title: Evaluation of the performance of national health systems in 2004-2011: An analysis of 173 countries.
abstract: In an effort to improve health service delivery and achieve better health outcomes, the World Health Organization (WHO) has called for improved efficiency of health care systems to better use the available funding. This study aims to examine the efficiency of national health systems using longitudinal country-level data. Data on health spending per capita, infant mortality rate (IMR), under 5 mortality rate (U5MR), and life expectancy (LE) were collected from or imputed for 173 countries from 2004 through 2011. Data envelopment analyses were used to evaluate the efficiency and regression models were constructed to examine the determinants of efficiency. The average efficiency of the national health system, when examined yearly, was 78.9%, indicating a potential saving of 21.1% of health spending per capita to achieve the same level of health status for children and the entire population, if all countries performed as well as their peers. Additionally, the efficiency of the national health system varied widely among countries. On average, Africa had the lowest efficiency of 67%, while West Pacific countries had the highest efficiency of 86%. National economic status, HIV/AIDS prevalence, health financing mechanisms and governance were found to be statistically associated with the efficiency of national health systems. Taking health financing as an example, a 1% point increase of social security expenses as a percentage of total health expenditure correlated to a 1.9% increase in national health system efficiency. The study underscores the need to enhance efficiency of national health systems to meet population health needs, and highlights the importance of health financing and governance in improving the efficiency of health systems, to ultimately improve health outcomes.
authors.affiliation: School of Transportation and Civil Engineering, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China.
authors.forename: Daxin
authors.initials: D
authors.lastname: Sun
authors.affiliation: School of Social Work, University of Maryland, Baltimore, MD, United States of America.
authors.forename: Haksoon
authors.initials: H
authors.lastname: Ahn
authors.affiliation: Oxford Policy Management, Oxford, United Kingdom.
authors.forename: Tomas
authors.initials: T
authors.lastname: Lievens
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, MA, United States of America.
authors.forename: Wu
authors.initials: W
authors.lastname: Zeng
mesh_terms: D003695:Delivery of Health Care / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008017:Life Expectancy; D009313:National Health Programs; D015397:Program Evaluation; D014944:World Health Organization