FII‑I Healthcare Study

Healthcare Investment Pays Off

A benchmark study of healthcare systems. 35 countries worldwide in comparison.

AIMS OF THE STUDY
The study covers 35 countries, representing every region of the world and a broad spread in terms of population size and media coverage of their handling of the Covid-19 pandemic. Based on an expert survey and publicly available data, its aim is fourfold:
 
  • UNDERSTAND the differences among diverse healthcare systems
  • RANK countries based on their healthcare system quality
  • IDENTIFY performance drivers and risk factors
  • DERIVE tailored optimization levers

In 2020, health­care sys­tems around the world have been sub­ject not only to new pres­sures but also to intense scruti­ny, reveal­ing gaps and defi­cien­cies every­where. At the same time, com­mu­ni­ties have drawn on deep reserves of resilience and inge­nu­ity to address the chal­lenges. Once the Covid-19 pan­dem­ic is behind us, how will health­care sys­tems have been trans­formed? To track these devel­op­ments, the FII‑I is launch­ing an annu­al bench­mark study.

Now is the time to invest in health­care. Do it right, and we will not only be bet­ter pre­pared for anoth­er pan­dem­ic, but will also build more robust sys­tems that deliv­er bet­ter out­comes for every­one.

KEY FINDINGS
 
  • An additional 5 percent of GDP invested in healthcare could potentially increase average healthy life expectancy in developing countries by roughly 9 years.
  • The use of AI and robotics in healthcare has the potential to increase investment efficiency by up to 20 percent.
  • Signs of wealth and a successful healthcare system in “normal times” appear to be a risk factor during pandemics.
  • Regardless of their healthcare system setup, countries worldwide should focus their future initiatives heavily on preventive measures.

THE RANKING

This first study com­pares health­care sys­tems in 35 coun­tries. More coun­tries will be added in future issues. While the rank­ing sup­ports the com­mon opin­ion that devel­oped and tran­si­tion coun­tries have a high­er health­care sys­tem qual­i­ty than devel­op­ing coun­tries, it also deliv­ers some sur­pris­es. For exam­ple, giv­en recent media cov­er­age of the Covid-19 pan­dem­ic, one might not expect Spain, the UK and Italy to achieve lead­ing rank­ing posi­tions. Anoth­er sur­prise is that some coun­tries reveal a vari­ance in their per­for­mance with regard to struc­ture, process and out­come. Clear­ly, oth­er fac­tors out­side the health­care sys­tem, such as lifestyle, also play a role in the over­all out­come.

METHODOLOGY

Over­all rank­ing is based on a weight­ed aver­age of indi­vid­ual indi­ca­tors. A wide range of indi­ca­tors was tak­en into con­sid­er­a­tion, grouped into three clus­ters: struc­ture, process and out­come. This approach is based on Avedis Donabedian’s frame­work for eval­u­at­ing the qual­i­ty of health ser­vices.


RANKING HEALTHCARE SYSTEMS IN 35 COUNTRIES


THE RELATIONSHIP BETWEEN STRUCTURE, PROCESS AND OUTCOME IN HEALTHCARE

The rank­ing per indi­ca­tor clus­ter shows that struc­ture, process and out­come are inter­de­pen­dent. Coun­tries with a high rank­ing for one gen­er­al­ly have a high rank­ing for the oth­er two. How­ev­er, for some coun­tries the rank­ings vary sig­nif­i­cant­ly. For exam­ple, Bangladesh’s high rank­ing for process con­trasts strong­ly with its rank­ings for struc­ture and 25 out­come. This is dri­ven main­ly by its high immu­niza­tion cov­er­age. In many cas­es, the rank­ing shows that oth­er fac­tors, such as lifestyle, 34 also dri­ve health­care out­comes.

UNITED KINGDOM
OMAN
KUWAIT
SPAIN
SAUDI ARABIA
COLOMBIA
BRAZIL
NEW ZEALAND
BAHRAIN
CHINA
EGYPT
INDIA
GERMANY
KENYA
JAPAN
INDONESIA
BANGLADESH
MEXICO
TURKEY
AUSTRALIA
SOUTH AFRICA
THAILAND
UNITED STATES
SOUTH KOREA
PAKISTAN
RUSSIA
VIETNAM
SENEGAL
FRANCE
PHILIPPINES
ETHIOPIA
NIGERIA
UNITED ARAB EMIRATES
ITALY
CONGO

 


PERFORMANCE - Identifying Significant Drivers

CORRELATION BETWEEN INPUTS AND OUTPUT

In the next step, key dri­vers of health­care sys­tem qual­i­ty are iden­ti­fied using sta­tis­ti­cal cor­re­la­tion between inputs and out­put (healthy life expectan­cy). A coef­fi­cient of 0 in this con­text implies no cor­re­la­tion in the direc­tion the two vari­ables move; a coef­fi­cient of 1 means per­fect cor­re­la­tion. In terms of inputs, of all the struc­ture and process indi­ca­tors ana­lyzed, capac­i­ty and finan­cial invest­ment inputs are the most sig­nif­i­cant dri­vers of healthy life expectan­cy, with cor­re­la­tion coef­fi­cients greater than 0.7. This result is reflect­ed in the rank­ing. Most coun­tries that invest rel­a­tive­ly heav­i­ly in their health­care sys­tems achieve a rel­a­tive­ly high rank­ing.


