in approaches focusing on subsectors performance is most often measured on the basis of outputs eg number of consultations and surgical procedures treatment may however be provided by different subsectors and this could lead to biased crosscountry comparisons moreover outcome measures at the subsector level are seldom available because health gains are often the result of a mix of outpatient care inpatient care and pharmaceuticals whose respective impact is impossible to disentangle a subsector approach would also not take into account the coordination of care within the health system eg between longterm and inpatient care which has been identified as a key element affecting effectiveness hofmarcher etal in addition data on subsector inputs are sparse