Health systems performance assessment: debates, methods, and empiricism
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| adam_text | Table of Contents
Foreword xxvii
List of Acronyms xxix
List of Affiliations xxxi
Acknowledgements xxxiii
Part I: Introduction
Chapter 1 Health Systems Performance Assessment: Goals, Framework and Overview 3
Christopher ).L. Murray, David B. Evans
Part II: Regional Perspectives on Performance Assessment
Chapter 2 African Regional Consultation on Health Systems Performance Assessment 23
WHO Regional Office for Africa
Chapter 3 American Regional Consultation on Health Systems Performance Assessment 27
WHO Regional Office for the Americas
Chapter 4 Eastern Mediterranean Regional Consultation on Health Systems Performance
Assessment 35
WHO Regional Office for the Eastern Mediterranean
Chapter 5 European Regional Consultation on Health Systems Performance Assessment 55
WHO Regional Office for Europe
Chapter 6 South-East Asian Regional Consultation on Health Systems Performance Assessment 69
WHO Regional Office for South-East Asia
Chapter 7 Western Pacific Regional Consultation on Health Systems Performance Assessment 95
WHO Regional Office for the Western Pacific
Part III: Expert Consultation Reports
Chapter 8 Technical Consultation on Measurement of the Efficiency of Health Systems 109
Chapter 9 Technical Consultation on Concepts and Methods for Measuring the
Responsiveness of Health Systems 115
Chapter 10 Technical Consultation on Effective Coverage in Health Systems 125
Chapter 11 Technical Consultation on Stewardship 135
Chapter 12 Technical Consultation on Statistical Strategies for Cross-Population Comparability 141
Chapter 13 Technical Consultation on Fairness in Financial Contribution 147
Chapter 14 Technical Consultation on the Measurement of Health Inequalities 155
Chapter 15 WHO Meetings of Experts on Measuring and Summarizing Health 163
vi Health Systems Performance Assessment
Part IV: Methods and Empiricism
Inputs
Chapter 16 National Health Accounts: Concepts, Data Sources, and Methodology 185
Jean-Pierre Poullier, Patricia Hernandez, Kei Kawabata
Chapter 17 Patterns of Global Health Expenditures: Results for 191 Countries 195
Jean-Pierre Poullier, Patricia Hernandez, Kei Kawabata, William D. Savedoff
Financing
Chapter 18 Monitoring the Health Financing Function 205
William D. Savedoff, Guy Carrin, Kei Kawabata, Abdelhay Mechbal
Chapter 19 Developing Health Financing Policies 211
William D. Savedoff, Guy Carrin
Provision and Coverage
Chapter 20 Beyond Access and Utilization: Defining and Measuring Health System Coverage 221
Bakhuti Shengelia, Christopher J.L. Murray, Orvill B. Adams
Chapter 21 Provision of Personal and Non-personal Health Services: Proposal for Monitoring 235
Orvill B. Adams, Bakhuti Shengelia, Barbara Stilwell, Itziar Larizgoitia, Andrei Issakov,
Sylvester Y. Kwankam, Ferdinand Siem Tjam
Chapter 22 Inequalities in Coverage: Valid DTP3 and Measles Vaccination in 40 Countries 251
Saba Moussavi, Bakhuti Shengelia, Ajay Tandon, Neeru Gupta, Christopher J.L. Murray
Chapter 23 Validity of Reported Vaccination Coverage in 45 Countries 265
Christopher J.L. Murray, Bakhuti Shengelia, Neeru Gupta, Saba Moussavi,
Ajay Tandon, Michel Thieren
Resource Generation
Chapter 24 Human, Physical, and Intellectual Resource Generation: Proposals for Monitoring 273
Orvill B. Adams, Mario R. Dal Poz, Bakhuti Shengelia, Sylvester Y. Kwankam,
Andrei Issakov, Barbara Stilwell, Pascal Zurn, Alexandre Goubarev
Stewardship
Chapter 25 Towards Better Stewardship: Concepts and Critical Issues 289
Phyllida Travis, Dominique Egger, Philip Davies, Abdelhay Mechbal
Population Health
Chapter 26 Quantifying Individual Levels of Health: Definitions, Concepts, and
Measurement Issues 301
Joshua A. Salomon, Colin D. Mathers, Somnath Chatterji, Ritu Sadana,
T. Bedirhan Ustun, Christopher J.L. Murray
Chapter 27 Alternative Summary Measures of Average Population Health 319
Colin D. Mathers, Joshua A. Salomon, Christopher J.L. Murray, Alan D. Lopez
Chapter 28 Life Tables for 191 Countries for 2000: Data, Methods, Results 335
Alan D. Lopez, Omar B. Ahmad, Michel Guillot, Brodie D. Ferguson,
Joshua A. Salomon, Christopher J.L. Murray, Kenneth H. Hill
Table of Contents vii
Chapter 29 Modified Logit Life Table System: Principles, Empirical Validation, and Application 355
Christopher J.L. Murray, Brodie D. Ferguson, Alan D. Lopez, Michel Guillot,
Joshua A. Salomon, Omar B. Ahmad
Chapter 30 Empirical Evaluation of the Anchoring Vignette Approach in Health Surveys 369
Christopher J.L. Murray, Emre Ozaltin, Ajay Tandon, Joshua A. Salomon,
Ritu Sadana, Somnath Chatterji
Chapter 31 Unpacking Health Perceptions Using Anchoring Vignettes 401
Joshua A. Salomon, Ajay Tandon, Christopher J.L. Murray, World Health Survey
Pilot Study Collaborating Groups
Chapter 32 Health State Valuations in Summary Measures of Population Health 409
Joshua A. Salomon, Christopher J.L. Murray, T. Bedirhan Ustu n, Somnath Chatterji
Chapter 33 Methods for Measuring Healthy Life Expectancy 437
Colin D. Mathers, Christopher J.L. Murray, Joshua A. Salomon
Health Inequality
Chapter 34 A Framework for Measuring Health Inequality 471
Emmanuela Gakidou, Christopher J.L. Murray, Julio Frenk
Chapter 35 Measuring Total Health Inequality: Adding Individual Variation to Group-Level
Differences 485
Emmanuela Gakidou, Gary King
Chapter 36 Determinants of Inequality in Child Survival: Results from 39 Countries 497
Emmanuela Gakidou, Gary King
Chapter 37 Measurement Methods for Inequality in the Risk of Adult Mortality 503
Emmanuela Gakidou, Ajay Tandon
Fairness in Financial Contribution
Chapter 38 Assessing the Distribution of Household Financial Contributions to the
Health System: Concepts and Empirical Application 513
Christopher J.L. Murray, Ke Xu, Jan Klavus, Kei Kawabata, Piya Hanvoravongchai,
Riadh Zeramdini, Ana Mylena Aguilar-Rivera, David B. Evans
Chapter 39 Household Health System Contributions and Capacity to Pay: Definitional,
Empirical, and Technical Challenges 533
Ke Xu, Jan Klavus, Kei Kawabata, David B. Evans, Piya Hanvoravongchai,
Juan Pablo Ortiz, Riadh Zeramdini, Christopher J.L. Murray
Chapter 40 Summary Measures of the Distribution of Household Financial Contributions
to Health 543
Ke Xu, Jan Klavus, Ana Mylena Aguilar-Rivera, Guy Carrin, Riadh Zeramdini,
Christopher ].L. Murray