OVERALL PERFORMANCE VS. PANDEMIC PERFORMANCE

High-qual­i­ty health­care sys­tems have not fared as well as expect­ed in the pan­dem­ic. The sta­tis­ti­cal cor­re­la­tion analy­sis reveals why. Signs of wealth and pros­per­i­ty, such as inter­na­tion­al con­nect­ed­ness and a gen­er­al­ly well-func­tion­ing health­care sys­tem with high healthy life expectan­cy, seem to cor­re­late at least to some extent with Covid-19 death fig­ures. Fac­tors that are nor­mal­ly desir­able are a risk in pan­demics – an old­er pop­u­la­tion is more vul­ner­a­ble to dis­ease, and inter­na­tion­al con­nect­ed­ness eas­es the spread.


PERFORMANCE - Differences in Country Clusters

In oder to make tai­lored rec­om­men­da­tions for improve­ments, the find­ings were aggre­gat­ed on a coun­try-clus­ter lev­el, based on the respec­tive state of eco­nom­ic devel­op­ment. The group­ings are in line with those defined by the UN, which dif­fer­en­ti­ates between devel­oped and tran­si­tion coun­tries and devel­op­ing coun­tries. A bench­mark­ing of the two coun­try clus­ters shows strong dif­fer­ences between them with regard to input into health­care sys­tems and aver­age life expectan­cy.

GLOBAL COUNTRY CLUSTERS BASED ON STATE OF ECONOMIC DEVELOPMENT:

 


HEALTHCARE SYSTEMS INPUTS AND OUTPUT BY COUNTRY CLUSTER

Devel­oped and tran­si­tion coun­tries achieved com­pa­ra­bly high aver­age healthy life expectan­cy scores, sup­port­ing the impres­sion from the cor­re­la­tion analy­sis that finan­cial and capac­i­ty input are sig­nif­i­cant dri­vers. How­ev­er, it becomes evi­dent that addi­tion­al input does not lead to a pro­por­tion­al­ly strong increase in out­put.


OPTIMIZATION - Marginal Value of Additional Investments

Data analy­sis shows that the mar­gin­al val­ue of addi­tion­al invest­ment is neg­li­gi­ble for devel­oped and tran­si­tion coun­tries, where­as for devel­op­ing coun­tries there is still upward poten­tial.

Devel­oped and tran­si­tion coun­tries are already at the upper end of the scale in terms of both inputs and out­comes, so increas­ing capac­i­ty or finan­cial input would not sig­nif­i­cant­ly improve healthy life expectan­cy. How­ev­er, for devel­op­ing coun­tries, increas­ing capac­i­ty and finan­cial invest­ment promis­es a sig­nif­i­cant increase in healthy life expectan­cy.

Tak­ing into account the pos­i­tive cor­re­la­tion between health expen­di­ture and healthy life expectan­cy, based on the ana­lyzed data points, increas­ing the lev­el of health expen­di­ture as a per­cent­age of GDP by around 5 per­cent for devel­op­ing coun­tries could poten­tial­ly result in an exten­sion of healthy life of approx­i­mate­ly 9 years.


AI INCREASES EFFICIENCY OF HEALTHCARE INVESTMENT BY UP TO 20 PERCENT

Addi­tion­al health expen­di­ture as a per­cent­age of GDP is strong­ly cor­re­lat­ed with the num­ber of med­ical doc­tors per 10,000 pop­u­la­tion, as finan­cial input is, to a sig­nif­i­cant extent, allo­cat­ed to med­ical per­son­nel. How­ev­er, accord­ing to a sur­vey of experts, up to 20 per­cent of the work of doc­tors could be sub­sti­tut­ed by AI and/or robot­ics by 2025. As a con­se­quence, AI has the poten­tial to sig­nif­i­cant­ly increase the effi­cien­cy of finan­cial invest­ment in health­care.

VALUE OF ADDITIONAL INPUT INTO HEALTHCARE SYSTEMS – POSITIVE EFFECT WITH DECREASING MARGINAL BENEFIT

Data analy­sis sug­gests that increas­ing the num­ber of med­ical doc­tors and the amount of health expen­di­ture has a pos­i­tive effect on healthy life expectan­cy. How­ev­er, the mar­gin­al val­ue of addi­tion­al input decreas­es beyond approx­i­mate­ly 25 doc­tors per 10,000 pop­u­la­tion or health expen­di­ture of 10 per­cent of GDP. Below that lev­el – where most devel­op­ing coun­tries lie – addi­tion­al input cre­ates sig­nif­i­cant mar­gin­al val­ue.


VALUE OF ADDITIONAL FINANCIAL INVESTMENT IN DEVELOPING COUNTRIES

+5% GDP invest­ed in health­care
+9 years healthy life expectan­cy

Read the next topicRanking: Methodology