WHR 2000 to WHR 2010: what progress in health care financing?

The World Health Report 2000 (WHR 2000) is probably best remembered for trying to stack the health systems of different countries up against each other using a uniform set of measures (WHO 2000). Certainly, senior health officials in my own country (South Africa) repeatedly referred to our ranking of 175 out of 191 countries, in terms of overall health system performance, to highlight our plight. The problem is that nothing was done to improve our performance (Coovadia et al. 2009). Simply knowing the ranking of individual countries’ health systems is of very little value to policy makers and health managers within these countries. Instead, what is required is clear guidance on the principles that should underlie our health systems, conceptual frameworks for approaching efforts to improve their performance and integrated analyses of key lessons from international experience. Indeed, these issues were dealt with in the WHR 2000, but the related messages were not disseminated or received by policy makers as forcefully as the performance index ranking was. This commentary focuses on some of the useful conceptual frameworks and guidance on potentially fruitful directions for health system performance improvements in the WHR 2000, with reference to the issue of health care financing.