The Performance of Health Systems: An Assessment Framework and Comparison of Developed and Developing Countries

Background: In recent decades, especially after the publication of the World Health Report in 2000, many efforts have been made to develop assessment tools and improve the performance of health systems at the global and national levels. The purpose of this study was to design a method and assess the performance of health systems in various countries in its use.Methods: In this retrospective study, health systems were evaluated using the opinions of experts as well as international data. Health system experts expressed their views on appropriate indicators for evaluation. The performance of the studied health systems was ranked using multi-criteria decision-making techniques (SAW TOPSIS). Collected data were analyzed using multiple regression analysis.Results: Data related to 38 indexes in eight general areas of macroeconomics, affordability for health costs, disease control, health care financing, health and nutrition, life expectancy, health resources, and mortality rates were collected in 105 countries from 2018 to 2020. According to the findings of country ranking, the health systems of Sweden, Norway, and Japan have the best performance and Afghanistan, Nigeria and Guinea have the weakest performance in the years examined.Conclusion: Health systems face major challenges around the world. Scientific evaluations show that spending more resources and costs does not necessarily enhance the performance of health systems, yet using and distributing these resources and costs in health systems could enhance the hope for better performance.