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Home » Research Projects » International Comparison of Responsiveness using Anchoring Vignettes

Whose grass is greenest?

Users in different countries have different expectations of their health care systems. How can their experiences be compared and what lessons can be learned?

International rankings of public service performance are common today, but they can be beguiling when differences between the countries ranked are less than the likely measurement error and when differences in context and practical detail make reported data (for instance on crime rates) hard to interpret.

One way to cut across the problem of noncomparability in international rankings of administratively-reported data is to use a questionnaire that asks respondents in different countries for their assessment of the behaviour of the public services in a common hypothetical situation (eg. how long it would take to replace a lost driving licence). This so called ‘anchoring vignette’ approach was used by the WHO in its 2002 survey of 70 countries to compare the responsiveness of the national health care services.

This study, undertaken in association with the World Health Organization, will assess the anchoring vignette method of comparison by taking the findings of the 2002 World Health Survey and looking in detail at two things. It will examine the best way of analysing such data, assessing the usefulness of the vignette method, and pull out the characteristics associated with good performance as revealed by the vignette comparison.

What the research means for policymakers and the wider community

Research Methods

This study will:

Project Outputs

Project Poster 2009

Nigel Rice, Silvana Robone, and Peter C. Smith (2010) International Comparison of Public Sector Performance: The Use of Anchoring Vignettes to adjust Self-Reported Data, Evaluation, 16: 81-101

Nicole Valentine, Amit Prasad, Nigel Rice, Sivana Robone and Somnath Chatterji (2009) ‘Health systems responsiveness: a measure of the acceptability of health-care processes and systems from the user’s perspective’ in Smith P.C et al (eds.) Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects, Cambridge University Press

HEDG Working Paper 09/29: Vignettes and health systems responsiveness in cross-country comparative analyses

HEDG Working Paper 09/28: Analysis of the Validity of the Vignette Approach to Correct for Heterogeneity in Reporting Health System Responsiveness

HEDG Working Paper 08/27: Early retirement and inequality in Britain and Germany: How important is health?

Research Team

Nigel Rice

Nigel Rice

Nigel Rice is Reader and Director of the Health, Econometrics and Data Group, Centre for Health Economics, University of York. Recent publications have included studies of health-related attrition in the British Household Panel Survey (BHPS) as well as of the dynamics of health in the BHPS, and the influence of health care organizations on health systems performance.


Peter Smith

Peter Smith

Peter Smith is Director of the Centre for Health Economics and Professor in the Department of Economics and Related Studies at the University of York. He has published widely on the uses of analysis and performance indicators in the National Health Service.