A cross country explanation of performance of heath care systems: The consumer point of view using the Euro Health Consumer Index

This paper performs an empirical analysis based on a published assessment of several health care systems. This assessment, performed by the think tank Health Consumer Powerhouse, reports outcomes, and ranks accordingly several countries. In turn, this paper explores the ability of national data at explaining the differences observed in that ranking. The innovative features of this paper are mainly two. First, it shows how the Euro Health Consumer Index - which is comprised from 6 indicators - can be used as a single-outcome latent variable. This feature expands the possibilities of incorporating EHCI in future research. Secondly, this paper also serves as an example of the use of Partial Least Squares (PLS) and its characteristics. The analytical technique is PLS. The empirical analysis uses a set of 22 European countries (20 from European Union plus Norway and Switzerland) and departs from a model that relates four latent constructs, one representing National Performance (the aggregated measure of the EHCI) and the others representing financial investment in health care and human and physical resources. The final estimates provide very interesting results. The main result, or a judgment from the point of view of political implications of this research, is that a successful health care system needs mainly financial investment. Secondly, it also benefits - to a lesser extent - from physical capabilities. Finally, the way resources - namely human resources - are organized is possibly critical to the overall performance, measured from a consumer point of view.