WHO World Health Report 2000 - Health Systems Facts

World Health Report Overview

“To assess a health system, one must measure five things: the overall level of health; the distribution of health in the population; the overall level of responsiveness; the distribution of responsiveness; and the distribution of financial contribution. For each one, WHO has used existing sources or newly generated data to calculate measures of attainment for the countries where information could be obtained. These data were also used to estimate values when particular numbers were judged unreliable, and to estimate attainment and performance for all other Member States. Several of these measures are novel and are explained in detail in the Statistical Annex, where all the estimates are given, along with intervals expressing the uncertainty or degree of confidence in the point estimate. The correct value for any indicator is estimated to have an 80% probability of falling within the uncertainty interval, with chances of 10% each of falling below the low value or above the high one. This recognition of inexactness underscores the importance of getting more and better data on all the basic indicators of population health, responsiveness and fairness in financial contribution, a task which forms part of WHO’s continuing programme of work.

“The achievements with respect to each objective are used to rank countries, as are the overall measures of achievement and performance described below. Since a given country or health system may have very different ranks on different attainments, Annex Table 1 shows the complete ranking for all Member States on all the measures. In several subsequent tables, countries are ranked in order of achievement or performance, and the order varies from one table to another. Since the ranking is based on estimates which include uncertainty as to the exact values, the rank assigned also includes uncertainty: a health system is not always assigned a specific position relative to all others but is estimated to lie somewhere within a narrower or broader range, depending on the uncertainties in the calculation. The ranks of different health systems therefore sometimes overlap to a greater or lesser degree, and two or more countries may have the same rank.”

Source: World Health Organization. The World Health Report 2000: Health Systems : Improving Performance. Geneva: World Health Organization, 2000. https://www.who.int/whr/2000/en/

“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

McKee on the WHO World Health Report 2000
“The main criticisms were, however, of technical aspects of the methods used to assess performance. By common consent those undertaking this exercise faced a major problem if they were to include all 192 WHO Member States, some of which barely functioned as states and certainly lacked control over all of their territory. Many lacked even ...
Reinhardt and Cheng on the WHO World Health Report 2000
“First, the WHO research team should have been sure that their estimates are robust. Can they, in good conscience, make that claim? An artificially high ranking, for example, could take the wind out of the sails of desirable health-reform efforts. Similarly, an artificially low ranking could assign a bad grade to past reform efforts that ...
WHO World Health Report 2000: Methodology
“Undoubtedly, many of the concepts and measures used in the report require further refinement and development. To date, our knowledge about health systems has been hampered by the weakness of routine information systems and insufficient attention to research. This report has thus required a major effort to assemble data, collect new information, and carry out ...
WHO World Health Report 2000: Rankings
WHO World Health Report Annex Table 10: Health System Performance in all Member States, WHO Indexes. Click on thumbnails to view pages as individual image files (jpg format) or click on the link below to view a PDF of the data.whr2000-annex-table-10-1Download1234
WHO World Health Report: Results
“The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th . Several small countries – San Marino, Andorra, ...
WHO World Health Report 2000: Overview and Defense
“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 ...
WHO World Health Report: Overview
“To assess a health system, one must measure five things: the overall level of health; the distribution of health in the population; the overall level of responsiveness; the distribution of responsiveness; and the distribution of financial contribution. For each one, WHO has used existing sources or newly generated data to calculate measures of attainment for ...

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Nov. 23, 2020 by Doug McVay, Editor.