Academic journal article Bulletin of the World Health Organization

World Health Report 2000: Improving Health System Performance

Academic journal article Bulletin of the World Health Organization

World Health Report 2000: Improving Health System Performance

Article excerpt

France has the best overall health system performance based on data published in The world health report 2000 -- Health systems: improving performance released on 21 June. Surprisingly, the United States is ranked in 37th place. Many health ministers will be looking at this year's World health report to find out where their countries stand. The report sets out to answer the following questions: What makes for a good health system, what makes a health system fair, and how do we evaluate the performance of existing health systems? Ambitious in scope, any ranking of health systems in different countries is likely to cause vigorous debate.

Dr Gro Harlem Brundtland, Director-General of the World Health Organization, commented: "Dollar for dollar spent on health, many countries are falling short of their performance potential. The result is a large number of preventable deaths ... The impact of this failure is born disproportionately by the poor." What is needed, she argues, is a means of evaluating health system performance to tackle the inherent deficiencies: "Ultimate responsibility for the performance of a country's health system lies with government."

The world health report 2000 presents, for the first time, an index of national health systems' performance in trying to achieve three overall goals: good health; responsiveness to the expectations of the population; and fairness of financial contribution. Progress towards achieving these goals, it argues, depends on four functions: providing health services; generating resources that make service delivery possible; raising and pooling resources used to pay for health care; and stewardship -- the setting and enforcing of rules to provide strategic direction to all parties involved. …

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