To the extent that a health system achieves a long disability-adjusted life expectancy, or
a high level of responsiveness (or a high degree of equality in either or both), or a fair
distribution of the financing burden, it can be said to perform well with respect to that
objective. Since a system can do well on one or more dimensions and poorly on others,
comparison across countries or through time requires that the five goals be summed into a
single overall measure. There is no natural scale on which to add together years of life,
responsiveness scores, and measures of inequality or fairness, so combining the measures
of achievement means assigning a weight or relative importance to each one. Box 2.4 describes
the procedure and the results.
Applying these weights to the achievements described in Annex Tables 5, 6 and 7 yields
an overall attainment score for each health system. These scores are presented in Annex
Table 9, together with an estimate of the uncertainty around each value, derived from the
uncertainties for the components. Because rich countries generally enjoy good health, and
because high incomes allow for large health expenditures which are also predominantly
prepaid and often largely public, the ranking by overall attainment is closely related to
income and health spending. However, the large weight given to distributional goals explains
why, for example, Japan outranks the United States and why Chile, Colombia and
Cuba outrank all other Latin American countries. It is not surprising that, with three Asian
exceptions, the 30 worst-off countries are all in Africa.