population, they then ranked the health systems of each country according to their efficiency in turning expenditure into health.
Estimated efficiency varied from nearly fully efficient to nearly fully inefficient, implying that although some countries may be close to their potential, others are not reaching anywhere near maximum levels of health, explain the authors.
Oman is ranked first, perhaps because it has drastically reduced child mortality over the past 40 years, say the authors. Many other countries performing best are characterised by "Mediterranean" diets, reinforcing the idea that many different factors affect health. The United Kingdom is ranked 24th.
Countries with a history of civil conflict or high prevalence of HIV and AIDS were less efficient. Performance sharply increased with health expenditure per capita.
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, they conclude.
Despite its many limitations, the report has achieved something, argues Professor Martin McKee in an accompanying editorial. It has exhorted governments to take a much more active role in promoting health. It has provided a useful conceptual framework that begins to tease out the goals of health systems, and it has emphasised the need for a much better understanding of the undoubted impact that health systems have on health.
It has not, however, provided a valid answer to the question of whether one system is better than another, he concludes.
Comparative efficiency of national health systems: cross national econometric analysis BMJ Volume 323, pp 307-310
Editorial: Measuring the efficiency of health systems BMJ Volume 323, pp 295-296