Comparative efficiency of national health systems: cross national econometric analysis.

OBJECTIVE To improve the evidence base for health policy by devising a method to measure and monitor the performance of health systems. DESIGN Estimation of the relation between levels of population health and the inputs used to produce health. SETTING 191 countries. MAIN OUTCOME MEASURE Health system efficiency (performance). RESULTS Estimated efficiency varied from nearly fully efficient to nearly fully inefficient. Countries with a history of civil conflict or high prevalence of HIV and AIDS were less efficient. Performance increased with health expenditure per capita. CONCLUSIONS Increasing the resources for health systems is critical to improving health in poor countries, but important gains can be made in most countries by using existing resources more efficiently.