The World Health Report 2000 olied by the actual percentage of the population within these vulnerable groups in a coun- try to calculate a simple measure of responsiveness inequality ranging from 0 to 1.The total score was calculated taking into account the fact that some individuals belong to more than one disadvantaged group. Annex Table 6 provides a measure of the equality of responsive- ness, scaled such that 1 is complete equality and 0 is complete inequality. For other coun- ies, achievement on the distribution of responsiveness has been estimated using indirect techniques and information on important covariates of the distribution of responsiveness including absolute poverty and access to health care ANNEX TABLE 7 The index presented in this table is meant to measure both fairness of financial contri bution and financial risk protection; the basic concepts and principles are outlined in detail elsewhere 26 The measurement of achievement in fairness of financial contribution starts with the concept of a household s contribution to the financing of the health system. The health financing contribution of a household is defined as the ratio of total household spending on health to its permanent income above subsistence. Total household spending on health includes payments towards the financing of the health system through income taxes, value-added tax, excise tax, social security contributions, private voluntary insurance, and out-of-pocket payments. Permanent income above subsistence is estimated for a house- hold as total expenditure plus tax payments not included in total expenditure minus ex- penditure on food The distribution of households'financial contribution is calculated using household sur- vey data which includes information on income(individual level)and household expend ture(by goods and services including health). In addition, the calculations require govemment tax documents(including information on income tax, sales tax, and property tax), national health accounts, national accounts, and government budgets. Such in-depth analysis has been completed for selected countries where such information is available. For other coun tries, the distribution of health financing contribution has been estimated using indirect methods and information on important covariates. 2 To allow for comparisons of the faimess of financial contribution, the distribution of health financing contribution across households has been summarized using an index. This index is designed to weight highly households that have spent a very large share of their income beyond subsistence on health. The index therefore reflects inequality in house hold financial contribution but particularly reflects those households at risk of impoverish ment from high levels of health expenditure. The index is of the form HFC:-HFC Fairness of financial contribution=1-4 ial 0.125n where HFC is the financial contribution of a given household and HFC is the average finan cial contribution across households The index is designed so that complete equality of household contributions is 1 and O is below the largest degree of inequality observed across countries
148 The World Health Report 2000 plied by the actual percentage of the population within these vulnerable groups in a country to calculate a simple measure of responsiveness inequality ranging from 0 to 1. The total score was calculated taking into account the fact that some individuals belong to more than one disadvantaged group. Annex Table 6 provides a measure of the equality of responsiveness, scaled such that 1 is complete equality and 0 is complete inequality. For other countries, achievement on the distribution of responsiveness has been estimated using indirect techniques and information on important covariates of the distribution of responsiveness including absolute poverty and access to health care. ANNEX TABLE 7 The index presented in this table is meant to measure both fairness of financial contribution and financial risk protection;1 the basic concepts and principles are outlined in detail elsewhere.26 The measurement of achievement in fairness of financial contribution starts with the concept of a household’s contribution to the financing of the health system. The health financing contribution of a household is defined as the ratio of total household spending on health to its permanent income above subsistence. Total household spending on health includes payments towards the financing of the health system through income taxes, value-added tax, excise tax, social security contributions, private