Chapter 41 The Impact of Vertical and Horizontal Inequality on the Fairness in Financial
Contribution Index 557
Ke Xu, Jan Klavus, David B. Evans, Piya Hanvoravongchai, Riadh Zeramdini,
Christopher J.L. Murray
vin Health Systems Performance Assessment
Chapter 42 Understanding Household Catastrophic Health Expenditures: a Multi-country
Analysis 565
Ke Xu, David B. Evans, Kei Kawabata, Riadh Zeramdini, Jan Klavus,
Christopher J.L. Murray
i
Responsiveness
Chapter 43 Health System Responsiveness: Concepts, Domains and Operationalization 573
Nicole B. Valentine, Amala de Silva, Kei Kawabata, Charles Darby,
Christopher J.L. Murray, David B. Evans
Chapter 44 Classical Psychometric Assessment of the Responsiveness Instrument in the
WHO Multi-country Survey Study on Health and Responsiveness 2000-2001 597
Nicole B. Valentine, Rene Lavallee, Bao Liu, Gouke J. Bonsel, Christopher J.L. Murray
Chapter 45 Weights for Responsiveness Domains: Analysis of Country Variation in
65 National Sample Surveys 631
Nicole B. Valentine, Joshua A. Salomon
Chapter 46 Patient Experiences with Health Services: Population Surveys from
16 OECD Countries 643
Nicole B. Valentine, Juan Pablo Ortiz, Ajay Tandon, Kei Kawabata, David B. Evans,
Christopher J.L. Murray
Chapter 47 Inequality in Responsiveness: Population Surveys from 16 OECD Countries 653
Juan Pablo Ortiz, Nicole B. Valentine, Emmanuela Gakidou, Ajay Tandon,
Kei Kawabata, David B. Evans, Christopher J.L. Murray
Composite Attainment
Chapter 48 Quality and Equity: Preferences for Health System Outcomes 667
Emmanuela Gakidou, Christopher J.L. Murray, David B. Evans
Chapter 49 Measuring Health System Attainment: the Impact of Variability in the
Importance of Social Goals 677
Jeremy A. Lauer, David B. Evans, Christopher J.L. Murray
Efficiency
Chapter 50 Health System Efficiency: Concepts 683
Ajay Tandon, Jeremy A. Lauer, David B. Evans, Christopher J.L. Murray
Chapter 51 Determinants of Health System Performance: Second-Stage Efficiency Analysis 693
David B. Evans, Jeremy A. Lauer, Ajay Tandon, Christopher J.L. Murray
Chapter 52 Health System Efficiency: Time, Attribution, and Multiple Indicators 699
David B. Evans, Christopher J.L. Murray, Ajay Tandon
Measurement Challenges
Chapter 53 Cross-Population Comparability of Evidence for Health Policy 705
Christopher J.L. Murray, Ajay Tandon, Joshua A. Salomon, Colin D. Mathers,
Ritu Sadana
Chapter 54 Towards Evidence-Based Public Health 715
Christopher J.L. Murray, Colin D. Mathers, Joshua A. Salomon
Table of Contents ix
Chapter 55 Statistical Models for Enhancing Cross-Population Comparability 727
Ajay Tandon, Christopher J.L. Murray, Joshua A. Salomon, Gary King
Chapter 56 Estimating Permanent Income Using Indicator Variables 747
Brodie D. Ferguson, Ajay Tandon, Emmanuela Gakidou, Christopher J.L. Murray
Chapter 57 WHO Multi-country Survey Study on Health and Responsiveness 2000-2001 761
T. Bedirhan Vstu n, Somnath Chatterji, Maria Villanueva, Lydia Bendib, Can Celik,
Ritu Sadana, Nicole B. Valentine, Juan Pablo Ortiz, Ajay Tandon, Joshua A. Salomon,
Yang Cao, Wanjun Xie, Emre Ozaltin, Colin D. Mathers, Christopher J.L. Murray
Chapter 58 The World Health Surveys 797
T. Bedirhan tJstu n, Somnath Chatterji, Abdelhay Mechbal, Christopher J.L. Murray,
WHS Collaborating Groups
Increasing Policy Relevance
Chapter 59 Subnational Health Systems Performance Assessment: Objectives, Challenges
and Strategies 809
Phyllida Travis, Abdelhay Mechbal, Ajay Tandon, Brodie D. Ferguson, Michel Thieren,
Christopher J.L. Murray
Chapter 60 WHO-CHOICE: CHOosing Interventions That Are Cost-Effective 823
Raymond C.W. Hutubessy, Rob M.P.M. Baltussen, Tessa Tan Torres-Edejer,
David B. Evans, WHO-CHOICE Working Group
Part V: Report of the Scientific Peer Review Group on Health Systems
Performance Assessment
Chapter 61 Report of the Scientific Peer Review Group on Health Systems Performance
Assessment 839
Sudhir Anand, Walid Ammar, Timothy Evans, Toshihiko Hasegawa,
Katarzyna Kissimova-Skarbek, Ana Langer, Adetokunbo O. Lucas, Lindiwe Makubalo,
Alireza Marandi, Gregg Meyer, Andrew Podger, Peter Smith, Sutvit Wibulpolprasert
Index 917
x Health Systems Performance Assessment
List of Tables
Table 1.1 Intrinsic goals to which the health system contributes 8
Table 11.1 Tasks of the stewardship function 136
Table 13.1 The dimensions of health system contributions 150
Table 17.1 Health spending by income groups and regions 196
Table 17.2 Share of total spending on health by type and region, 2000 (%) 198
Table 17.3 External resources, consumption, and health spending, selected countries,
2000 (1 capita) 201
Table 18.1 Indicators for the financing function 207
Table 21.1 Expenditure shares to salary and drugs and supplies in eight LAC countries 237
Table 21.2 Incentives 244
Table 21.3 Matrix for the assessment and monitoring of health service provision function 246
Table 22.1 Summary table of the four inequality indices for DTP3 and measles 255
Table 22.2 Correlation of inequalities indices for probability of being covered for DTP3
and measles (Spearman s rho) 257
Table 22.3A Measles: estimated covariates and random effect from probit model 258
Table 22.3B DTP3: estimated covariates and random effect from probit model 260
Table 24.1 Classification of human resources for health systems 277
Table 24.2 Flow of workers remittances and its share in imports and exports of goods
in selected labour exporting countries 280
Table 24.3 Admissions of non-UK qualified nurses to the nursing register, 1990-1998 280
Table 27.1 SMPH criteria met by various forms of health expectancies 323
Table 27.2 Different questions and time perspectives for describing individual health 326
Table 28.1 Mortality data sources (number of countries) for WHO subregions, 2000 335
Table 28.2 Mortality data sources (% of deaths covered) for WHO subregions, 2000 336
Table 28.3 Life expectancy at birth (years), both sexes combined, top 10 and bottom
10 countries, 2000 343
Table 28.4 Countries with male life expectancy greater than 75.0 years, 2000 343
Table 28.5 Countries with female life expectancy greater than 80.0 years, 2000 343
Table 28.6 Difference in life expectancy at birth for all possible causes of death and causes
excluding AIDS, by sex, 2000 (years) 344
Table 28.7 Total deaths by sex, age and WHO subregion, 2000 346
Table 28.8 Life expectancy at birth (years) by WHO subregion, 2000 348
