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Published in: Israel Journal of Health Policy Research 1/2017

Open Access 01-12-2017 | Integrative article

Perceived health status in a comparative perspective: Methodological limitations and policy implications for Israel

Author: Baruch Levi

Published in: Israel Journal of Health Policy Research | Issue 1/2017

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Abstract

Background

The perceived health status indicator included in the OECD Health Statistics suffers from severe methodological limitations related to data collection. Furthermore, this indicator is also included in the OECD's Better Life Index, thus distorting the total health score of some OECD countries, among them Israel. The purpose of this paper is to explore the erroneous use of OECD health data in Israel and to warn of its implications.

Methods

Analysis of data from the OECD Health Database, Better Life Index and the Israeli Central Bureau of Statistics, review of media reports and governmental documents concerning health measures, conversations and correspondence held with officials in the relevant organizations.

Results

OECD's perceived health status outcomes for Israel are biased upwards, resulting also in an upward bias of the Israeli overall health grade in the Better Life Index. This is due to the methodological differences between the OECD's standard survey questionnaire and the Israeli one. Yet, erroneous comparisons constantly appear in governmental documents and media reports, presenting health status in Israel in an excessive positive light.

Conclusions

Data from the OECD Health Statistics and the Better Life Index are reaching policy makers and the public in a manner that potentially distorts professional and political discourse on health. This may lead to a decrease in the resources allocated to health based on a flawed comparison. In the long run, and no less serious, the systematic imprecision may detract from the reliability of authority reports in the eyes of the public. Caution is essential in dealing with health indices and international comparisons. The OECD and relevant national agencies should invest greater efforts in the consolidation of definitions and methodologies.
Footnotes
1
In addition, OECD also publishes perceived health status from Lithuania that is not an OECD member.
 
2
There could be slight variations in the phrasing of options as in the cases of Japan and Mexico (for instance "regular" instead of "fair").
 
3
Differences may also be found in the minimum age of the sample population, however they are relatively negligible. In some of the countries, subjects are 15 and over, and in others the minimum age is 16. In Israel, the survey is administered to people over 20.
 
4
Alternatively, the subject may say his condition is unclear to him or refuse to answer.
 
5
BLI 2016 is based mainly on data from 2013.
 
6
The index also includes three non-OECD countries: Brazil, South Africa and Russia.
 
7
This calculation is based on OECD health data for 2013, which unlike BLI, do not include Brazil, South Africa and Russia, non-OECD members. Mexico is a member, but for an unclear reason it only sends the OECD the positive category data and therefore is also not included in the alternative rating I created. Hence my calculation includes 34 countries instead of 38.
 
8
Although caution should be exercised when comparing different surveys with different methodologies, indication of that can be found in the European Social Survey (ESS) which includes Israel. ESS is an academically driven cross-national survey that has been conducted across Europe since 2001 every two years. The survey includes a question of subjective general health with the same five-option scale recommended by the OECD. Israel's aggregated proportion of positive responses (good / very good) in this survey reached 74% in 2012 and 72.4% in 2014 compared with 83.5% and 84.3% in the CBS social survey respectively. Further information on ESS can be found in the survey's website: http://​www.​europeansocialsu​rvey.​org/​
 
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Metadata
Title
Perceived health status in a comparative perspective: Methodological limitations and policy implications for Israel
Author
Baruch Levi
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Israel Journal of Health Policy Research / Issue 1/2017
Electronic ISSN: 2045-4015
DOI
https://doi.org/10.1186/s13584-016-0128-x

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