voluntary insurance, and out-of-pocket payments. Permanent income above subsistence is estimated for a household as total expenditure plus tax payments not included in total expenditure minus expenditure on food. The distribution of households’ financial contribution is calculated using household survey data which includes information on income (individual level) and household expenditure (by goods and services including health). In addition, the calculations require government tax documents (including information on income tax, sales tax, and property tax), national health accounts, national accounts, and government budgets. Such in-depth analysis has been completed for selected countries where such information is available.27 For other countries, the distribution of health financing contribution has been estimated using indirect methods and information on important covariates.28 To allow for comparisons of the fairness of financial contribution, the distribution of health financing contribution across households has been summarized using an index. This index is designed to weight highly households that have spent a very large share of their income beyond subsistence on health. The index therefore reflects inequality in household financial contribution but particularly reflects those households at risk of impoverishment from high levels of health expenditure. The index is of the form: where HFC is the financial contribution of a given household and HFC is the average financial contribution across households. The index is designed so that complete equality of household contributions is 1 and 0 is below the largest degree of inequality observed across countries. Σ 1 – 4 n i=1 HFCi – HFC 3 Fairness of financial contribution = 0.125n
Statistical annex ANNEX TaBLE 8 National health accounts are designed to be a policy relevant, comprehensive, consis tent, timely and standardized instrument that traces the levels and trends of consumption of medical goods and services( the expenditure approach), the value-added created by service nd manufacturing industries producing these commodities(the production approach) and the incomes generated by this process as well as the taxes, mandatory contributions premiums and direct payments that fund the system(the financial approach). The current developmental stage of WHO national health accounts leans more towards a measure- hent of the financing flows Health care finance is divided into public and private flows. For public expenditure, the source most frequently used was Table B on expenditure by function published by the IMF in Government finance statistics yearbook. This rests on a body of exacting rules (not always strictly applied by the respondent countries) and deals in most cases only with central government expenditure. IMF and national sources have been used as far as possible to complement the central government data. United Nations National accounts (Tables 2.1 and 2.3 )and consistent domestic sources have also been used. OECD Health data has sup plied much of the information for the 29 OECD Member countries. Private expenditure on health has been estimated from United Nations and OECD National accounts ( Tables 2.3 and 2.1, respectively) and from the ratio of medical care to total consumption as derived from household surveys, that ratio being applied to total private consumption. This con- cerns mainly out-of-pocket spending. Private insurance premiums, mandated employer health programmes, expenditure by non-profit institutions serving mainly households and less frequently, private investment have been obtained from national sources. National health accounts prepared by a number of countries have been used to the extent that they were accessible. The plausibility of the estimates has been tested against financial and other analyses conducted in some countries or involving a group of countries A first complete table was reviewed by a large number of experts on individual countries and by policy analysts and statisticians of WHO Member States. Their observations led toa reassessment of certain sub-aggregate ANNEX TABLE 9 Overall health system attainment is presented in Annex Table 9. This composite meas- are of achievement in the level of health, the distribution of health, the level of responsive ness, the distribution of responsiveness and faimess of financial contribution has been constructed based on weights derived from the survey of over one thousand public health practitioners from over 100 countries. The composite is constructed on a scale from 0 to 100, the maximum