A New Approach for Constructing a Health Care Index including the Subjective Level.

Until now, health care systems have been compared by means of macro criteria, an approach that might have its shortcomings in assessing the actual benefits that health care systems may provide for people. Therefore, a new health care index is presented which combines individual assessments of health care systems with objective macro health care system criteria. Two steps are taken for furthering this approach: First, a data-driven procedure is used to determine the influence of self-rated health on confidence in the health care system through macro criteria of health care systems. The macro indicators are weighted accordingly and created into an index, which adds to the subjective level of the link. In a second step, the constructed health care index is tested in a multilevel model with self-rated health being the dependent variable, to avoid tautological conclusions. The index is able to reduce country differences, decrease explained variability and has a statistically significant effect without affecting other estimates.