The New Conventional Wisdom: An Evaluation of the Who Report Health Systems: Improving Performance

Abstract

The World Health Organization's recent report, Health Systems: Improving Performance, has been highly visible in the professional and popular media. The report evaluates the world's health care systems according to three characteristics—effectiveness, responsiveness to users, and the progressivity of their funding—then uses these evaluations to rank countries by each of these characteristics and by an overall indicator of performance, a composite of all three characteristics. The ranking has been widely cited, but rarely subjected to scientific scrutiny. This article analyzes the concepts and methods used in the study and the assumptions and values inherent in the report. The author demonstrates how the report's uncritical acceptance of what has become the new conventional wisdom on health and medical care policies in the United States and other developed countries seriously limits its value.

Get full access to this article

View all access options for this article.

References

World Health Organization. World Health Report 2000: Health Systems: Improving Performance. Geneva, June 2000.

El Pais, various issues, June 2000.

Blendon

Spain's citizens assess their health care system. Health Aff. 10(3): 216–228, 1991.

Wilkinson

Unhealthy Societies. Routledge, London, 1996.

Berkman

Kawachi

(eds.). Social Epidemiology. Oxford University Press, Oxford, 2000.

Navarro

(ed.). The Political Economy of Social Inequalities. Baywood, Amityville, N.Y., 2001.

Navarro

Shi

The political context of social inequalities and health. Int. J. Health Serv. 31(1): 1–21, 2001.

Public Policy and Health Program, PAHO. Health Services Financing and Private Sector Participation: Developing a Model Incorporating American and Caribbean Experiences. Technical Report Series No. 65. Washington, D.C., November 1998.

Alleyne

A. O.

, Director General of PAHO. Health Sector Reform, Financing and the Poor. Presentation to the Global Council's 26th Annual Conference, Who Pays? Health Care Reform and Financing in Developing Countries, Arlington, Va., June 20, 1999.

10.

Nunez

Inequity in the Utilization of Health Services in Chile: Analysis of the Effects of Individual Income and Health Insurance Coverage on Timely Receipt of Health Care Services. Doctoral thesis, Department of Health Policy and Management, The Johns Hopkins University, in progress.

11.

American Hospital Association. Reality Check: Public Perceptions of Health and Hospitals: A Report from Dick Davidson to American Hospital Association Member CEO's (Poll). Chicago, 1997.

12.

Banerji

A fundamental shift in the approach to international health by WHO, UNICEF, and the World Bank. Int. J. Health Serv. 29(2): 227–259, 1999.