value. As explained in Box 2.4, the weights on the five components are 25%level of health, 25% distribution of health, 12.5% level of responsiveness, 12.5% distr bution of responsiveness and 25% fairness of financial contribution. The mean value and uncertainty intervals have been estimated for overall health system achievement using the uncertainty intervals for each of the five components. In addition, the table provides un- certainty intervals for the ranks as well as the value of overall health system achievement Rank uncertainty is not only a function of the uncertainty of the measurement for each country but also the uncertainty of the measurement of adjacent countries in the league
Statistical Annex 149 ANNEX TABLE 8 National health accounts are designed to be a policy relevant, comprehensive, consistent, timely and standardized instrument that traces the levels and trends of consumption of medical goods and services (the expenditure approach), the value-added created by service and manufacturing industries producing these commodities (the production approach) and the incomes generated by this process as well as the taxes, mandatory contributions, premiums and direct payments that fund the system (the financial approach). The current developmental stage of WHO national health accounts leans more towards a measurement of the financing flows.29 Health care finance is divided into public and private flows. For public expenditure, the source most frequently used was Table B on expenditure by function published by the IMF in Government finance statistics yearbook. This rests on a body of exacting rules (not always strictly applied by the respondent countries) and deals in most cases only with central government expenditure. IMF and national sources have been used as far as possible to complement the central government data. United Nations National accounts (Tables 2.1 and 2.3) and consistent domestic sources have also been used. OECD Health data has supplied much of the information for the 29 OECD Member countries. Private expenditure on health has been estimated from United Nations and OECD National accounts (Tables 2.5 and 2.1, respectively) and from the ratio of medical care to total consumption as derived from household surveys, that ratio being applied to total private consumption. This concerns mainly out-of-pocket spending. Private insurance premiums, mandated employer health programmes, expenditure by non-profit institutions serving mainly households and, less frequently, private investment have been obtained from national sources. National health accounts prepared by a number of countries have been used to the extent that they were accessible. The plausibility of the estimates has been tested against financial and other analyses conducted in some countries or involving a group of countries. A first complete table was reviewed by a large number of experts on individual countries and by policy analysts and statisticians of WHO Member States. Their observations led to a reassessment of certain sub-aggregates. ANNEX TABLE 9 Overall health system attainment is presented in Annex Table 9. This composite measure of achievement in the level of health, the distribution of health, the level of responsiveness, the distribution of responsiveness and fairness of financial contribution has been constructed based on weights derived from the survey of over one thousand public health practitioners from over 100 countries.22 The composite is constructed on a scale from 0 to 100, the maximum value. As explained in Box 2.4, the weights on the five components are 25% level of health, 25% distribution of health, 12.5% level of responsiveness, 12.5% distribution of responsiveness and 25% fairness of financial contribution. The mean value and uncertainty intervals have been estimated for overall health system achievement using the uncertainty intervals for each of the five components.30 In addition, the table provides uncertainty intervals for the ranks as well as the value of overall health system achievement. Rank uncertainty is not only a function of the uncertainty of the measurement for each country but also the uncertainty of the measurement of adjacent countries in the league table
