Vignettes and health systems responsiveness in cross-country comparative analyses

The paper explores the use of anchoring vignettes as a means to adjust survey reports of health system performance for differential reporting behaviour by using data contained within the World Health Survey. Survey respondents are asked to rate their experiences of health systems across a number of domains on a five-point categorical scale. Using data provided through a set of vignettes we investigate variations in reporting of interactions with health services across both sociodemographic groups and countries. We show how the method of anchoring vignettes can be used to enhance cross-country comparability of performance. Our results show large changes in the rankings of country performance once adjustment for systematic country level reporting behaviour has been undertaken compared with a ranking based on raw unadjusted data.