FII‑I Healthcare Study

Ranking: Methodology

How was the research approach? We take a look at the methodology for the overall ranking.

The over­all rank­ing is based on a weight­ed aver­age of indi­vid­ual indi­ca­tor rank­ings. 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. 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.

The selection of target countries is based on three criteria:
  • Size of population
  • Global coverage
  • Media coverage on handling COVID-19 pandemic

Research approach

The pri­ma­ry & sec­ondary research built upon pub­licly avail­able data from high­ly rep­utable sources such as the World Health Orga­ni­za­tion, the World Bank and the Johns Hop­kins Uni­ver­si­ty and an expert sur­vey.

Clustering healthcare system quality indicators

Con­trary to oth­ers, the rank­ing builds on the estab­lished Don­abe­di­an mod­el which clus­ters rel­e­vant health­care sys­tem qual­i­ty indi­ca­tors into groups (struc­ture, process and out­come) to com­pile an over­all coun­try rank­ing.

Weighted ranking of datapoints

The ranks per indi­ca­tor as well as indi­ca­tor group ranks and over­all ranks were then cal­cu­lat­ed build­ing upon a weight­ed con­sol­i­da­tion of the indi­vid­ual ranks rel­a­tive to the indi­ca­tor impor­tance.

The weights per indicator and indicator cluster are defined based on the perceived indirect or direct impact on the quality of a healthcare system:
  • Structure: Weighed 25%
  • Process: Weighed 25%
  • Outcome: Weighed 50%

The following list shows the weight of the indicators in each category:


Fac­tors that affect the con­texts in which care is deliv­ered (e.g. phys­i­cal facil­i­ty, equip­ment, social secu­ri­ty sys­tem and human resources). Con­sid­ered indi­ca­tors are:


Sum of all actions that make up health­care: diag­no­sis, treat­ment, pre­ven­tive care, and patient edu­ca­tion.


Con­tains all the effects of health­care on patients or pop­u­la­tions (e.g. changes to health sta­tus, behav­ior, patient sat­is­fac­tion, health-relat­ed qual­i­ty of life).

To develop an overall ranking, the ranks per indicator are consolidated using different weights:
  • The overall ranking is based on a weighted average of the ranks per indicator.
  • The ranks of a country per indicator are multiplied by the according weights.
  • Then the overall ranking is compiled by ranking the average scores of the results.
  • In case of missing scores and ranks, the respective indicator is disregarded in the course of the average assessment.
In addition to the indices, correlation analyses were conducted in order to identify performance drivers and to derive recommendations. Additional insights and evaluations of the results were gained from a separately conducted study. It is based on a survey in between selected healthcare professionals from around the globe.  
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