The World Health Report 2000 ANNEX TABLE 10 The index of performance on the level of health reports how efficiently health systems translate expenditure into health as measured by disability-adjusted life expectancy ALE) Performance on the level of health is defined as the ratio between achieved levels of health and the levels of health that could be achieved by the most efficient health system. More specifically, the numerator of the ratio is the difference between observed DALE in a coun try and the dale that would be observed in the absence of a functioning modern health system given the other non-health system determinants that influence health, which are represented by education. The denominator of the ratio is the difference between the maxi- mum possible dALE that could have been achieved for the observed levels of health ex- penditure per capita in each country and the daLE in the absence of a functioning health system Econometric methods have been used to estimate the maximum DALE for a given level of health expenditure and other non-health system factors using frontier production alysis. The relationship between life expectancy and human capital at the turn of the ntury was used to estimate the minimum dale that would have been expected in each country(at current levels of educational attainment) in the absence of an effective health system The details of the data, methods and results are provided elsewhere. 3 Annex Table 10 provides uncertainty intervals for both the absolute value of performance and the rank of each country Overall performance of health systems was measured using a similar process relating overall health system achievement to health system expenditure. Maximum attainable com posite goal achievement was estimated using a frontier production model relating overall health system achievement to health expenditure and other non-health system determi- nants represented by educational attainment. Results of this analysis were largely invariant to model specification. More detail is provided in the corresponding technical paper. 2 1 Murray CJL, Frenk. A WHO framework for health system perfor assessment. Bulletin of the World Health Organization, 2000, 78(6)(in press) 2 Evans DE, Bendib L, Tandon A, Lauer J, Ebener S, Hutubessy R, AsadaY, Murray CJL. Estimates of incon er capita, literacy, educational attainment, absolute poverty, and Report 2000. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 7). 3 Hill K, Rohini PO, Mahy M, Jones G. Trends in child mortality in the developing world: 1960 to 1996. New York, UNICEF 1999 World population prospects: the 1998 revision. New York, United Nations, 1999 s Murray CJL, Lopez AD, Ahmad O, Salomon J WHO system of model life tables. Geneva, World Health Organization, 2000(GPE Discussion Paper No 8) Lopez AD, Salomon J, Ahmad O, Murray CL Life tables for 191 countries: data, methods and results. Ge neva, World Health Organization, 2000(GPE Discussion Paper No 9) sis. Geneva, World Health Organizaton, 20o naya Salomon J, Murray CJL. Methods for life exp 0(G 8 Salomon J, Gakidou EE, Murray C]L Methads for modelling the HIVIAIDS epidemic in sub-Saharan Africa Geneva, World Health Organization, 2000( GPE Discussion Paper No. 3). 9 Murray CJL, Lopez AD, eds. The global burden of disease: a comprehensice assessment of mortality and di ability from diseases 1990 and projected to 2020. Cambridge, MA, Harvard Schoo of Public Health on behalf of the World Health Organization and the World Bank, 1996( Global Burden of Disease and Injury Series, Vol. 1). Salomon J, Murray CJL. Compositional models for mortality by age, ser and cause. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 11)
150 The World Health Report 2000 ANNEX TABLE 10 The index of performance on the level of health reports how efficiently health systems translate expenditure into health as measured by disability-adjusted life expectancy (DALE). Performance on the level of health is defined as the ratio between achieved levels of health and the levels of health that could be achieved by the most efficient health system. More specifically, the numerator of the ratio is the difference between observed DALE in a country and the DALE that would be observed in the absence of a functioning modern health system given the other non-health system determinants that influence health, which are represented by education. The denominator of the ratio is the difference between the maximum possible DALE that could have been achieved for the observed levels of health expenditure per capita in each country and the DALE in the absence of a functioning health system. Econometric methods have been used to estimate the maximum DALE for a given level of health expenditure and other non-health system factors using frontier production analysis. The relationship between life expectancy and human capital at the turn of the century was used to estimate the minimum