Performance assessment has gained particular momentum on national and international agendas with the publication of the World Health Report 2000 and
its ranking of the world’s health systems, stimulating a wide-ranging debate about approaches to assessing health system performance both nationally and internationally. While offering valuable insights into different health care systems, current approaches to performance assessment are facing numerous
challenges, most crucially related to underlying definitions, selection of indicators, methodological issues and interpretation of data: this paper examines and debates them, arguing in favour of a means of assessing performance of health care systems based on two stages: the first involves a broad ssessment of health outcomes that might identify topics deserving further attention; whereas the second stage involves an in-depth assessment of how the systems deal with any issues of potential concern identified in the first stage.