Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health

Abstract

Objective: To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design: Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting: Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants: Nationally representative sample of adults aged 50 years and older. Main outcome measures: We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results: We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions: These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.