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The World Health Report 2000

Il rapporto annuale dell'Organizzazione mondiale della Sanità che vede l'Italia al secondo posto, dietro la Francia, per il rendimento globale del proprio servizio sanitario nazionale. (21/06/2000)

Full Report

World Health Report 2000

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CONTENTS


MESSAGE FROM THE DIRECTOR-GENERAL


OVERVIEW

How health systems have evolved

The potential to improve

Providing better services

Finding a better balance

Protecting the poor


CHAPTER 1:

WHY DO HEALTH SYSTEMS MATTER?

The changing landscape

What is a health system?

What do health systems do?

Why health systems matter

How modern health systems evolved

Three generations of health system reform

Focusing on performance


CHAPTER 2:

HOW WELL DO HEALTH SYSTEMS PERFORM?

Attainment and performance

Goals and functions

Goodness and fairness:both level and distribution matter

Measuring goal achievement

Overall attainment:goodness and fairness combined

Performance:getting results from resources

Improving performance:four key functions


CHAPTER 3:

HEALTH SERVICES: WELL CHOSEN, WELL ORGANIZED?

Organizational failings

People at the centre of health services

Choosing interventions:getting the most health from resources

Choosing interventions:what else matters?

Choosing interventions:what must be known?

Enforcing priorities by rationing care

After choosing priorities:service organization and provider incentives

Organizational forms

Service delivery configurations

Aligning incentives

Integration of provision


CHAPTER 4:

WHAT RESOURCES ARE NEEDED?

Balancing the mix of resources

Human resources are vital

Adjusting to advances in knowledge and technology

Public and private production of resources

The legacy of past investments

Health care resource profiles

Changing investment patterns

The way forward


CHAPTER 5:

WHO PAYS FOR HEALTH SYSTEMS?

How financing works

Prepayment and collection

Spreading risk and subsidizing the poor:pooling of resources

Strategic purchasing

Organizational forms

Incentives

How financing affects equity and efficiency


CHAPTER 6:

HOW IS THE PUBLIC INTEREST PROTECTED?

Governments as stewards of health resources

What is wrong with stewardship today?

Health policy – vision for the future

Setting the rules,ensuring compliance

Exercising intelligence,sharing knowledge

Strategies,roles and resources

:who should do what?

What are the challenges?

How to improve performance

STATISTICAL ANNEX

Explanatory notes

Annex Table 1 Health system attainment and performance in all Member States,

ranked by eight measures,estimates for 1997

Annex Table 2 Basic indicators for all Member States

Annex Table 3 Deaths by cause,sex and mortality stratum in WHO Regions,

estimates for 1999

Annex Table 4 Burden of disease in disability-adjusted life years (DALYs)

by cause,sex and mortality stratum in WHO Regions, estimates for 1999

Annex Table 5 Health attainment,level and distribution in all Member States,

estimates for 1997 and 1999

Annex Table 6 Responsiveness of health systems,level and distribution in

all Member States,WHO indexes,estimates for 1999

Annex Table 7 Fairness of financial contribution to health systems in all

Member States,WHO index,estimates for 1997

Annex Table 8 Selected national health accounts indicators for all Member

States, estimates for 1997

Annex Table 9 Overall health system attainment in all Member States,

WHO index,estimates for 1997

Annex Table 10 Health system performance in all Member States,

WHO indexes, estimates for 1997

LIST OF MEMBER STATES BY WHO REGION

AND MORTALITY STRATUM

ACKNOWLEDGEMENTS

TABLES

Table 3.1 Interventions with a large potential impact on health outcomes

Table 3.2 Examples of organizational incentives for ambulatory care

Table 5.1 Estimated out-of-pocket share in health spending by income level,1997

Table 5.2 Approaches to spreading risk and subsidizing the poor:country cases

Table 5.3 Provider payment mechanisms and provider behaviour

Table 5.4 Exposure of different organizational forms to internal incentives

Table 5.5 Exposure of different organizational forms to external incentives

FIGURES

Figure 1.1 Coverage of population and of interventions under different notions of

primary health care

Figure 2.1 Relations between functions and objectives of a health system

Figure 2.2 Life expectancy and disability-adjusted life expectancy for males

and females,by WHO Region and stratum defined by child

mortality and adult mortality,1999

Figure 2.3 Inequality in life expectancy at birth,by sex,in six countries

Figure 2.4 Relative scores of health system responsiveness elements,

in 13 countries,1999

Figure 2.5 Household contributions to financing health,as percentage of

capacity to pay,in eight countries

Figure 2.6 Performance on level of health (disability-adjusted life expectancy)

relative to health expenditure per capita,191 Member States,1999

Figure 2.7 Overall health system performance (all attainments)relative to

health expenditure per capita,191 Member States,1997

Figure 3.1 The multiple roles of people in health systems

Figure 3.2 Questions to ask in deciding what interventions to finance and provide

Figure 3.3 Different ways of rationing health interventions according to cost and

frequency of need

Figure 3.4 Different internal incentives in three organizational structures

Figure 4.1 Health system inputs:from financial resources to health interventions

Figure 4.2 Health systems input mix:comparison of four high income countries,

around 1997

Figure 4.3 Health systems input mix:comparison of four middle income countries,

around 1997

Figure 5.1 Pooling to redistribute risk,and cross-subsidy for greater equity

Figure 5.2 Structure of health system financing and provision in four countries

BOXES

Box 1.1 Poverty,ill-health and cost-effectiveness

Box 1.2 Health knowledge,not income,explains historical change

in urban –rural health differences

Box 2.1 Summary measures of population health

Box 2.2 How important are the different elements of responsiveness?

Box 2.3 What does fair contribution measure and not measure?

Box 2.4 Weighting the achievements that go into overall attainment

Box 2.5 Estimating the best to be expected and the least to be demanded

Box 4.1 Substitution among human resources

Box 4.2 Human resources problems in service delivery

Box 4.3 A widening gap in technology use?

Box 4.4 The Global Alliance for Vaccines and Immunization (GAVI)

Box 4.5 Investment in hospitals in countries of the former Soviet Union

prior to policy reform

Box 5.1 The importance of donor contributions in revenue collection

and purchasing in developing countries

Box 5.2 The Chilean health insurance market:when stewardship fails

to compensate for pooling competition problems and for

imbalances between internal and external incentives

Box 6.1 Trends in national health policy:from plans to frameworks

Box 6.2 Ghana ’s medium-term health policy framework

Box 6.3 SWAPs:are they good for stewardship?

Box 6.4 Stewardship:the Hisba system in Islamic countries

Box 6.5 South Africa:regulating the private insurance market to

increase risk pooling

Box 6.6 Opening up the health insurance system in the Netherlands

Box 6.7 Responsiveness to patients ’ rights

Box 6.8 Towards good stewardship – the case of pharmaceuticals

Box 6.9 Thailand:the role of the media in health system stewardship

For further information, contact Thomson Prentice, World Health Report, WHO, Geneva.
Telephone (41-22) 791 4224. Fax (41-22) 791 4870.
Email: prenticet@who.int

All WHO Press Releases, Fact Sheets and Features can be obtained on Internet on the WHO home page http://www.who.int