Table 28.9 Availability of vital registration data on mortality in the WHO database,
1980-2000 (as of 15 September 2001) 350
Table 29.1 Life tables comprising the empirical dataset 360
Table of Contents xi
Table 29.2 Characteristics of life tables comprising the empirical dataset 360
Table 29.3 Values of 6x, yx and lx standard, by sex 361
Table 29.4 Comparison of root mean square error of n(mx) of the Coale-Demeny, Brass
and modified logit systems using the 30% life table subset 366
Table 29.5A Results of regression of selected observed life table parameters on those predicted
by the modified logit system (n=541) 367
Table 29.5B Results of regression of selected observed life table parameters on those predicted
by the modified logit system, using 25th percentile values for males ages 65+ 367
Table 30.1 Number of respondents for each set of vignettes by domain in 69 MCSS surveys 372
Table 30.2 Mobility vignettes as included in the WHO Multi-country Survey Study on
Health and Responsiveness 2000-2001 372
Table 30.3 Consistent and near consistent orderings of vignettes by domain in 69
MCSS surveys 373
Table 30.4 Per cent consistent and near consistent orderings by domain and survey 375
Table 30.5 Benefit of the doubt rank order correlation coeffcients for mobility and cognition,
69 surveys 377
Table 30.6 Average BDROCC (benefit of the doubt rank order correlation coefficient) by
domain and survey 380
Table 30.7 Average BDROCC (benefit of the doubt rank order correlation coefficient) by
education group for all domains 382
Table 30.8 Regression analysis of BDROCC (benefit of the doubt rank order correlation
coefficient) as a function of age, sex, educational attainment, and survey mode 382
Table 30.9 Eighteen most commonly used vignette response patterns in 69 surveys among
consistent raters 383
Table 30.10 Modal mobility vignette response patterns for consistent raters, pooled and
across 69 surveys 384
Table 30.11 Distribution of respondents in 69 multi-country survey studies by 28 self-response
and vignette response patterns 386
Table 30.12 Distribution of vignette-adjusted raw score (VARS) and self-response categories
for mobility in 69 multi-country survey studies 387
Table 30.13 Vignette thetas and sigmas for mobility for full dataset and for BDROCC 0.8
dataset 390
Table 31.1 Distribution of sample used in pilot study of health module for the World Health
Survey by country, age, sex, and years of schooling 403
Table 32.1 Characteristics of responses to different valuation methods 415
Table 32.2 Regression models for visual analogue scale values 417
Table 32.3 Characteristics of the study population 418
Table 32.4 Median categorical descriptions of each condition by domain 419
Table 32.5 Correlation coefficients for mean VAS scores across countries 420
xii Health Systems Performance Assessment
Table 32.6 Characteristics of the multi-method study population 421
Table 32.7 Spearman s rank order correlation coefficients for different valuation methods,
within and between countries 422
Table 32.8 Mean, median and standard deviation of valuation results by method and condition 423 ,
Table 32.9 Results from multi-method analyses 425
Table 32.10 Estimation of valuation function 427
Table 32.11 Implications of estimated valuation functions: changes in overall health decrements
associated with changes in levels on individual domains 429
Table 32.12 Predictive validity of regression models 430
Table 33.1 Life expectancy (LE), healthy life expectancy (HALE), and lost healthy years as
per cent of total LE (LHE%), at birth and at age 60, by sex and total, WHO
regions and world, 2000 438
Table 33.2 Life expectancy (LE), healthy life expectancy (HALE), and lost healthy years
(LHE) as per cent of total LE (HLE%), at birth and at age 60, by sex and total,
by mortality subregion, 1999 440
Table 33.3 Overall prevalence YLD rates (%) for WHO epidemiological subregions for the
year 2000 446
Table 33.4 Cause-specific methods used for estimation of country-level prevalence YLD 448
Table 33.5 Average per cent of total prevalence YLD estimated by every method, for WHO
Member States within each epidemiological subregion, GBD 2000 Version 1 449
Table 33.6 Major cause groups for which independent comorbidity assumed 450
Table 33.7 Estimation of uncertainty in GBD prior estimates of comorbidity-adjusted
prevalences by age and sex for WHO Member States in the year 2000 452
Table 33.8 Estimated correlation matrix for age-specific uncertainty distributions for prevalence
YLD estimates for the AFRO and SEARO D regions, year 2000 estimates 453
Table 33.9 Population surveys conducted using WHO survey instrument 1999-2000 454
Table 35.1 DHS survey year and sample size 486
Table 35.2 Child survival inequality index for 50 countries, estimates and 95% confidence
intervals 489
Table 35.3 Relative ranks of child survival inequality by four measures of inequality 490
Table 36.1 Demographic and Health Surveys used in this analysis: country name,
three-letter acronym, survey year, and sample size 498
Table 37.1 Some existing individual-level datasets 504
Table 37.2 Predicted mean and median hazard rate, interquartile range, standard deviation,
and coefficient of variation, by age and sex, USA 507
Table 37.3 Expected death rates and estimated standard deviation of the expected death rate
across small areas in the USA 509
Table 37.4 Standard deviation of estimated risk of death across individuals from two analyses:
full survival analysis model with random effect and small-area analysis 510
Table of Contents xiii
Table 38.1 Main indicators used in the income and burden approaches to analysing the
consequences of household health system payments 513
Table 38.2 Redistributive effect (RE) and poverty headcount difference (DH) 521
Table 38.3 Fairness in financial contribution and catastrophic payments 525
Table 38.4 Correlation coefficients between measures in the income and burden space 527
Table 40.1 Standard deviation of HFC and augmented standard deviation based on equal
burden HFC (HFCO) 548
Table 40.2 The FFC index based on equal burden HFC (HFCJ and HFC mean (HFC) 549
Table 40.3 Theil s index and the mean logarithmic deviation (MLD) 551
Table 40.4 Inequality in HFC implied by Atkinson s index 552
Table 40.5 Rank order using different inequality measures 553
