Health systems' responsiveness and its characteristics: a cross-country comparative analysis

Health Serv Res. 2011 Dec;46(6pt2):2079-100. doi: 10.1111/j.1475-6773.2011.01291.x. Epub 2011 Jul 15.


OBJECTIVES. Responsiveness has been identified as one of the intrinsic goals of health care systems. Little is known, however, about its determinants. Our objective is to investigate the potential country-level drivers of health system responsiveness. DATA SOURCE. Data on responsiveness are taken from the World Health Survey. Information on country-level characteristics is obtained from a variety of sources including the United Nations Development Program (UNDP). STUDY DESIGN. A two-step procedure. First, using survey data we derive a country-level measure of system responsiveness purged of differences in individual reporting behavior. Secondly, we run cross-sectional country-level regressions of responsiveness on potential drivers. PRINCIPAL FINDINGS. Health care expenditures per capita are positively associated with responsiveness, after controlling for the influence of potential confounding factors. Aspects of responsiveness are also associated with public sector spending (negatively) and educational development (positively). CONCLUSIONS. From a policy perspective, improvements in responsiveness may require higher spending levels. The expansion of nonpublic sector provision, perhaps in the form of increased patient choice, may also serve to improve responsiveness. However, these inferences are tentative and require further study.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Delivery of Health Care / economics*
  • Delivery of Health Care / trends
  • Developed Countries / statistics & numerical data*
  • Europe
  • Global Health
  • Health Care Sector / economics*
  • Health Care Sector / trends
  • Health Expenditures / trends*
  • Health Services Accessibility / economics*
  • Health Services Accessibility / trends
  • Health Services Research
  • Humans
  • Outcome Assessment, Health Care
  • Public Health / economics*
  • Public Health / trends