Hussey Peter S, Edelen Maria O
RAND, 20 Park Plaza, Suite 920, Boston, MA, 02540, USA.
Isr J Health Policy Res. 2018 Jan 8;7(1):5. doi: 10.1186/s13584-017-0199-3.
International comparisons of health systems are frequently used to inform national health policy debates. These comparisons can be used to gauge areas of strength and weakness in a health system, and to find potential solutions from abroad that can be applied locally. But such comparisons are methodologically fraught and, if not carefully performed and used, can be misleading.In a recent IJHPR article, Baruch Levi has raised concerns about the use of international comparisons of self-reported health data in health policy debates in Israel. Self-reported health is one of the most robust and frequently used measures of health, and the OECD uses a commonly accepted measure specification, which has five response categories. Israel's survey question, unlike the OECD measure specification, includes only four response categories. While this may be a valid method when applied over time as a scale within Israel, it creates problems for international comparison.To improve comparability, Israel's Central Bureau of Statistics could revise the survey question. However, revising the question would introduce a "break" in the data series that interrupts comparisons within Israel over time. Israeli policymakers therefore face a decision about priorities: is it more important to them to be able to track health status within Israel over time, or to be able to make meaningful comparisons to other countries? If the priority were international comparisons and the Israel survey was revised, a small study could be conducted among a sample of Israeli respondents to enable crosswalking of self-reported health responses from the four-point scale to the five-point scale. If the Central Bureau of Statistics does not revise its survey, the OECD should examine whether a stronger caveat is possible for its comparisons.
卫生系统的国际比较经常被用于为国家卫生政策辩论提供信息。这些比较可用于衡量卫生系统的优势和劣势领域，并从国外寻找可在本地应用的潜在解决方案。但此类比较在方法上存在诸多问题，如果执行和使用不当，可能会产生误导。在最近发表于《国际卫生政策与管理研究》的一篇文章中，巴鲁克·利维对以色列卫生政策辩论中使用自我报告健康数据的国际比较提出了担忧。自我报告健康状况是衡量健康最可靠且常用的指标之一，经合组织采用一种被广泛接受的指标规范，该规范有五个回答类别。与经合组织的指标规范不同，以色列的调查问题仅包括四个回答类别。虽然随着时间推移在以色列国内作为一个量表应用时这可能是一种有效的方法，但它给国际比较带来了问题。为提高可比性，以色列中央统计局可修订调查问题。然而，修订问题会在数据序列中引入一个“断点”，从而中断以色列国内不同时间的比较。因此，以色列政策制定者面临一个优先事项的抉择：对他们来说，能够长期追踪以色列国内的健康状况，还是能够与其他国家进行有意义的比较，哪个更重要？如果优先事项是国际比较并对以色列的调查进行修订，可以在一部分以色列受访者样本中开展一项小型研究，以便将自我报告健康状况的回答从四点量表转换为五点量表。如果中央统计局不修订其调查，经合组织应研究是否有可能在其比较中加入更强的警示说明。