Table 40.7 Comparison of different summary measures 554
Table 40.6 The rank correlation coefficient of different inequality measures 554
Table 42.1 Data sources and country codes 567
Table 42.2 Percentage of households with catastrophic health expenditures due to out-of-pocket
payments, 59 countries 568
Table 42.3 The determinants of catastrophic health expenditure from cross-country analysis 570
Table 43.1 Existing questionnaires that incorporate domains of responsiveness 576
Table 43.2 Operationalization of the domains in the World Health Survey 2002 588
Table 44.1 Criteria and approaches for constructing an instrument 598
Table 44.2 The operationalization of responsiveness domains in the WHO Multi-country
Survey Study 600
Table 44.3 The number of items in the responsiveness module of the Multi-country Survey
Study with a short description of the sections and the targeted respondents 601
Table 44.4 Average item missing rates for the responsiveness module across 65 surveys 603
Table 44.5 Average item missing rates by survey for 65 surveys 604
Table 44.6 Size of samples for retests in eight countries 605
Table 44.7 Kappa rates for sections of the responsiveness module, calculated from retests in
eight countries 606
Table 44.8 Item correlations and alpha coefficients for domain questions on the level of
responsiveness 607
Table 44.9 Confirmatory factor analysis standardized coefficients—outpatients 609
Table 44.10 Confirmatory factor analysis standardized coefficients—inpatients 611
Table 45.1 List of 65 surveys analysed, survey modes, and respondent numbers 632
Table 45.2 Domain coefficients from the ordered probit model for 65 surveys 636
Table 45.3 Domain weights for eight domains across 65 surveys 638
xiv Health Systems Performance Assessment
Table 45.4 Comparison of responsiveness domain weights from 65 national sample surveys
with The World Health Report 2000 key informant survey results 640
Table 45.5 Correlation of responsiveness domain weights with GDP per capita and total
health expenditure per capita for 65 surveys 641
Table 46.1 Descriptive statistics of the responsiveness module for 16 OECD countries:
survey mode, response rates, the number of respondents, and the percentage of
respondents using health services 644
Table 46.2 Wording of responsiveness module items and response options for inpatient and
outpatient services in the Multi-country Survey Study for the domains of prompt
attention, dignity, communication, autonomy, confidentiality, choice, quality of
basic amenities, and support 645
Table 46.3 Responsiveness domain and overall results for inpatient services in 16 OECD
countries: means and standard errors, standardized by country, age and sex 648
Table 46.4 Responsiveness domain and overall results for outpatient services in 16 OECD
countries: means and standard errors, standardized by country, age and sex 648
Table 46.5 Countries with high and low performance for two of the most important
responsiveness domains: dignity and prompt attention 649
Table 46.6 Correlation of the percentage of the population very satisfied or satisfied with
the way health care runs in their country and responsiveness domain-specific
and overall inpatient and outpatient results 650
Table 46.7 Responsiveness inpatient and outpatient results compared with satisfaction results
for the poor and wealthy in 16 OECD countries 651
Table 47.1 Information on the countries analysed 654
Table 47.2 Overall outpatient and inpatient level of responsiveness for 16 OECD countries 654
Table 47.3 Exercise based on key informants 656
Table 47.4 Overall, outpatient, and inpatient inequality in responsiveness (coefficient of
variation) 657
Table 47.5 Inequality in responsiveness by domain 659
Table 47.6 A comparison of different inequality measures (coefficient of variation, relative
mean deviation, standard deviation of logs, Gini coefficient, Theil index, and mean) 660
Table 47.7 Rank correlation between different inequality measures 660
Table 47.8 Inequality of responsiveness by sex 661
Table 48.1 Sample size and characteristics of surveys used 669
Table 48.2 Relative weights assigned to the three main health system goals 670
Table 48.3 Relative weights and sample standard deviations assigned to system quality vs. equity 672
Table 48.4 Results from the seemingly unrelated regression model 673
Table 49.1 Original weights and benefit of the doubt weights with summary statistics 678
Table 51.1 Variables used in the second-stage analysis 695
Table 51.2 Multivariate analysis for determinants of efficiency on health 696
Table of Contents xv
Table 51.3 Multivariate analysis for determinants of overall efficiency 697
Table 54.1 A taxonomy of evidence relating to population health and health systems 720
Table 54.2 Example of taxonomy for WHO estimates of life expectancy at birth for
Member States for year 2000 722
Table 54.3 Average uncertainty range for life expectancy at birth (e0) estimates 722
Table 54.4 Example of taxonomy for UNICEF/WHO joint estimates of maternal mortality
ratios (MMRs) per 100 000 for Member States for year 2000 722
Table 54.5 Average uncertainty ranges for estimates of maternal mortality ratio (MMR)
per 100 000 722
Table 55.1 Descriptive statistics (simulated data) 729
Table 55.2 Estimation results: ordered probit 730
Table 55.3 Estimation results: two-stage partial credit 732
Table 55.4 Estimation results: partial credit with covariates 733
Table 55.5 Estimation results: HOPIT 742
Table 55.6 Estimation results: HOPIT t1 742
Table 55.7 Estimation results: HOPIT t2 743
Table 55.8 Estimation results: HOPIT r3 743
Table 55.9 Estimation results: HOPIT x4 744
Table 55.10 Estimation results: hierarchical partial credit 744
Table 55.11 Estimation results: hierarchical partial credit 81 745
Table 55.12 Estimation results: hierarchical partial credit 62 745
Table 55.13 Estimation results: hierarchical partial credit 53 746
Table 55.14 Estimation results: hierarchical partial credit S4 746
Table 56.1 Variables used in the estimation and validation of permanent income using DIHOPIT 753
Table 56.2 Results of application of random-effect DIHOPIT to Greece ECHP, 1995 754
Table 56.3 Correlation of estimated permanent income with reported income measures,
Greece ECHP, 1995 754
Table 56.4 Results of application of random-effect DIHOPIT to Pakistan IHS, 1991 755
