Evaluación comparativa del desempeño sanitario en países de la OCDE mediante el índice GOWLAD: un enfoque de agregación logarítmica y lógica difusa

Abstract

This study analyzes structural disparities in the performance of OECD health systems from 2000 to 2021 using the GOWLAD* index (Generalized Ordered Weighted Logarithmic Aggregated Distance), a fuzzy logic–based aggregation model that estimates relative distances to an empirical optimum. Seven official indicators grouped into four functional dimensions—human resources, access to medical technologies, health financing, and effective service coverage—were used to construct optimal benchmarks and evaluate the relative lag of each country. The findings reveal a persistent gap between high-income and upper-middle-income countries, with a trend of increasing divergence since 2010. Some systems, such as South Korea, show consistent improvements, while others, including Mexico and Chile, remain considerably distant from the optimum. The study discusses methodological and policy implications and proposes the GOWLAD index as an alternative tool for assessing health system performance beyond conventional approaches.