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. 2017 Aug;13(1):59–73. doi: 10.12927/hcpol.2017.25191

Table 2.

A summary of methodologies for ranked performance and Canada's ranking

Author (year) Title No. HSP methodology HSP measurement indicators Canada's overall/ranked performance
WHO (2000) The World Health Report 2000 – Health Systems: Improving Performance 191 A composite of indicators as a measure of HSP: focused on objectives of the HS Health status: DALE
Responsiveness: Survey
Fairness: Survey

  • Overall goal attainment: 7/191

  • Overall performance: 30/191
Anderson and Hussey (2001) Comparing Health System Performance in OECD Countries 26 Individual indicators as a measure of HSP on key subject areas Individual indicators:

  1. Immunization rate, smoking and alcohol consumption

  2. Physicians and hospitals

  3. MRI per million, coronary bypass and dialysis per 100,000

  4. DALE and PYLL

  5. WHR Responsiveness

  6. Health spending per capita and percentage of GDP

 Compared to OECD median, Canada has:

  • a lower immunization rate

  • higher smoking and lower alcohol consumption

  • higher physician visit per capita

  • lower MRI and higher coronary bypass and dialysis

  • higher DALE and LE

  • lower PYLL

  • higher spending
Nolte et al. (2006) Diabetes as a Tracer Condition in International Benchmarking of Health Systems 29 Disease as a tracer condition to assess HSP Diabetes incidence and mortality Diabetes mortality to incidence ratio: 6/29
The Conference Board of Canada (2006) Healthy Provinces, Healthy Canadians: A Provincial Benchmarking Report 24 A composite of indicators as a measure of HSP: benchmarking all indicators together Health status: 11 indicators
Healthcare outcomes: 7 indicators
Healthcare utilization: 1 indicator		 Overall ranking:11/24
Gay et al. (2011) Mortality Amenable to Healthcare in 31 OECD Countries: Estimates and Methodological Issues 31 Mortality amenable to healthcare intervention Amenable mortality

  • Nolte and McKee: 11/31 (male = 9; female = 12)

  • Tobias and Yeh: 15/31 (male = 11; female = 16)
Tchouaket et al. (2012) HSP of 27 OECD Countries 27 A composite of indicators as a measure of HSP: Donabedian's structure-process-outcome and effectiveness, efficiency and productivity Health status: 27 indicators
Resources: 21 indicators
Health services: 20 indicators

  • Absolute performance (below average, average or above average): average

  • Relative performance (below average, average or above average): above average

  • Integrated overall performance (limited, weakly polarized, promising or satisfactory): promising
Verguet and Jamison (2013) Performance in Rate of Decline of Adult Mortality in the OECD, 1970–2010 22 Individual indicator as a measure of HSP: adult mortality Female adult mortality

  • Ranking based on FAM:

  • 1971–1980 = 15/22

  • 1981–1990 = 7/22

  • 1991–2000 = 15/22

  • 2001–2010 = 15/22

  • Ranking based rate of decline:

  • from 1971–1980 to 1981–1990 = 6/22

  • from 1981–1990 to 1991–2000 = 17/22

  • from 1991–2000 to 2001–2010 = 13/22
Veillard et al. (2013), CIHI (2011, 2013) Methods to Stimulate National and Sub-National Benchmarking through International Health System Performance Comparisons: A Canadian Approach 34 Individual indicators as measures of HSP: directional measures for four dimensions of HSP: (1) Health status, (2) Non-medical determinant, (3) Access and (4) Quality of care Health status: 15 indicators
Non-medical determinant: 6 indicators
Access: 3 indicators
Quality of care: 15 indicators		 Compared to OECD average, Canada performs well on some indicators and needs improvement on others
Murray et al. (2013) UK Health Performance: Findings of the Global Burden of Disease Study 2010 19 Individual indicator as a measure of HSP: benchmarking individual indicators Mortalities and causes of death, YLL, YLD, DALY, HALE (259 diseases and injuries and 67 risk factors)

  • Age-standardized YLLs: 1990 = 4/19; 2010 = 10/19

  • LEB: 1990 = 2/19; 2010 = 7/19

  • Health-adjusted LEB: 1990 = 2/19; 2010 = 5/19
Gerring et al. (2013) Assessing Health System Performance: A Model-Based Approach 190 Composite index: economy–education, epidemiology, geography, culture and residual is modelled as public health index in which residual is considered as HSP Health outcome: 9 indicators
Culture and history: 2 indicators
Education: 2 indicators
Epidemiology: 3 indicators
Geography: 11 indicators
Economy: 3 indicators
Miscellaneous: 8 indicators		 Canada's overall ranking: 97/190
Davis et al. (2014) Mirror, Mirror on the Wall 11 Composite: ranking based in individual indicators and averaging the ranks Quality: 44 indicators
Access: 12 indicators
Efficiency: 11 indicators
Equity: 10 indicators
Healthy lives: 3 indicators		 Canada's overall ranking: 10/11
The Conference Board of Canada (2015) International Ranking: Canada Benchmarked Against 15 Countries 17 Composite: normalizing and averaging indicators 11 indicators: LEB; self-reported health status; premature mortality (PYLL); infant mortality; mortality from cancer, circulatory disease, respiratory disease, diabetes, musculoskeletal system, mental disorders and medical misadventures Canada's overall grade: “B”
Canada's overall ranking: 10/17

CIHI = Canadian Institute for Health Information; DALE = disability-adjusted LE; DALY = disability-adjusted life year; FAM = female adult mortality; GDP = gross domestic product; HALE = health-adjusted LE; HS = health system; HSP = HS performance; LE = life expectancy; LEB = LE at birth; MRI = magnetic resonance imaging; No. = number of countries compared; OECD = Organisation for Economic Co-operation and Development; PYLL = potential YLL; WHO = World Health Organization; WHR = World Health Report; YLD = years lived with disability; YLL = years of life lost.