Levels of resources mobilization characterizing overperforming health systems: Evidence from the OECD countries

In the quest of improving the performance of their respective health systems, decision-makers need to be provided with relevant evidence to make informed decisions. Yet, there is a lack of evidence regarding the determinants of overperformance and the absence of new approaches in analyzing data. This study aims to identify levels of mobilized resources that characterize overperforming health systems within the Organization for Economic Cooperation and Development (OECD). For this cross-sectional study, data were extracted from the OECD 2018 health data set. Through t test and z test, means and proportions were estimated to compare resources between the overperforming and the underperforming countries. Then, using Khi-square test, further analyses were carried out to estimate odds ratios so as to investigate the association between high levels of health resources and the overperformance of health systems. Data from 37 OECD countries were analyzed and revealed that overperforming health systems are significantly characterized by high levels of both health expenditure as percentage of GDP (9.38% vs 7.49%, p = 0.020) and physician density (3.75 vs 3.03, p = 0.028), compared to the underperforming group. With the associative approach, similar results were found, supporting that overperformance is achieved with high levels of health expenditure (OR = 10.63, 95% CI: 1.87-60.25) and physician density (OR = 5.42, 95% CI: 0.98-29.92). High levels of hospital bed density and the application of compulsory public schemes were found not to be the characteristic features of overperforming health systems. This study provides decision-makers with evidence that chances of making a health system overperforming, compared with its OECD peers, are increased when the levels of both health expenditure as percentage of GDP and physician density overpass the Organizational average.