Comparing health system performance

Alessandro Lombrano - PhD Associate Professor, DIES, University of Udine, Italy, Silvia Iacuzzi - Research Fellow, DIES, University of Udine, Italy


At a time of growing expectations and diminishing public resources for healthcare, improving the performance of health systems becomes a crucial issue as well as identifying key challenges and weaknesses. This paper provides insights into the comparison of health system performance in order to explore on the one hand whether there is any convergence of policy indications and, on the other, how structures and processes of health systems affect their performance. In particular, it sheds light on the contribution that management studies have provided to the appreciation of these core management issues in comparing health systems, while identifying important gaps in the literature and sketching out an agenda for future research. The paper develops an informed analysis of published articles on comparing health system performance using a Structured Literature Review. While there are more and more articles comparing health systems, i) few focus on comparing their performance, ii) even less deal with the impact of structures and processes and iii) a limited number was published in management journals. Overall, poor quality data, different methodological approaches and level of analysis have led to inconclusive evidence about the performance of different health systems. Hence, results reveal the need for more management studies on the performance of different health systems, while raising awareness about what constitutes high quality research in comparing them and developing insights for future comparative research.


health systems comparisons; health systems performances

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Registered by the Cancelleria del Tribunale di Pavia N. 685/2007 R.S.P. – electronic ISSN 2038-5498


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