Vignettes and health systems responsiveness in cross-country comparative analyses

Nigel Rice, Silvana Robone, Peter C Smith

Research output: Contribution to journalArticlepeer-review


This paper explores the use of anchoring vignettes as a means to adjust survey reports of health system performance for differential reporting behaviour using data contained within the World Health Survey (WHS). Survey respondents are asked to rate their experiences of health systems across a number of domains on a five-point categorical scale. Using data provided through a set of vignettes we investigate variations in reporting of interactions with health services across both socio-demographic groups and countries. We show how the method of anchoring vignettes can be used to enhance cross-country comparability of performance. Our results show large changes in the rankings of country performance once adjustment for systematic country-level reporting behaviour has been undertaken compared to a ranking based on raw unadjusted data.
Original languageEnglish
Pages (from-to)337–369
Number of pages21
JournalJournal of the Royal Statistical Society: Series A (Statistics in Society)
Issue number2
Publication statusPublished - Apr 2012

Bibliographical note

Note: This paper was read before The Royal Statistical Society at the 58th World Statistics Congress of the International Statistical Institute in Dublin on Tuesday, August 23rd 2011, the President, Professor V. S. Isham, in the Chair. The paper was subsequently published together with discussant comments (16 contributions)and an authors’ response.


  • Anchoring vignettes
  • Cross-country comparison
  • Health care responsivenes
  • Health system performance
  • Hierarchical Ordered Probit

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