The World Health Report 2000 - Health Systems: Improving Performance

CONTENTS......Page 4
MESSAGE FROM THE DIRECTOR-GENERAL......Page 8
OVERVIEW......Page 11
How health systems have evolved......Page 13
The potential to improve......Page 14
Providing better services......Page 15
Finding a better balance......Page 16
Protecting the poor......Page 18
CHAPTER 1 WHY DO HEALTH SYSTEMS MATTER?......Page 20
The changing landscape......Page 21
What is a health system?......Page 23
What do health systems do?......Page 25
Why health systems matter......Page 26
How modern health systems evolved......Page 29
Three generations of health system reform......Page 31
Focusing on performance......Page 35
CHAPTER 2 HOW WELL DO HEALTH SYSTEMS PERFORM?......Page 38
Goals and functions......Page 39
Goodness and fairness: both level and distribution matter......Page 42
Measuring goal achievement......Page 43
Performance: getting results from resources......Page 56
Improving performance: four key functions......Page 60
CHAPTER 3 HEALTH SERVICES: WELL CHOSEN, WELL ORGANIZED?......Page 63
Organizational failings......Page 64
People at the centre of health services......Page 65
Choosing interventions: getting the most health from resources......Page 67
Choosing interventions: what else matters?......Page 70
Choosing interventions: what must be known?......Page 72
Enforcing priorities by rationing care......Page 73
After choosing priorities: service organization and provider incentives......Page 76
Organizational forms......Page 77
Service delivery configurations......Page 78
Aligning incentives......Page 79
Integration of provision......Page 83
CHAPTER 4 WHAT RESOURCES ARE NEEDED?......Page 88
Balancing the mix of resources......Page 89
Human resources are vital......Page 91
Adjusting to advances in knowledge and technology......Page 95
Public and private production of resources......Page 96
The legacy of past investments......Page 98
Health care resource profiles......Page 99
Changing investment patterns......Page 102
The way forward......Page 104
CHAPTER 5 WHO PAYS FOR HEALTH SYSTEMS?......Page 107
How financing works......Page 108
Prepayment and collection......Page 110
Spreading risk and subsidizing the poor: pooling of resources......Page 112
Strategic purchasing......Page 117
Organizational forms......Page 121
Incentives......Page 123
How financing affects equity and efficiency......Page 126
CHAPTER 6 HOW IS THE PUBLIC INTEREST PROTECTED?......Page 129
Governments as stewards of health resources......Page 130
What is wrong with stewardship today?......Page 131
Health policy – vision for the future......Page 133
Setting the rules, ensuring compliance......Page 135
Exercising intelligence, sharing knowledge......Page 140
Strategies, roles and resources: who should do what?......Page 143
What are the challenges?......Page 146
How to improve performance......Page 148
STATISTICAL ANNEX......Page 153
Explanatory notes......Page 154
Annex Table 1 Health system attainment and performance in all Member States, ranked by eight measures, estimates for 1997......Page 162
Annex Table 2 Basic indicators for all Member States......Page 166
Annex Table 3 Deaths by cause, sex and mortality stratum in WHO Regions, estimates for 1999......Page 174
Annex Table 4 Burden of disease in disability-adjusted life years (DALYs) by cause, sex and mortality stratum in WHO Regions, estimates for 1999......Page 180
Annex Table 5 Health attainment, level and distribution in all Member States, estimates for 1997 and 1999......Page 186
Annex Table 6 Responsiveness of health systems, level and distribution in all Member States, WHO indexes, estimates for 1999......Page 194
Annex Table 7 Fairness of financial contribution to health systems in all Member States, WHO index, estimates for 1997......Page 198
Annex Table 8 Selected national health accounts indicators for all Member States, estimates for 1997......Page 202
Annex Table 9 Overall health system attainment in all Member States, WHO index, estimates for 1997......Page 206
Annex Table 10 Health system performance in all Member States, WHO indexes, estimates for 1997......Page 210
LIST OF MEMBER STATES BY WHO REGION AND MORTALITY STRATUM......Page 214
ACKNOWLEDGEMENTS......Page 216
C......Page 217
D......Page 218
F......Page 219
H......Page 220
I......Page 221
M......Page 222
P......Page 223
S......Page 225
U......Page 226
Z......Page 227