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Brief analytical summaries or syntheses #41

A working guide to international comparisons of health


This guide published by the Australian government highlights the types of questions to ask before comparing health systems in countries or presenting health data in an international context.

The guide is intended to encourage users of international health-related data to consider the complexities before comparing countries, and to assist them in interpreting the results of these comparisons. It presents examples to highlight the types of questions to ask when using health data in an international context.


It is common practice to compare health between countries. Such comparisons provide a broader perspective of health and health care. They enable researchers, policy makers and the general public to see how national experiences of health and health care compare on an international scale. These comparisons often attract much attention from the media, particularly if countries are ranked according to performance. Health care systems around the world are diverse. They vary in the way they are financed, how services are delivered and how health information is collected and used. Their evolution may have been influenced by the country’s political, cultural and historical experiences. Despite these differences, many countries share the same health goals and face similar health challenges. This makes international comparisons of health experiences an important tool to inform priorities and policies for health services and to monitor progress in achieving health objectives.

International comparisons can highlight successful experiences and ‘best practices’ for a particular health issue or health system. Using data from other countries increases the amount of information available to assess the factors influencing the success or failure of health and health care practices.

Analysis and results

Checklist for international comparisons of health

  • Data quality
  • Choice of countries
  • Presentation and interpretation
  • Consistency—are the data defined consistently across countries?
  • Methodology—do all countries use the same method to collect the data?
  • Coverage—do the data cover similar parts of the population?
  • Time period—do the data refer to the same time period?
  • Comparability—are countries sufficiently similar to support comparison?
  • Presentation—are the data presented appropriately?
  • Explanation—is the variation between countries adequately explained?
  • Underlying differentials—are differences within countries considered?
  • Context—can the data be used outside of the international comparison?


The diverse nature of health information and health care systems adds a level of complexity in making international comparisons. Consequently, using and interpreting such comparisons needs to be done carefully to minimize misinterpretation of the results. The aim of this guide is to encourage users of international comparisons of health and health care data to consider some of the factors that can influence variation between countries, and to assist them in interpreting the results. Drawing on a range of examples — using health and health care data for OECD countries — this guide highlights the types of question to consider about data quality, the basis for country selection and the techniques used to present results.

Implications and recommendations

The use and interpretation of international comparisons need to be considered carefully. If the data and methods that underlie these comparisons are not assessed, the results can be misinterpreted. There are methodological issues to consider in assessing data availability and quality, and in deciding which countries to compare. Decisions about the data used and the countries selected should be documented with adequate rationale to ensure the limitations and assumptions are clear and duly considered. These decisions can influence the differences observed between countries and the conclusions made.


A working guide to international comparisons of health