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COMPARATIVE HEALTH SYSTEMS

For much of the last two decades, health policy makers have been concerned with the performance of their health systems and countries have introduced reforms to improve performance of their health systems. Reforms have ranged across all functions of the health system like financing, managed care, autonomous hospitals, regulation of the private sector, health policies and resource development .An increasing number of studies have started to evaluate the impact of these reforms. But it requires identifying goals and objectives of health care system and then comparing against the outcome which have been achieved and then it is quantified relatively to see the performance. So comparative analysis of health systems is done to know about health system efficiency.

Murray and Frenk have defined “health system performance in a way, which would enable performance in different countries to be compared and performance over time within a country to be monitored”. Quantifying the health system performance will help to identify factors which influenced these measures and make policies to for achieving better results. With defined goals we can compare level of goal attainment in different health systems in different countries and within countries. But performance of a health system is a concept which cannot be totally quantified and depends relatively on what worst and best can be achieved for a given set of circumstances.

For comparison of health system either it should be between populations and countries with same socioeconomic status or with a given level of circumstances the maximum attainable level of health that can be achieved with each level of health expenditure. In comparing the performance, careful attention has to be also given to the determinants that can also affect the health systems like education, diet, sexual activity. Time frame is another important factor which should be considered during comparison analysis of health systems. One cannot compare what a health system can achieve in a year to what a health system can achieve in 6-7 yrs. Long time horizon is a good measure for comparing and measuring the health system performance. Third scope of comparison and accountability is the subsystems and institutions like hospitals comparison. It narrows the scope and accountability which are achieved by actions which the institutions influence.

Annual assessments by these comparisons of health system performance are important to focus attention to policies made by the government, what policies can increase these performances, and whether they are implemented effectively. How health systems can be strengthened to deliver cost-effective interventions and services can also be analyzed. The development of agendas based on these comparisons will help countries all over the world and within population of countries to organize a better response to the ever growing and changing needs of the health of their population.

By Mitali Pande

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