Some
of the world's poorest and least developed countries
have more efficient health systems than many
western countries, according to a report by the World
Health Organisation.
A comparison of 191 country's health systems,
published in the British Medical Journal on Friday,
shows significant variations across the world. Oman
has the most effective health system in the world in
terms of outcome, while countries in sub-Saharan
Africa had the worst performance records, according
the WHO analysis.
In the report, David B. Evans of the Global Programme
on Evidence for Health Policy at the WHO and
colleagues suggest that countries like Malta, Jamaica
and
Morocco provide more efficient healthcare than
the UK, Canada and the US. The report ranks the UK
as 24th, Canada as 35th and the US at 72nd.
Three intrinsic goals of health systems were
considered in the analysis. These included "improving
health, increasing responsiveness to the legitimate
demands of the population, and ensuring that
financial burdens are distributed fairly," Evan's group
explains. The researchers then assessed the
effectiveness of health systems by comparing the
amount of money spent with the extent of health
improvement of the population.
The authors suggest that Oman's top ranking could be
attributed to the fact that it has drastically reduced
child mortality over the past 40 years, cutting rates
from 310 to 18 per 1000 live births.
Similarly, poor health records in countries like
Zimbabwe (ranked 191st), Zambia and the Democratic
Republic of Congo could be attributed to a record of
civil unrest and high rates of HIV infection and
AIDS.
The WHO report notes that improvements in the
health of a population can be achieved in a number of
different ways, not just by spending more on
healthcare. It suggests that the healthy diet of
Mediterranean countries is responsible for giving them
a high ranking. Mediterranean countries, including
Italy and
Spain, occupy six of the seven top places.
However, the authors add that government spending
is an important factor. "We found that efficiency is
positively related to health expenditure per capita.
Performance increased greatly with expenditure up to
about $80 per capita a year, suggesting it is difficult
for systems to be efficient at low expenditure."
Evans and colleagues added that some countries, in
particular the US and sub-Saharan African states,
could improve the effectiveness of their systems by
reallocating money for schemes that are not
cost-effective to schemes that provide a good return
in terms of improving people's health.
In an editorial in the BMJ, Martin McKee, professor of
European public health at the London School of
Hygiene and Tropical
medicine, welcomed the study
but warned that it was difficult to make comparisons
between individual countries.
"I think the idea of trying to assess the performance
of healthcare systems in different countries is a good
one and the work done in this paper is a good start,"
McKee told Reuters Health.
"We should be careful reading into individual rankings
and I would warn against any comparisons," he added.
"But certainly this report is a very good start in terms
of enabling us to determine which countries have the
most efficient health systems."
McKee said it was important that countries were given
an opportunity to compare their health policies, but
more work needed to be done. "It will enable
countries and governments to learn from those that
are better. There is a quest for comparison, in the
same way as we compare the economic performance
or literacy levels of countries."