“Differentiation between attainment and efficiency in health systems is crucial. Every society should be concerned about attainment of standards of health, responsiveness, inequalities in both of these, and fairness in financial contribution. What explains variation in these five key outcomes is an important scientific issue. Table 9 in the World Health Report 2000,⁹ contained the best available evidence on attainment of these outcomes. But, what was the contribution of the health system to these outcomes? And how efficiently have resources invested in the health system been used? Figure 3 shows the theory of overall efficiency. Country A could have achieved more with the resources that it has invested in the health system and in the other determinants of health outcome. In other words, the resources could have been used more efficiently. Our emphasis is not on more money for health but on more health for money.

“How can we measure what a country could achieve with available resources? Navarro is convinced that we have overestimated the potential of health systems to achieve more with available resources. Two methods can be used to estimate what is achievable: detailed analysis of the costs and effects of clinical and public health, health promotion, and rehabilitation interventions that are available in every country; or statistical analysis of countries’ production possibilities based on their previous experience. WHO, various national technology assessment agencies, and many researchers are trying to build the evidence base for intervention cost and effect.¹¹ Because we do not yet have all this knowledge, the only practical way to assess what can be achieved is to use frontier production analysis, which is a method widely applied in economics.^12,13 Tandon and colleagues,^14,15 use many production functions to estimate what can be achieved by a country, such as its spending on the health system, standards of educational attainment, and other general determinants of health and responsiveness. Navarro implies that we have overestimated what can be achieved by the health system, whereas we are more likely to have underestimated the potential achievements. Even the most efficient country can do better by investing in cost-effective interventions and improving technical efficiency. As the evidence on the costs and effects of interventions accumulates, estimates of efficiency will become more and more robust.”

Source: Murray, C., & Frenk, J. (2001). World Health Report 2000: A step towards evidence-based health policy. Lancet, 357(9269), 1698-1700. https://doi.org/10.1016/S0140-6736(00)04826-1 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)04826-1/fulltext