Good health at low cost 25 years on. What makes a successful health system?
This study has certain limitations. First, we are focusing on success
stories. Ideally, we would have compared the countries included with
others that were generally similar but which have failed to improve
health outcomes to the same extent. However, this would pose many
problems, especially the cost and time required to do in-depth case
studies in a large number of countries. In addition, at least some of the
other potential countries lack indigenous capacity to undertake the
research and have weak data systems. In addition, it may be difficult to
identify triggers for implementation of particular programmes and
policies. It may be that, especially in political environments where there
is considerable insecurity, local policy-makers are reluctant to participate
in interviews. We did, however, attempt to compensate for this
limitation by making regional comparisons where possible, and
including the original four countries in the study to take into account
their trajectories and mixed fortunes.
Second, while we can identify potential contributors to ‘good health at
low cost’, we cannot quantify their relative contribution. One promising
avenue for investigation could have used subnational longitudinal data
on health outcomes and the coverage of health interventions to explore
the relative contribution of different determinants on changes over time
and to seek associations with policy developments. However, in most
cases (with the exception of Thailand), there were severe limitations on
the availability of good quality data that precluded such an analysis.
Finally, on a related note, while there were many more data available to
us than to the authors of the 1985 Good health at low cost report, the
quality of data remains variable, often limiting comparisons both
nationally and regionally.
Highlights from the study countries