Table 56.5 Correlation of permanent income estimates with reported household income
and expenditure, Pakistan IHS, 1991 756
Table 56.6 Results of application of random-effect DIHOPIT to Peru LSMS, 2000 757
Table 56.7 Correlation of permanent income estimates with reported household income
and expenditure, Peru LSMS, 2000 757
Table 56.8 Item reduction subsets, Peru LSMS, 2000 758
Table 56.9 Spearman rank correlation of permanent income estimated from indicator subsets
with full-set permanent income, household income and household expenditure,
Peru LSMS, 2000 758
xvi Health Systems Performance Assessment
Table 57.1 Assessment instrument domains 766
Table 57.2 Distribution of survey countries by WHO regions 778
Table 57.3 Countries participating in the survey study 778
Table 57.4 Summary survey diagnostics for different modes 779
Table 57.5 Sex ratio (male/female) in the UN Population Database and in the household
survey country samples 779
Table 57.6 Timing of individual sections of full-length household interviews, pilot phase
(data from 10 countries) 780
Table 57.7 Mean interview duration (minutes) of full-length household interviews, main phase
(data from 10 countries) 781
Table 57.8A Reliability statistics for major sections of the health component of the survey
(data from 10 countries in full-length household interview mode) 781
Table 57.8B Reliability statistics for major sections of the responsiveness component of the survey 782
Table 57.9 Summary results of calibration tests 782
Table 57.10A Survey metrics for the household survey, health and responsiveness components 783
Table 57.10B Survey metrics for the brief face-to-face survey, health and responsiveness
components 784
Table 57.10C Survey metrics for the postal survey, health and responsiveness components 785
Table 57.11 Average cost per completed interview 790
Table 58.1 Modules of the WHS instrument in 2002-2003 799
Table 58.2 Countries participating in the WHS 2002-2003 803
Table 59.1 Assessment of health system outcomes 813
Table 59.2 Illustration of types of indicators 814
Table 60.1 Leading 10 selected risk factors as per cent of disease burden measured in DALYs 827
Table 60.2 Interventions evaluated 828
Table 60.3 Annual costs, effects, and cost-effectiveness of interventions for AmrA 830
Table 61.1 Matrix for the assessment of human resource generation 856
Table 61.2 Matrix for the assessment of human resource maintenance and utilization 856
Table 61.3 Indicators discussed with the Scientific Peer Review Group, Dec. 2001 862
Table 61.4 Three classifications of tasks for stewardship 866
Table of Contents xvii
List of Figures
Figure 1.1 Boundaries of the health system 7
Figure 1.2 From functions to outcomes 9
Figure 1.3 Defining health system efficiency 10
Figure 12.1 Mapping from unobserved latent variable to observed categorical response
categories 141
Figure 16.1 Private and public health expenditures by function, Sri Lanka 190
Figure 16.2 Per capita expenditure on health by region in Mexico, 1995 191
Figure 17.1 Health spending around the world as share of GDP (%), 2000 196
Figure 17.2 Inequality in health spending and income by region, 2000 197
Figure 17.3 Healthy life expectancy and health spending, 2000 198
Figure 17.4 Composition of world spending on health, 2000 199
Figure 17.5 Public share of health spending by income group 199
Figure 17.6 Out-of-pocket share of health spending by income 200
Figure 18.1 The process of developing indicators for the financing function 206
Figure 21.1 Health service provider 235
Figure 21.2 Assessment of health service provision 236
Figure 21.3 Physicians, nurses, and dentists per 1 000 population, in selected OECD
countries, 1998 238
Figure 21.4 Matrix of decision autonomy 241
Figure 22.1 Distribution of the probability of valid DTP3 254
Figure 22.2 Comparison of DTP3 and measles inequality variance index 256
Figure 23.1 DTP3 immunization coverage rates by birth cohort (1985-1998) from the DHS,
45 countries (sorted by increasing total valid immunization rates) 267
Figure 23.2 DTP3 vaccination rates by birth cohort (1985-1998), according to source of data,
41 countries 268
Figure 23.3 Differences in DTP3 vaccination rates by birth cohort (1985-1998), according
to source of data, 45 countries 268
Figure 23.4 Comparison of total valid DTP3 vaccination rates for overlapping birth cohorts
across two successive DHS surveys in three countries 269
Figure 23.5 Quinquennial change in coverage rates for DTP3 by birth cohort (1986-1998),
according to source of data, 16 countries 269
Figure 24.1 Availability of health technology. 1997 274
Figure 24.2 Total health employment per 1 000 population, 1997 275
Figure 24.3 Comparison of the total health expenditure (THE) and total investment in
medical facilities, 1998 275
xvin Health Systems Performance Assessment
Figure 24.4 Comparison of total health expenditure (THE) and total investment in medical
facilities, 1998 276
Figure 24.5 The link between resource generation and service provision functions 276
Figure 24.6A Distribution of countries by physicians per 100 000 inhabitants 278
Figure 24.6B Distribution of countries by nurses per 100 000 inhabitants 278
Figure 24.7 Comparison of the number of health care personnel in selected African
countries, 1996 278
Figure 24.8 Comparison of the number of health care personnel in selected European
countries, 1998 279
Figure 24.9 Comparison of the number of nurses to the number of doctors in Europe, 1998 279
Figure 24.10 Trends in total per capita investments in medical facilities in PPP terms 283
Figure 26.1 Health and disability in a single health domain 306
Figure 26.2 Domains of health 309
Figure 26.3 Multidimensional health profile, WHO Health and Responsiveness Surveys
2000-2001, selected surveys and countries 311
Figure 26.4 Latent variable for a health domain: an illustration for mobility 312
Figure 27.1 Survivorship function for a population 321
Figure 27.2 Survivorship function for four health states 322
Figure 28.1 Trends in 45q15 from vital registration data—China, 1990-1998 338
Figure 28.2 Trends in 4Sql5 (unadjusted) based on estimates from the Sample Survey
of Population Change—China, 1991-1998 339
Figure 28.3 Age pattern of HIV mortality 342
Figure 28.4 Distribution of male-female difference in life expectancy at birth, WHO Member
States, 2000 344
Figure 28.5 Chances of dying in childhood (0-4 years) and adulthood (15-59 years),