DALE that would have been expected in each country (at current levels of educational attainment) in the absence of an effective health system The details of the data, methods and results are provided elsewhere.31 Annex Table 10 provides uncertainty intervals for both the absolute value of performance and the rank of each country. Overall performance of health systems was measured using a similar process relating overall health system achievement to health system expenditure. Maximum attainable composite goal achievement was estimated using a frontier production model relating overall health system achievement to health expenditure and other non-health system determinants represented by educational attainment. Results of this analysis were largely invariant to model specification. More detail is provided in the corresponding technical paper.32 1 Murray CJL, Frenk J. A WHO framework for health system performance assessment. Bulletin of the World Health Organization, 2000, 78(6) (in press). 2 Evans DE, Bendib L, Tandon A, Lauer J, Ebener S, Hutubessy R, Asada Y, Murray CJL. Estimates of income per capita, literacy, educational attainment, absolute poverty, and income Gini coefficients for The World Health Report 2000. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 7). 3 Hill K, Rohini PO, Mahy M, Jones G. Trends in child mortality in the developing world: 1960 to 1996. New York, UNICEF, 1999. 4 World population prospects: the 1998 revision. New York, United Nations, 1999. 5 Murray CJL, Lopez AD, Ahmad O, Salomon J. WHO system of model life tables. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 8). 6 Lopez AD, Salomon J, Ahmad O, Murray CJL. Life tables for 191 countries: data, methods and results. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 9). 7 Salomon J, Murray CJL. Methods for life expectancy and disability-adjusted life expectancy uncertainty analysis. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 10). 8 Salomon J, Gakidou EE, Murray CJL. Methods for modelling the HIV/AIDS epidemic in sub-Saharan Africa. Geneva,World Health Organization, 2000 (GPE Discussion Paper No. 3). 9 Murray CJL, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA, Harvard School of Public Health on behalf of the World Health Organization and the World Bank, 1996 (Global Burden of Disease and Injury Series, Vol. 1). 10 Salomon J, Murray CJL. Compositional models for mortality by age, sex and cause. Geneva,World Health Organization, 2000 (GPE Discussion Paper No. 11)
Statistical annex 1 Lozano R, Murray C L, Lopez AD, Satoh T Miscoding and misclassification of ischaemic heart disease mor- tality. Geneva, World Health Organization, 2000(GPE Discussion Paper No 12) Boschi-Pinto C, Murray CJL, Lopez AD, Lozano R Cancer survival by site for 14 regions of the woord Geneva, World Health Organization, 2000( GPE Discussion Paper No 13) alth. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 2) u Murray CL, Lopez AD. Progress and directions in refining the global burden of disease approach: re- Rs Sponse to Williams. Health Economics, 2000,9: 69-82. I Moesgaard-Iburg K, Murray CL, Salomon J. Expectations for health distorts: self-reported and ph assessed health status compared to observed health status. Geneva, World Health Organization, 2000(GP Discussion Paper No 14) 16 Sadana R, Mathers C, Lopez A, Murray CJL. Comparative analysis of more than 50 household surveys on health staties. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 15) Mathers C, Sadana r, Salomon J, Murray CL, Lopez AD of DALE for 191 countries: methods and results. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 16). 1s Gakidou EE, Murray CJL, FrenkJ Measuring health inequality: an approach based on the distribution of health expectancy. Bulletin of the World Health Organization, 2000, 78(1): 42-54 Lopez AD, Murray CJL, Ferguson B, Tamaskovic L. Life expectancy for small areas in selected countries Geneva, World Health Organization, 2000(GPE Discussion Paper No. 17) Gakidou EE, King G. Using an extended beta-binomial model to estimate the distribution of child mortality risk. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 18) 2 Gakidou EE, Murray C]L. Estimates of the distribution of child survival in 191 countries. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 19) World Health Organization, 2000( GPE Discussion Paper No 20) 2 de Silva A, Valentine N Measuring resp ss: results of a key informants survey in 35 countries. Geneva, World Health Organization, 2000(GPE Discussion Paper No 21) Valentine N, de Silva A, Murray CJL. Estimates of responsiveness level and distribution for 191 countries methods and results. