Health Care System Process Utility Compared; Using a Hierarchical Ordered Probit Regression Analysis

Health system performance is mostly measured in terms of health outcomes. While health outcomes can be seen as a measure for outcome utility, they do not measure process utility. Yet a large share of overall health care expenditures is used to respond to patients' wishes, even though this may not affect health outcomes. We argue that the WHO concept of responsiveness can be used to capture process utility. Moreover, when paired with a hierarchical ordered probit, it can be corrected for the subjectivity of responses. We improve the correction technique and use much better data to compare the process utility of 56 health care systems.