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A critique of the World Health Organisation's evaluation of health system performance

Lookup NU author(s): Professor John WildmanORCiD


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The World Health Organisation's (WHO) approach to the measurement of health system efficiency is briefly described. Four arguments are then presented. First, equity of finance should not be a criterion for the evaluation of a health system and, more generally, the same objectives and importance weights should not be imposed upon all countries. Secondly, the numerical value of the importance weights do not reflect their true importance in the country rankings. Thirdly, the model for combining the different objectives into a single index of system performance is problematical and alternative models are shown to alter system rankings. The WHO statistical analysis is replicated and used to support the fourth argument which is that, contrary to the author's assertion, their methods cannot separate true inefficiency from random error. The procedure is also subject to omitted variable bias. Country rankings based upon the model are correspondingly unreliable. It is concluded that, despite these problems, the study is a landmark in the evolution of system evaluation, but one which requires significant revision. Copyright © 2002 John Wiley & Sons, Ltd.

Publication metadata

Author(s): Richardson J, Wildman J, Robertson IK

Publication type: Article

Publication status: Published

Journal: Health Economics

Year: 2003

Volume: 12

Issue: 5

Pages: 355-366

ISSN (print): 1057-9230

ISSN (electronic): 1099-1050

Publisher: Wiley-Blackwell Publishing


DOI: 10.1002/hec.761

PubMed id: 12720253


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