by subregion, 2000 345
Figure 28.6 Adult mortality versus child mortality for 191 WHO Member States for the
year 2000 347
Figure 28.7 Average age of death and population, 2000, 191 countries 348
Figure 29.1 Annual logit life table values (1900-95) vs. 1900 logit values (US males) 358
Figure 29.2 Values of 6x, yx by age and sex 361
Figure 29.3 Deviations between observed and predicted logits by age, selected countries 362
Figure 29.4 Isoclines of e0, 45q15 and 20 ?60, selected values, males 362
Figure 29.5 Log Mx for four populations with male e0 = 65 years 363
Figure 29.6 Comparison of observed patterns of sq0 and eQ vs. Coale-Demeny model
values, males 365
Figure 29.7 Comparison of observed patterns of 5q0 and 4sqls vs. Coale-Demeny
model values, males 365
Table of Contents xix
Figure 29.8 Comparison of observed patterns of 45gH and 2o 76o vs- Coale-Demeny model values,
males 365
Figure 29.9 Predicted vs. observed male 4?gH using the Coale-Demeny and modified logit systems,
selecting on the basis of 5q0 and eQ 366
Figure 29.10 Predicted vs. observed male e0 using the Coale-Demeny and modified logit systems,
selecting on the basis of sq0 and ^qx 5 366
Figure 30.1 Latent mobility scale and cut-point variation in categorical responses 370
Figure 30.2 Stacked-bar diagram of vignette responses in China and the Netherlands 373
Figure 30.3 Three examples of consistent vignette orderings 376
Figure 30.4 Median BDROCC across domains 379
Figure 30.5 Median BDROCC across countries 379
Figure 30.6 28 self-response and vignette response patterns 385
Figure 30.7 Cumulative mobility distributions in Latvia, Estonia, Romania, and the
Czech Republic 388
Figure 30.8 Cut-points and vignette ratings for all respondents 391
Figure 30.9 Average cut-points for each survey and vignette ratings, 55 survey full run 392
Figure 30.10 Cut-point 1 by age category in six countries, y-axis is normalized to vignette 1
equals 100 392
Figure 30.11 Cut-points by educational attainment in Austria Postal Survey, y-axis is normalized
to vignette 1 equals 100 392
Figure 30.12 Cut-points by sex in eight countries 392
Figure 30.13 Posterior estimates of mobility versus expected values of mobility for the
entire dataset 393
Figure 30.14 Comparison of posterior estimates of mobility for full run and BDROCC 0.8 run 394
Figure 30.15 Comparison of age-standardized raw score with age-standardized posteriors in
55 surveys 394
Figure 31.1 Response category cut-point shift 401
Figure 31.2 Mobility items in the World Health Survey Pilot Study 402
Figure 31.3 Mobility ratings for self-assessment and selected vignettes, China and Sri Lanka
(N=l 061 for self-ratings, N=151 for vignettes) 404
Figure 31.4 Vignette ratings for two mobility questions, pooled results from six countries
(China, Myanmar, Pakistan, Sri Lanka, Turkey, United Arab Emirates) 404
Figure 31.5 Variation in vignette ratings across age groups in three countries, Myanmar,
Pakistan and Turkey 405
Figure 32.1 Measurement framework for health state valuations 411
Figure 32.3 Average VAS score by condition and country 418
Figure 32.2 Distribution of categorical ratings on difficulties performing usual activities for
the condition of drug dependence 418
xx Health Systems Performance Assessment
Figure 32.4 Box-and-whisker plots of VAS scores by country for four states: own health state,
infertility, major depression, and quadriplegia 420
Figure 32.5 Standard deviation of domain descriptions and VAS scores 421
Figure 32.6 Valuation results by method and condition 424
Figure 33.1 Average HALE at birth (males and females combined), 191 Member States, 2000 441
Figure 33.2 Average HALE at birth (males and females combined), 191 Member States, 2000 442
Figure 33.3 Healthy life expectancy at birth versus total life expectancy at birth, by sex,
WHO Member States, 2000 442
Figure 33.4 Healthy life expectancy at birth: males versus females, WHO Member States, 2000 442
Figure 33.5 Female-male difference in HALE at birth, 191 Member States, 2000 443
Figure 33.6 Overall prevalence YLD rates (%) for WHO Regions, 2000 445
Figure 33.7 Estimated age-standardized prevalence YLD rate versus life expectancy at birth,
by sex, WHO Member States, 2000 451
Figure 33.8 Estimated age-standardized prevalence YLD: country versus regional rate, by sex,
WHO Member States, 2000 451
Figure 33.9 Comparison of severity-weighted average prevalences from surveys and GBD
priors, developed and developing countries 455
Figure 33.10 Comparison of severity-weighted average prevalences from surveys for developed and
developing countries and for A regions versus Euro B and Euro C regions 456
Figure 33.11 Age-standardized average severity-weighted prevalences versus per capita Gross
Domestic Product (PPP 1998), 63 surveys in the WHO 2000-2001 household
survey study 456
Figure 33.12 Age-standardized average severity-weighted prevalences for females versus males,
63 surveys in the WHO 2000-2001 household survey study 456
Figure 33.13 Survey weights by age and sex, 63 surveys in 55 countries, 2000-2001 458
Figure 33.14 Estimated age-standardized posterior prevalence YLD rate versus life expectancy
at birth, by sex, WHO Member States, 2000 458
Figure 33.15 Estimated age-standardized posterior prevalence YLD: country versus regional
rate, by sex, WHO Member States, 2000 459
Figure 33.16 Uncertainty in average healthy life expectancy at birth (males and females
combined) for the year 2000 versus average health expenditure per capita (1998)
for 191 WHO Member States 461
Figure 33.17 HALE at birth with 95% uncertainty intervals, by sex, 17 epidemiological
regions, 2000 462
Figure 34.1 Healthy life span for an individual 472
Figure 34.2A Health survivorship function 472
Figure 34.2B Distribution of healthy life span 472
Figure 34.3A Health risk by age 473
Figure 34.3B Distribution of realized healthy life span 473
Table of Contents xxi
Figure 34.4 Mortality rates by age, UK females, 1901-1995 474
Figure 34.5A Health risk by age 475
Figure 34.5B Distribution of healthy life span 475
Figure 34.6 Distribution of healthy life expectancy 477
Figure 34.7 Transfer of healthy life expectancy 478
Figure 34.8 Transfer of healthy life expectancy 479
Figure 34.9 Transfer of healthy life expectancy 479
Figure 35.1 Distribution of probability of death between birth and age two (2qQ) for Benin
