• Riyadh Alshamsan, John Tayu Lee, Sangeeta Rana, Hasan Areabi, and Christopher Millett.
• 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11632, Saudi Arabia.
• J R Soc Med. 2017 Sep 1; 110 (9): 365-375.

AbstractObjective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.

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