Medicine

The Misleading WHO Health Care Rankings.

By Chris Rangel MD ⋅ August 25, 2007 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

In the mockumentary ‘Sicko’, Michael Moore points out that despite spending the most on health care of any nation ($7,400 per capita), the US ranks near the bottom among industrialized countries and only two spots above Cuba (that spends $251 per capita). What rankings? In 2000 the World Health Organization came up with rankings for the health care systems of 190 countries.

The problem is that the WHO ranking has very little to do with the quality of health care as implied by ‘Sicko’ and by many liberals. Of several variables, only life expectancy is used as a measure of health care quality. But this is a bad measure of overall health care quality and does not correlate exactly with health care spending. This is due to the fact that there are multiple other variables other than health care that directly impact life expectancy.

For example, obesity alone is calculated to decrease US life expectancy by 0.3 to 0.75 years and the US has the highest rates of obesity in the world. Notice that Japan has one of the lowest rates of obesity and is among the countries with the highest life expectancies. The WHO report acknowledges that other variables like higher HIV rates, higher tobacco abuse rates, higher rates of risk factors for coronary artery disease (including obesity), and higher rates of homicides in the US compared to other industrialized countries combine to decrease the life expectancy for Americans.

The generally poor life style choices of Americans are more likely to have a causative effect on health care spending than the other way around. I.e. more health care spending is needed to take care of the conditions like heart disease that result from our poor health habits. This is more logical than to assume that high health care spending has anything to do with rates of obesity or smoking.

The other measures have to do with how these health systems are funded, distributed, and how responsive they are to the health needs of the population. Of these, the one that correlates the closest with health care spending is responsiveness. This is because this measure is very closely tied to the availability of health care resources and countries that spend a lot on health care have plenty of resources. The US ranks #1 in responsiveness. The US ranks only #54-55 in something the WHO calls the “fairness of financial contribution” which is the liberal way of saying “it’s only fair that your health care is paid for by someone else”.

Even though the US is #1 in health care responsiveness (which translates into shorter wait times, greater access, more innovation, etc) this one measure is overshadowed by the fact that the WHO believes that equal health care distribution and financing has just as much if not more weight in its rankings. This is what leads to the strange juxtaposition of the US health system being ranked only two spots above Cuba’s. Of course everyone knows that Cuba has a pretty good health care system . . . . for 1959 (I hear they have some nice classic autos too).

The WHO rankings have more to do with what liberals value in a health care system (fairness, equality, etc.) than what most Americans value in a health care system (quality, access, efficiency, innovation, convenience). Though this doesn’t stop people like Mr. Moore from trying to convince everyone that these apples are really oranges.