and the Central African Republic 488
Figure 35.2 Child survival inequality index and 95% confidence intervals for 50 countries 491
Figure 35.3 Child survival inequality index, plotted against five economic and demographic
indicators by type of government 492
Figure 35.4 Country rankings of child survival inequality: comparing the individual-level
inequality index with existing indices of income- and ethnicity-related inequalities
in child survival. A rank of 1 on all scales indicates the highest levels of inequality. 493
Figure 36.1 Relationship of total child survival inequality with average level of child mortality 500
Figure 36.2 Within- vs. between-group inequality for 39 countries 500
Figure 36.3 Per cent reduction in total inequality resulting from removing income inequality
versus removing health services access inequality 500
Figure 36.4 Per cent reduction in total inequality resulting from raising income to the mean
versus raising health services access to the mean for those below the mean 501
Figure 37.1 Predicted distributions of risk of death for males and females aged 45-54 years,
USA 506
Figure 37.2 Coefficient of variation in expected death rate, males and females, USA 509
Figure 37.3 Coefficient of variation in expected death rate, males and females, United Kingdom 509
Figure 37.4 Coefficient of variation of risk of death from survival analysis model and small
area analysis, USA, males and females 510
Figure 38.1 Illustration of the progressivity index 515
Figure 38.2 The redistributive effect (RE) 516
Figure 38.3 Conceptual framework for the calculation of redistributive effect (RE) 516
Figure 38.4 Distribution of income and the poverty line 517
Figure 38.5 Distribution of household financial contribution (HFC) 519
Figure 38.6 Redistributive effect (RE) and its components (V, H and R) 523
Figure 38.7 Redistributive effect (RE) and out-of-pocket (OOP) share 523
Figure 38.8 Level of poverty and impoverishment due to health payments 524
Figure 38.9 The fairness in financial contribution index (FFC) and the prepayment share of
total health expenditure 524
xxii Health Systems Performance Assessment
Figure 38.10 The distribution of household financial contribution by income deciles 527
Figure 39.1 Current income, permanent income, and effective income 534
Figure 39.2 Subsistence expenditure as a share of total consumption expenditure, Bangladesh 539
Figure 40.1 Distribution of household financial contributions (HFC), Spain and Azerbaijan 543
Figure 40.2 The FFC index based on equal burden HFC (HFCJ and HFC mean (HFC) 548
Figure 40.3 HFC distributions, Viet Nam and Zambia 553
Figure 41.1 Decomposing the FFC index: removing the vertical effect 559
Figure 41.2 Concentration index of HFC (CI_HFC) vs. percentage increase in FFC after
removing the vertical effect 560
Figure 41.3 Decomposing the FFC index: removing both vertical and extreme horizontal effect 560
Figure 41.4 Sources of unfairness (1-FFC) 561
Figure 41.5 Redistributive effect (RE) vs. FFC 562
Figure 42.1 Proportion of households with catastrophic expenditures vs. share of out-of-pocket
payment in total health expenditures (OOP%THE) 569
Figure 44.1 Grouping of respondents (completed questionnaires) to responsiveness module 602
Figure 45.1 Question on the importance of responsiveness domains asked to respondents in
the responsiveness module of the Multi-country Survey Study 633
Figure 45.2 Frequency of respondents in a country rating a domain as least important or most
important 635
Figure 45.3 Domain weights under alternative anchor values 637
Figure 45.4 Comparisons of eight domain weights across 65 surveys. Surveys in decending
order based on prompt attention weights 640
Figure 46.1 National health expenditure compared with inpatient and outpatient responsiveness
results for 16 OECD countries 649
Figure 47.1 Distribution of responsiveness for 16 countries 658
Figure 47.2 Distribution of responsiveness for Belgium, Portugal, and Finland for males
and females 661
Figure 47.3 Inequality in responsiveness vs. total health expenditure as percentage of GDP 661
Figure 47.4 Regression analysis using basic variables (inequality in responsiveness vs. Gini,
total health expenditure as percentage of GDP and government effectiveness) 662
Figure 47.A1 Inequality scenario 1 664
Figure 47.A2 Inequality scenario 2 664
Figure 47.A3 Inequality scenario 3 665
Figure 48.1 Health system goals as part of the performance assessment framework 668
Figure 48.2 Relative weights assigned to the five health system goals, by country and
survey mode 671
Figure 49.1 Alternative (maximum) attainment scores versus original (World Health Report
2000) scores, showing 45-degree line 679
Table of Contents
XXI11
Figure 49.2 Histogram showing absolute differences in two sets of attainment scores: alternative
(maximum) versus original (World Health Report 2000) 679
Figure 49.3 Density plot of the changes induced under benefit of the doubt, showing the
standard normal distribution 679
Figure 49.4 Alternative ranks (based on maximum scores) versus original (World Health Report
2000) ranks 679
Figure 49.5 Histogram of absolute value of differences in two sets of ranks: based on
alternative (maximum) and original (World Health Report 2000) scores 680
Figure 50.1 The health system as a production unit 683
Figure 50.2 Efficiency: free disposal hull (FDH) 685
Figure 50.3 Efficiency: data envelopment analysis (DEA) 685
Figure 50.4 Efficiency: corrected ordinary least squares (COLS) 685
Figure 50.5 Efficiency: stochastic frontier truncated-normal model 685
Figure 50.6 Efficiency: fixed-effect model 686
Figure 50.7 Causal web relating income to health 687
Figure 50.8 Literacy rate versus GDP per capita, PPP 687
Figure 50.9 Educational attainment versus GDP per capita, PPP 687
Figure 50.10 Overall attainment versus health expenditure per capita, 1997 international dollars 688
Figure 50.11 Overall attainment versus educational attainment 688
Figure 50.12 Overall attainment versus proxy Other 688
Figure 51.1 Distributions of estimated efficiency for health and overall attainment 694
Figure 51.2 Overall efficiency versus efficiency for health: country means and confidence
intervals 694
Figure 51.3 Kernel density estimate of the distribution of logistic transformation of estimated
efficiencies 696
Figure 52.1 Defining health system efficiency 699
