World health system performance revisited: The impact of varying the relative importance of health system goals

Abstract

Background: In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries. Methods: We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives. Results: By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries. Conclusions: Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.