Health systems performance and ethical yardsticks [letter]

Although the World Health Report 2000 “Health systems: improving performance” has received much media attention especially the suggested ranking of health systems some of the reports key conclusions are ill understood by the general public. This article aims to clarify key assumptions and concepts underlying the refined analysis of WHO relating to the ethical theory the economic outcome measure and the perspective of assessment. It is noted that the underlying ethical theory of the report in calculating utilities for the comparison of health systems is best described as utilitarian and is aimed at the greatest good for the highest number of people. In terms of performance it is chosen as an economic outcome measure with a focus on the efficiency of health systems. Finally the societal or public interest viewpoint is taken in accordance with economic theory as the perspective of assessment. This approach to ranking of health system depends critically on the presented premises. The choosing of different assumptions results in a different ranking and can add to a balanced understanding of health systems. In view of this it should be that the ethical gauge used in the comparison of health systems must be chosen carefully.