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 22) 2 Darby C, Valentine N, Murray CJL. WHO strategy on measuring responsiveness. Geneva, World Health Organization, 2000( GPE Discussion Paper No 23) Murray CJL, Knaul E, Musgrove P, Xu K, Kawabata K Defining and measuring faimess of financial contribu tion. Geneva, World Health Organization, 2000(GPE Discussion Paper No 24) Xu K, Lydon P Ortiz de Iturbide J, Musgrove P, Knaul E, Kawabata K, Florez Ce, John J, Wibulpolpras S, Waters H, Tansel A Analysis of the faimess of financial contribution in 21 countries. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 25) Xu K, Murray CL, Lydon P, Ortiz de Iturbide J. Estimates of the fairness of financial contribution for 191 countries. Geneva, World Health Organization, 2000(GPE Discussion Paper No. 26) 2 Poullier JP, Hernandez P. Estimates of national health accounts. Aggregates for for 191 countries in 1997. Geneva, World Health Organization, 2000( GPE Discussion Paper No. 27) Tay CJL, Frenk J, Tandon A, Lauer J. Overall health system achievement for 191 countries. Geneva, World ath Organization, 2000( GPE Discussion Paper No. 28) Evans D, Tandon A, Murray CJL, LauerJ The comparative eficiency of national health systems in producing health: an analysis of 191 countries. Geneva, World Health Organization, 2000(GPE Discussion Paper No
Statistical Annex 151 11 Lozano R, Murray CJL, Lopez AD, Satoh T. Miscoding and misclassification of ischaemic heart disease mortality. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 12). 12 Boschi-Pinto C, Murray CJL, Lopez AD, Lozano R. Cancer survival by site for 14 regions of the world. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 13). 13 Murray CJL, Salomon J, Mathers C. A critical review of summary measures of population health. Geneva,World Health Organization, 2000 (GPE Discussion Paper No. 2). 14 Murray CJL, Lopez AD. Progress and directions in refining the global burden of disease approach: response to Williams. Health Economics, 2000, 9: 69-82. 15 Moesgaard-Iburg K, Murray CJL, Salomon J. Expectations for health distorts: self-reported and physicianassessed health status compared to observed health status. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 14). 16 Sadana R, Mathers C, Lopez A, Murray CJL. Comparative analysis of more than 50 household surveys on health status. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 15). 17 Mathers C, Sadana R, Salomon J, Murray CJL, Lopez AD. Estimates of DALE for 191 countries: methods and results. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 16). 18 Gakidou EE, Murray CJL, Frenk J. Measuring health inequality: an approach based on the distribution of health expectancy. Bulletin of the World Health Organization, 2000, 78(1): 42-54. 19 Lopez AD, Murray CJL, Ferguson B, Tamaskovic L. Life expectancy for small areas in selected countries. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 17). 20 Gakidou EE, King G. Using an extended beta-binomial model to estimate the distribution of child mortality risk. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 18). 21 Gakidou EE, Murray CJL. Estimates of the distribution of child survival in 191 countries. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 19). 22 Gakidou EE, Frenk J, Murray CJL. Measuring preferences on health system performance assessment. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 20). 23 de Silva A, Valentine N. Measuring responsiveness: results of a key informants survey in 35 countries. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 21). 24 Valentine N, de Silva A, Murray CJL. Estimates of responsiveness level and distribution for 191 countries: methods and results. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 22). 25 Darby C, Valentine N, Murray CJL. WHO strategy on measuring responsiveness. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 23). 26 Murray CJL, Knaul F, Musgrove P, Xu K, Kawabata K. Defining and measuring fairness of financial contribution. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 24). 27 Xu K, Lydon P, Ortiz de Iturbide J, Musgrove P, Knaul F, Kawabata K, Florez CE, John J, Wibulpolprasert S, Waters H, Tansel A. Analysis of the fairness of financial contribution in 21 countries. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 25). 28 Xu K, Murray CJL, Lydon P, Ortiz de Iturbide J. Estimates of the fairness of financial contribution for 191 countries. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 26). 