The new conventional wisdom: an evaluation of the WHO report, Health Systems: Improving Performance

Abstract

The World Health Organization's recent report, Health Systems: Improving Performance, has been highly visible in the professional and popular media. The report evaluates the world's health care systems according to three characteristics--effectiveness, responsiveness to users, and the progressivity of their funding--then uses these evaluations to rank countries by each of these characteristics and by an overall indicator of performance, a composite of all three characteristics. The ranking has been widely cited, but rarely subjected to scientific scrutiny. This article analyzes the concepts and methods used in the study and the assumptions and values inherent in the report. The author demonstrates how the report's uncritical acceptance of what has become the new conventional wisdom on health and medical care policies in the United States and other developed countries seriously limits its value.