International comparisons of the quality of health care: what do they tell us?
- Director of Research and Reader in Public Management, Manchester Centre for Healthcare Management, University of Manchester, Manchester M13 9PL, UK; kieran.walshe@man.ac.uk
What are international comparisons of healthcare quality for? Why and when should we want to compare the performance of health systems across countries and what should we do with the results?
International comparisons of quality, access, and cost in health care are all the rage. The publication of the World Health Organization’s World Health Report on health system performance in 2000,1 in which the health systems of 191 countries were ranked using an aggregate measure based on several dimensions—population health, health inequalities, responsiveness, distribution of responsiveness, and financial fairness—stimulated worldwide attention to the business of measuring and comparing health system performance and resulted in a storm of controversy. The WHO methodology was fiercely attacked and equally stoutly defended.2–4 The report aroused anger, especially among commentators from countries which had done badly such as the US. The US outspends almost every other country on health care and prides itself on the sophistication and enterprise of its health system, but was humiliatingly ranked 37th, bottom of all industrialised countries and below places such as Greece, Portugal, and Ireland. For healthcare providers in many countries like the UK who have been subjected to the publication of various hospital league tables, mortality comparisons and other performance measures over recent years, there was a certain “schadenfreude” to be had in watching the reactions of defensiveness, discomfort, and denial from …
