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

Silvana Robone, Nigel Rice, Peter C Smith

Research output: Contribution to journalArticlepeer-review


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 behaviour. 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 non-public 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.
Keywords: Health system performance, Responsiveness, Cross-country comparison, Health care spending per capita, Vignettes.
Original languageEnglish
Pages (from-to)2079-2100
Number of pages21
JournalHealth services research
Issue number6 pt 2
Early online date15 Jul 2011
Publication statusPublished - Dec 2011

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