Measuring the health of nations: analysis of mortality amenable to health care.
OBJECTIVE
To assess whether and how the rankings of the world's health systems based on disability adjusted life expectancy as done in the 2000 World Health Report change when using the narrower concept of mortality amenable to health care, an outcome more closely linked to health system performance.


METHODS
Analysis of mortality amenable to health care (including and excluding ischaemic heart disease).


METHODS
Age standardised mortality from causes amenable to health care


METHODS
19 countries belonging to the Organisation for Economic Cooperation and Development.


RESULTS
Rankings based on mortality amenable to health care (excluding ischaemic heart disease) differed substantially from rankings of health attainment given in the 2000 World Health Report. No country retained the same position. Rankings for southern European countries and Japan, which had performed well in the report, fell sharply, whereas those of the Nordic countries improved. Some middle ranking countries (United Kingdom, Netherlands) also fell considerably; New Zealand improved its position. Rankings changed when ischaemic heart disease was included as amenable to health care.


CONCLUSIONS
The 2000 World Health Report has been cited widely to support claims for the merits of otherwise different health systems. High levels of health attainment in well performing countries may be a consequence of good fortune in geography, and thus dietary habits, and success in the health effects of policies in other sectors. When assessed in terms of achievements that are more explicitly linked to health care, their performance may not be as good.
Nolte
Ellen
E
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London WC1E 7HT. ellen.nolte@lshtm.ac.uk
McKee
Martin
M
D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D014943:Global Health; D006305:Health Status Indicators; D006801:Humans; D007390:International Agencies; D008136:Longevity; D009026:Mortality