In approaches focusing on sub-sectors, performance is most often measured on the basis of outputs {e.g. number of consultations and surgical procedures). Treatment may, however, be provided by different sub-sectors and this could lead to biased cross-country comparisons.11 Moreover, outcome measures at the sub-sector level are seldom available because health gains are often the result of a mix of out-patient care, in-patient care and pharmaceuticals, whose respective impact is impossible to disentangle. A sub-sector approach would also not take into account the co-ordination of care within the health system (e.g. between long-term and in-patient care) which has been identified as a key element affecting effectiveness (Hofmarcher etal., In addition, data on subsector inputs are sparse.