Najafizada Said Ahmad Maisam, Sivanandan Thushara, Hogan Kelly, Cohen Deborah, Harvey Jean
Assistant Professor, Memorial University of Newfoundland, St. John's, NL.
Analyst, Canadian Institute for Health Information, Ottawa, ON.
Healthc Policy. 2017 Aug;13(1):59-73. doi: 10.12927/hcpol.2017.25191.
Since the release of the World Health Report in 2000, health system performance ranking studies have garnered significant health policy attention. However, this literature has produced variable results. The objective of this study was to synthesize the research and analyze the ranked performance of Canada's health system on the international stage.
We conducted a scoping review exploring Canada's place in ranked health system performance among its peer Organisation for Economic Co-operation and Development countries. Arksey and O'Malley's five-stage scoping review framework was adopted, yielding 48 academic and grey literature articles. A literature extraction tool was developed to gather information on themes that emerged from the literature.
Although various methodologies were used to rank health system performance internationally, results generally suggested that Canada has been a middle-of-the-pack performer in overall health system performance for the last 15 years. Canada's overall rankings were 7/191, 11/24, 10/11, 10/17, "Promising" and "B" grade across different studies. According to past literature, Canada performed well in areas of efficiency, productivity, attaining health system goals, years of life lived with disability and stroke mortality. By contrast, Canada performed poorly in areas related to disability-adjusted life expectancy, potential years of life lost, obesity in adults and children, diabetes, female lung cancer and infant mortality.
As countries introduce health system reforms aimed at improving the health of populations, international comparisons are useful to inform cross-country learning in health and social policy. While ranking systems do have shortcomings, they can serve to shine a spotlight on Canada's health system strengths and weaknesses to better inform the health policy agenda.
自2000年《世界卫生报告》发布以来，卫生系统绩效排名研究已引起卫生政策的高度关注。然而，该文献得出的结果各不相同。本研究的目的是综合相关研究，并分析加拿大卫生系统在国际舞台上的排名表现。
我们进行了一项范围界定审查，以探究加拿大在经济合作与发展组织（OECD）同类国家的卫生系统绩效排名中的地位。采用了阿克西和奥马利的五阶段范围界定审查框架，共筛选出48篇学术文献和灰色文献文章。开发了一种文献提取工具，以收集文献中出现的主题信息。
尽管国际上使用了各种方法对卫生系统绩效进行排名，但结果总体表明，在过去15年中，加拿大在整体卫生系统绩效方面一直处于中等水平。在不同研究中，加拿大的总体排名分别为7/191、11/24、10/11、10/17，评级为“有前景”和“B”级。根据以往文献，加拿大在效率、生产力、实现卫生系统目标、残疾生存年数和中风死亡率等方面表现良好。相比之下，加拿大在与伤残调整生命预期、潜在寿命损失年数、成人和儿童肥胖、糖尿病、女性肺癌和婴儿死亡率相关的领域表现不佳。
随着各国推行旨在改善民众健康的卫生系统改革，国际比较有助于促进卫生和社会政策方面的跨国学习。虽然排名系统确实存在缺陷，但它们可以突出加拿大卫生系统的优势和劣势，从而更好地为卫生政策议程提供信息。
