1. WHO World Health Report 2000—Health Systems: Improving Performance (World Health Organization Geneva 2000).
2. WHR2000 provides rankings of health systems with respect both to health (disability-adjusted life expectancies or DALEs) and overall performance. Overall performance combines measures of attainment not only on health but also on aspects of finance responsiveness and distribution. This policy forum discusses performance with respect to health but the same issues arise concerning overall performance. For a critical discussion of the content and construction of all these measures see A. Williams Health Econ. 10 93 (2001.
3. WHO World Health Report 1999: Making a Difference (World Health Organization Geneva 1999). Its Annex table 6 reports country performance relative to income between 1952 and 1992 on infant mortality rate and female life expectancy. One author of this policy forum (D.T.J.) was the lead author of WHR 1999.
4. Similar analysis is possible at the level of hospitals rather than countries. California for example assessed performance differences in management of acute myocardial infarction relative to variables that control for the complexity of the case mix presenting at the hospital. [See H. S. Luft P. S. Romano Principal Investigators Second Report of the California Hospital Outcomes Project vols. 1 and 2 (California Office of Statewide Health Planning and Development 1996). Hospitals differed markedly in risk-adjusted performance.
5. The percentiles refer to the countries' WHR1999 and WHR2000 ranks respectively relative to the subset of countries included in both rankings. WHR1999 used level of female life expectancy in 1992 as its outcome measure whereas WHR2000 used DALE in 1997. Data on life expectancy and DALE are virtually perfectly correlated so use of DALEs imposes the cost of lower transparency for virtually no gain and in particular this is not a source of difference between the WHR2000 and the WHR1999 rankings. (Female life expectancy in 1992 has a 0.95 correlation with DALEs in 1997.).