Abstract
The article analyzes the World Health Organization Report for 2000, with emphasis placed on the methodology used to analyze the indicators utilized to compare and classify the performance of the health systems of the 191 member countries. The Report's contribution was the compromise of monitoring the performance of the health systems of member countries, but because of the inconsistent way it was elaborated, and the utilization of questionable scientific evaluation methodologies, the Report fails to give a clear picture. A criterion-based methodology revision is imposed. The main problems in evidence are the choice of individual indicators of disparity in health that discount the population profile, the inadequate control of the impact of social disparities over the performance of the systems, the evaluation of the responsibility of systems that are only partially articulated to the right of the citizens, the lack of data for a great number of countries, consequently having inconsistent estimations, and the lack of transparency in the methodological procedures in the calculation of some indicators. The article suggests a wide methodological revision of the Report.
Highlights
Resumo O artigo discute o Relatório da Organização Mundial de Saúde para 2000, com ênfase na análise metodológica dos indicadores utilizados para comparar e classificar o desempenho dos sistemas de saúde dos 191 países membros
The 2000 WHR represents an important contribution, putting on the agenda the responsibility to monitor the performance of the Health Systems of the member countries
The methodology employed in the comparative evaluation of health services performance of the Member Countries is based upon five indicators, as follows: Health Level (DALE), Health Distribution, Responsiveness Level, Responsiveness Distribution and Fairness in Financial Contribution, which are respectively weighted at, 25%, 25%, 12,5%, 12,5%, and 25%
Summary
In the quantitative analysis of health indicators estimated for a number of countries for comparative purposes, a range of different objectives must be taken into account. The methodology employed in the comparative evaluation of health services performance of the Member Countries is based upon five indicators, as follows: Health Level (DALE), Health Distribution, Responsiveness Level, Responsiveness Distribution and Fairness in Financial Contribution, which are respectively weighted at, 25%, 25%, 12,5%, 12,5%, and 25%. The estimates for the remaining 170 countries were arrived at on the basis of predicted multiple regression values, using as independent variables the “fraction of health spending which is public” and “income distribution” (measured by Gini coefficient), and a binary variable indicating whether a given country had been Communist or not This regression presented a very low adjustment, where only 26% of the total variation was explained by the three co-variables (R2 = 0.26). Neither was the low adjustment taken into account when the 191 Member Countries were classified via the FCC indicator, which basically measures a composite of the three co-variables employed in the regression
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