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AbstractEfficiency is one of the most potent measures of health system performance and is of particular interest to policy makers because it seeks to assess the valued outcomes of a health system in relation to the resources that are sacrificed to achieve those outcomes. However, the production process of the health care system is a complex sequence, and most indicators are only able to capture part of that process; these indicators offer limited scope for analysis. While researchers have previously constructed composite indicators which combine partial measures into a single number, the weights used for aggregating data can be contentious and may not be universally applicable across systems. Data envelopment analysis (DEA) is most often used to compare the productivity of different producing entities, including health systems. In this article, we instead propose a method that relies on DEA to construct composite health system efficiency indicators from several partial efficiency measures. Among other noted benefits, this enables the construction of composite indicators where different weights are attached to partial indicators for each country, allowing countries to be viewed according to the weights that cast each in the best light. Our application of this method suggests that there is reasonable consistency among the countries that are found to be efficient.

"We too often form our perspectives or design policies based on simplistic notions of generational warfare or stereotypes. Precise definitions and examination of data on the life conditions of older people lead us to the same conclusion as a quick contemplation of our own lives: the situations, goals and behaviours of older people are very diverse. Defining older people is not simple. Even though population ageing is something that clearly occurs due to shifts in age-demographics in their entirety (i.e. increases in the number of people at older ages relative to the number of people at younger ages), when we talk about population ageing - and especially when we warn of the consequences of population ageing - usually we are really focusing our attention on older people. To understand then the consequences of population ageing it makes sense to turn our attention to focus primarily on the people that make up this group. It must be acknowledged that there is no age grouping that universally defines people as being older. Often (as we will discuss further below) age 65 is taken as a cut-off point, with anyone above age 65 being considered older. In fact, the diversity of the ageing experience can be divided to encompass 'older adults' (65-84) and the 'older old' (85+). These categories can be further divided by including the 'younger old' (65-74), but for the purposes of this book the two categories will suffice. Although it is convenient, using calendar age to identify older people is virtually meaningless in practice. People at the same age have varying degrees of health and activity, which ultimately affects their role in society."