“This report has several limitations. Some are related to the particulars of our analysis and some inherent in any effort to assess overall health system performance.
“First, as described above, our sensitivity analyses suggest that the overall country rankings are somewhat sensitive to small changes in the data or indicators included in the analysis.
“Second, despite improvements in recent years, the availability of cross-national data on health system performance remains highly variable. The Commonwealth Fund surveys offer unique and detailed data on the experiences of patients and primary care physicians. However, they do not capture important dimensions that might be obtained from medical records or administrative data. Furthermore, patients’ and physicians’ assessments might be affected by their expectations, which could differ by country and culture. In this report, we augment our survey data with other international sources, and include several important indicators of population health and disease-specific outcomes. However, in general, the report relies predominantly on patient experience measures. Moreover, there is little cross-national data available on mental health services and on long-term care services.
“Third, we base our assessment of overall health system performance on five domains—Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes—which we weight equally in calculating each countries’ overall performance score. In the past some have argued there are other important elements of system performance that should be considered as well, such as innovativeness or value. After consideration, and based on discussions with our advisory panel, we decided not to add new domains to the report. We believe our current five domains capture a sufficiently broad and comprehensive view of health system performance. In addition, there was a lack of meaningful data to assess these new domains.”
Source: Schneider, E. C., Sarnak, D. O., Squires, D., & Shah, A. (2017). Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better US Health Care.
World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.
Page last updated April 9, 2025 by Doug McVay, Editor.