The Public versus Experts on Health System Performance

The assessment of health systems is a bold venture. Both, Germany's debate about the actual reform's strengths and areas of improvement as well as WHO's approaches to the assessment of health systems in 191 countries are continuously discussed. The latter was mainly based on measures from public health experts. It was introduced in the World Health Report 2000 and had an immediate impact. The goal of this paper is to compare the WHO rankings (indicator approach by "experts") for seventeen industrialised countries with the perceptions of their citizens (questionnaire approach by "non-experts") (methodology). The results show little relationship between WHO assessments and the satisfaction of the citizens who experience these health systems. Some WHO top performers are rated poorely by their citizens e.g. Italy and Spain. The two rated most highly by the public: Denmark and Finland, rank at the bottom of the WHO assessments. The same situation occurs in Germany: politicians as well as public health experts applaud the recent reforms whereas the public is unsatisfied about it. These findings suggest that both public perceptions and expert views should be considered in health system assessments (conclusion).