Figure 52.2 Efficiency and effective coverage of critical interventions 702
Figure 53.1 Proportion of population 2I6 years of age, reporting bad and very bad general
health, 12 European countries, 1994 706
Figure 53.2 Comparison of average health levels by age and sex, China and the
United States of America 707
Figure 53.3 Mapping from latent mobility variable to categories 707
Figure 55.1 Mapping from unobserved latent variable to observed response categories 727
Figure 55.2 Distribution of responses for three self-report questions in countries A and B 729
Figure 55.3 Predicted versus true cut-points: ordered probit for main question 730
Figure 55.4 Predicted versus true mobility: ordered probit for main question 730
Figure 55.5 Predicted probabilities: ordered probit for main question 731
xxiv Health Systems Performance Assessment
Figure 55.6 Predicted versus true mobility: two-stage partial credit 732
Figure 55.7 Predicted probabilities: two-stage partial credit for main question 732
Figure 55.8 Predicted versus true mobility: partial credit with covariates 733
Figure 55.9 Predicted versus true mobility: partial credit with covariates (Bayesian) 734
Figure 55.10 Distribution of vignette responses for country A 735
Figure 55.11 Distribution of vignette responses for country B 736
Figure 55.12 Predicted versus true mobility: HOPIT 737
Figure 55.13 Predicted versus true cut-points: HOPIT main question 737
Figure 55.14 Predicted versus true cut-points: HOPIT auxiliary question 1 737
Figure 55.15 Predicted versus true cut-points: HOPIT auxiliary question 2 738
Figure 55.16 Predicted versus true mobility: HOPIT (Bayesian) 738
Figure 55.17 Predicted versus true mobility: partial credit model 739
Figure 55.18 Predicted versus true mobility: partial credit model (Bayesian) 739
Figure 56.1 Hypothetical indicator cut-points on the permanent income latent variable 750
Figure 56.2 Indicator variable ladder for 23 indicators, Greece ECHP, 1995 754
Figure 56.3 Indicator variable ladder for 30 indicators, Pakistan IHS, 1991 756
Figure 56.4 Indicator variable ladder for 24 indicators, Peru LSMS, 2000 757
Figure 57.1 Response category shift — different rulers 764
Figure 57.2 Quality assurance steps for data 776
Figure 57.3 Different survey modes in the WHO Multi-country Survey Study, 2000-2001 777
Figure 57.4 WHO Multi-country Survey Study, 2000-2001 777
Figure 57.5 Example of a sample population deviation index 780
Figure 57.6 Sample population representativeness by survey mode 786
Figure 57.7A Comparison of household vs. postal surveys for representativeness 787
Figure 57.7B Comparison of brief face-to-face vs. postal surveys for representativeness 787
Figure 57.8A Summary quality assessment of household surveys by reliability and missing value 787
Figure 57.8B Summary quality assessment of household surveys by reliability and
representativeness 787
Figure 57.8C Summary quality assessment of household surveys by representativeness and
missing value 788
Figure 57.8D Summary quality assessment of WHO surveys by representativeness and
missing value 788
Figure 57.8E Summary quality assessment of WHO surveys by response rate and missing value 788
Figure 57.8F Summary quality assessment of WHO surveys by representativeness and
response rate 788
Figure 57.9A Representativeness of DHS surveys by country 789
Table of Contents xxv
Figure 57.9B Relationship between missing data and representativeness for DHS surveys 789
Figure 57.10 Comparison of representativeness across different surveys 789
Figure 57.11 Comparison of cost by mode 790
Figure 57.12 Adjusted and unadjusted mobility by age 790
Figure 57.13 Adjusted and unadjusted self-care by age 791
Figure 57.14 Adjusted and unadjusted dignity by age 791
Figure 57.15 Plot of weighted and smoothed log of death rates from survey, compared with
corresponding WHO 2000 estimates for females in Nigeria 791
Figure 58.1 Different information collection modes for health information systems 798
Figure 58.2 The WHS 2002-2003 geographical distribution of participating countries 804
Figure 58.3 WHS quality assurance procedures 805
Figure 58.4 Example of a sample population deviation index 806
Figure 59.1 Effect of increasing sample size on accuracy of sample and posterior estimates for
a given prior estimate 818
Figure 59.2 Proportion of a provincial population estimated to be poor 819
Figure 59.3 Effects of item reduction: deriving estimates of economic status from asset questions 819
Figure 60.1 Health system efficiency 823
Figure 60.2 Annual costs and effectiveness for CVD risk factor interventions, AmrA 831
Figure 60.3A Probability of inclusion in the optimal mix at low levels of resources availability
in subregion AmrA 832
Figure 60.3B Probability of inclusion in the optimal mix at high levels of resources availability
in subregion AmrA 832
Figure 60.4 Maximum possible health gains from selected CVD risk factor interventions,
subregion AmrA 833
Figure 61.1 A framework for stewardship 869
Figure 61.2 Response category cut-point shift 900
|
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| spellingShingle | Health systems performance assessment debates, methods, and empiricism Health Services cabt Public Health cabt Quality Controls cabt |
| title | Health systems performance assessment debates, methods, and empiricism |
| title_auth | Health systems performance assessment debates, methods, and empiricism |
| title_exact_search | Health systems performance assessment debates, methods, and empiricism |
| title_full | Health systems performance assessment debates, methods, and empiricism World Health Organization. Ed. by Christopher J. L. Murray ... |
| title_fullStr | Health systems performance assessment debates, methods, and empiricism World Health Organization. Ed. by Christopher J. L. Murray ... |
| title_full_unstemmed | Health systems performance assessment debates, methods, and empiricism World Health Organization. Ed. by Christopher J. L. Murray ... |
| title_short | Health systems performance assessment |
| title_sort | health systems performance assessment debates methods and empiricism |
| title_sub | debates, methods, and empiricism |
| topic | Health Services cabt Public Health cabt Quality Controls cabt |
| topic_facet | Health Services Public Health Quality Controls |
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