![]() Furthermore, there are likely to be a range of influences on the health system beyond the immediate control of health policy makers that should also in principle be modelled. Characteristics such as institutional factors have also been suggested as important determinants of whether a country's health system meets its citizens' expectations ( Blendon, Kim, and Benson 2001 Azfar and Gurgur 2008). However, such bivariate association may be misleading, and it has been argued that responsiveness is not just a matter of health spending ( World Health Organization 2000). In the few studies that do exist, attention has focused on an apparent positive association between health care spending per capita and responsiveness (World Health Organization 2000 Anderson and Hussey 2001). 2003b, 2009 Sirven, Santos-Eggimann, and Spagnoli 2008 Rice, Robone, and Smith 2011), there has been little investigation of the determinants of responsiveness, particularly of system-wide determinants ( World Health Organization 2000). While there exists evidence on variation in reported levels of health system responsiveness across countries ( Valentine et al. 2003a) has operationalized the concept through measurement across eight domains that aim to distinguish between aspects of health systems related to the rights of patients as human beings (e.g., domain of dignity) and aspects related to how the system meets the needs of patients as clients of the system (e.g., quality of health care facilities). The World Health Organization ( Valentine et al. ![]() Responsiveness relates to a system's ability to respond to the legitimate expectations of potential users about nonhealth enhancing aspects of care ( Murray and Frenk 2000) and in broad terms can be defined as the way in which individuals are treated and the environment in which they are treated, encompassing the notion of an individual's experience of contact with the health system ( Valentine et al. Health system responsiveness has been identified as one of the intrinsic goals of health care systems, alongside health outcomes and fairness of financial contributions ( World Health Organization 2000). ![]()
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