29 Poullier JP, Hernández P. Estimates of national health accounts. Aggregates for for 191 countries in 1997. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 27). 30 Murray CJL, Frenk J, Tandon A, Lauer J. Overall health system achievement for 191 countries. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 28). 31 Evans D, Tandon A, Murray CJL, Lauer J. The comparative efficiency of national health systems in producing health: an analysis of 191 countries. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 29). 32 Tandon A, Murray CJL, Lauer J, Evans D. Measuring overall health system performance for 191 countries. Geneva, World Health Organization, 2000 (GPE Discussion Paper No. 30)
The World Health Report 2000 Annex Table 1 Health system attainment and performance in all Member States, ranked by eight measures, estimates for 1997 ATTAINMENT OF GOALS PERFORMANCE Member State Distributi Distribution contribution attainment international 182 181-182172-173103-10418 178 116-120 9427 89-95 92111-112 12-13 Austria 12 199 125116-120 2006818 16260109 roads 53 3-38 45 11672 163137-13889-95144 Bolivia 151-153 101142126 osmia and herzegovina Rm的 111-112 125 Brunei Darussalam 89-95 102 137-138137-138 172164 Canada 154134-135 105-106 仍4 Colombi 157- 153-15579-81 Costa rica Cote d'lvoire 34195 115-11 23-25 131-133 5934 84-86 76-79 128-129
152 The World Health Report 2000 Annex Table 1 Health system attainment and performance in all Member States, ranked by eight measures, estimates for 1997 ATTAINMENT OF GOALS PERFORMANCE Member State Health Responsiveness Fairness in Overall On level Overall Level Distribution Level Distribution financial goal of health health (DALE) contribution attainment system performance Afghanistan 168 182 181 – 182 172 – 173 103 – 104 183 184 150 173 Albania 102 129 136 117 173 – 174 86 149 64 55 Algeria 84 110 90 – 91 50 – 52 74 – 75 99 114 45 81 Andorra 10 25 28 39 – 42 33 – 34 17 23 7 4 Angola 165 178 177 188 103 – 104 181 164 165 181 Antigua and Barbuda 48 58 47 – 48 39 – 42 116 – 120 71 43 123 86 Argentina 39 60 40 3 – 38 89 – 95 49 34 71 75 Armenia 41 63 92 111 – 112 181 81 102 56 104 Australia 2 17 12 – 13 3 – 38 26 – 29 12 17 39 32 Austria 17 8 12 – 13 3 – 38 12 – 15 10 6 15 9 Azerbaijan 65 99 130 – 131 125 116 – 120 103 162 60 109 Bahamas 109 67 18 3 – 38 138 – 139 64 22 137 94 Bahrain 61 72 43 – 44 3 – 38 61 58 48 30 42 Bangladesh 140 125 178 181 51 – 52 131 144 103 88 Barbados 53 36 39 3 – 38 107 38 36 87 46 Belarus 83 46 76 – 79 45 – 47 84 – 86 53 74 116 72 Belgium 16 26 16 – 17 3 – 38 3 – 5 13 15 28 21 Belize 94 95 105 – 107 90 146 104 88 34 69 Benin 157 132 175 – 176 160 140 – 141 143 171 136 97 Bhutan 138 158 163 137 – 138 89 – 95 144 135 73 124 Bolivia 133 118 151 – 153 178 68 117 101 142 126 Bosnia and Herzegovina 56 79 108 – 110 124 82 – 83 79 105 70 90 Botswana 187 146 76 – 79 111 – 112 89 – 95 168 85 188 169 Brazil 111 108 130 – 131 84 – 85 189 125 54 78 125 Brunei Darussalam 59 42 24 3 – 38 89 – 95 37 32 76 40 Bulgaria 60 53 161 2 170 74 96 92 102 Burkina Faso 178 137 174 164 173 – 174 159 173 162 132 Burundi 179 154 171 168 114 161 186 171 143 Cambodia 148 150 137 – 138 137 – 138 183 166 140 157 174 Cameroon 156 160 156 183 182 163 131 172 164 Canada 12 18 7 – 8 3 – 38 17 – 19 7 10 35 30 Cape Verde 118 123 154 134 – 135 89 – 95 126 150 55 113 Central African Republic 175 189 183 191 166 190 178 164 189 Chad 161 175 181 – 182 185 58 – 60 177 175 161 178 Chile 32 1 45 103 168 33 44 23 33 China 81 101 88 – 89 105 – 106 188 132 139 61 144 Colombia 74 44 82 93 – 94 1 41 49 51 22 Comoros 146 143 157 – 160 153 – 155 79 – 81 137 165 141 118 Congo 150 142 137 – 138 151 162 155 122 167 166 Cook Islands 67 92 65 89 45 – 47 88 61 95 107 Costa Rica 40 45 68 86 – 87 64 – 65 45 50 25 36 Côte d’Ivoire 155 181 157 – 160 153 – 155 116 – 120 157 153 133 137 Croatia 38 33 76 – 79 83 108 – 111 36 56 57 43 Cuba 33 41 115 – 117 98 – 100 23 – 25 40 118 36 39 Cyprus 25 31 11 44 131 – 133 28 39 22 24 Czech Republic 35 19 47 – 48 45 – 47 71 – 72 30 40 81 48 Democratic People’s Republic of Korea 137 145 139 130 – 131 179 149 172 153 167 Democratic Republic of the Congo 174 174 142 169 – 170 169 179 188 185 188 Denmark 28 21 4 3 – 38 3 – 5 20 8 65 34 Djibouti 166 169 170 140 3 – 5 170 163 163 157 Dominica 26 35 84 – 86 77 – 78 99 – 100 42 70 59 35 Dominican Republic 79 97 95 72 154 66 92 42 51 Ecuador 93 133 76 – 79 182 88 107 97 96 111 Egypt 115 141 102 59 125 – 127 110 115 43 63 El Salvador 87 115 128 128 – 129 176 122 83 37 115 Health expenditure per capita in international dollars