Ranking of Healthcare Systems Worldwide

[RetireeRobert]

An article titled "Strong Medicine" in the December 2007 Univ Washington alum magazine included World Health Organization rankings of national health systems for 50 major countries. The article discussed the man whom the UW just hired (away from Harvard) who helped WHO devise the way to do the rankings.

Columns Magazine - The University of Washington Alumni Magazine - Strong Medicine: Page 6

Don't know how valid the ranking system is, or what "politics" may or may not have played a role, but the list of 50 countries in ranked order is interesting reading.

 

[Rich_by_the_Bay]

My 33 years of personal experience leads me to believe that ranking is plausible.

Problem with the rankings, so critics say, is that it depends "too" greatly on access to care and universal coverage, at the expense of high tech. and critical care services. From a population perspective, the ranking seems valid, but from the perspective of individuals who are prosperous, have insurance, can work the system, and know when to threaten with legal action you can get world class care here, and the rankings seem surprising.

All things considered, the article you cite seems about right to me.

 

[ziggy29]

Rankings like this are too situationally dependent.

A health care system can very highly if you have secure access to health care you can afford, but the same system can rank far, far lower if you are uninsured or underinsured, and in perception even if you are adequately insured but fear losing your job (and your 'affordable' health care).

 

[waltwill8]

I agree with Ziggy.

Lesson: Avoid the health care system as long as possible, while you get affluent. Do all the things that will keep you healthy. Strive for FI, Retire early. Then, you can afford US health care!

 

[Rich_by_the_Bay]

I agree with Ziggy.

Lesson: Avoid the health care system as long as possible, while you get affluent. Do all the things that will keep you healthy. Strive for FI, Retire early. Then, you can afford US health care!

Yep.

And for the other 60 million un- or under-insured, well...

 

[RetireeRobert]

Some surprises to me, Columbia, Andorra ranked failry high---above the US.

Cuba ranked only two places below US.

New Zealand ranked several more slots below US (and Cuba).

I am not sure I entirely "buy" the WHO ranking scheme.

 

[lets-retire]

Cuba ranked only two places below US.

I must say this one really surprised me also. Especially when not too long ago there was a chart posted on here about how the life expectance for a Cuban resident was higher than ours, but the costs were much lower. Maybe it's because the system is so bad nobody goes, thus lowering the costs and the quacks don't have a chance of goofing up your health.

 

[Cantuar]

I'm surprised at the low rankings given to New Zealand and Denmark. If wide-scale access is a big deal I would have expected Denmark to rank higher. I'm not surprised to see the USA near the bottom of the western countries. It's all very well to have the best possible care for the people who can afford it if the people who can't afford it make up around a fifth of the population.

 

[youbet]

Interesting that Thailand is ranked near the bottom. Isn't that the place where folks go for inexpensive, quality healthcare when they can't afford it here?

Canada is ranked only slightly ahead of the USA despite having universal coverage? The implication seems to be that, according to this ranking, everyone gets mediocre care in Canada.......

 

[Martha]

My hunch with Thailand is that if you are a foreigner with money, all is well, but if you are a poor person from Thailand you are SOL. Only a guess though.

 

[Rich_by_the_Bay]

The core problem is defining quality. Access, timeliness, mortality (overall and infant), and cost are important surrogates but each misses the mark in some ways.

If you spend 200% or 300% of what another country spends and have little or no lead in the traditional parameters of quality you get ranked lower. Fancy waiting rooms, more MRI machines, etc. don't help you out.

I think Americans tend to overestimate their alleged "superiority" in this area. On the other hand, we have low tolerance for things that are not "instant." It's very complicated.

 

[youbet]

My hunch with Thailand is that if you are a foreigner with money, all is well, but if you are a poor person from Thailand you are SOL. Only a guess though.

That's what I was thinking (guessing)........

 

[youbet]

I think Americans tend to overestimate their alleged "superiority" in this area.

I generally agree Rich. But, when I look at the countries above the good ole USA on the list, I don't see any that I'd prefer to recieve my medical care in. (I have relatively good insurance.)

I understand we are talking about the effectivity of a system for the entire population and not about the care one individual recieves, an important distinction.

I think the USA has top notch care for those who can afford it and lousy care for those who can't, resulting in mediocre average care. Some other countries have a very tight distribution of quality/availability of care with nearly everyone recieving mediocre care.

 

[RetireeRobert]

The core problem is defining quality. Access, timeliness, mortality (overall and infant), and cost are important surrogates but each misses the mark in some ways.

If you spend 200% or 300% of what another country spends and have little or no lead in the traditional parameters of quality you get ranked lower. Fancy waiting rooms, more MRI machines, etc. don't help you out.

I think Americans tend to overestimate their alleged "superiority" in this area. On the other hand, we have low tolerance for things that are not "instant." It's very complicated.

The methodology of the WHO ranking system is the question here. I went back and read the rest of the UW article, but unfortunately it didn't go into the methodology, but was more biographical on Murray, the fellow at the center of that ranking study.

Maybe if I google it I can find more.

It is odd that Canada and US and Cuba rank similarly with such different systems. That Thailand, the mecca of medical tourism ranks low, along with Denmark. That Norway and Sweden do not rank similarly to each other. The WHO ranking begs a lot of questions.

 

[Rich_by_the_Bay]

I generally agree Rich. But, when I look at the countries above the good ole USA on the list, I don't see any that I'd prefer to recieve my medical care in. (I have relatively good insurance.)

Based on.... ?? I think mostly familiarity.

I expect there are zillions of foreigners who feel the same way about getting care here -- horror stories about lost patients, wrong limb amputation, filthy conditions (in some hospitals), etc., not to mention life-shattering costs.

Your reaction is very understandable, but may not always be valid. Alas, we are not the only place that can deliver good care. Hey, I have practiced here for 33 years and am very proud of the care we have given. I just am not so proud of what has happened to the delivery system.

Meantime, others may have caught up. I wouldn't be terrified of getting my appendix out in most developed countries.

 

[youbet]

Based on.... ?? I think mostly familiarity.

I expect there are zillions of foreigners who feel the same way about getting care here -- horror stories about lost patients, wrong limb amputation, filthy conditions (in some hospitals), etc., not to mention life-shattering costs.

Your reaction is very understandable, but may not always be valid. Alas, we are not the only place that can deliver good care. Hey, I have practiced here for 33 years and am very proud of the care we have given. I just am not so proud of what has happened to the delivery system.

Meantime, others may have caught up. I wouldn't be terrified of getting my appendix out in most developed countries.

Rich....

Perhaps you're reading more into my post than intended. I'm simply saying that, with good health insurance and the ability to research where and by whom I'd like to recieve my care, I don't know where else I'd prefer to be for medical care.

But, help me understand, given you have good insurance and good knowledge of procurring care, where would you prefer to have your appeddix removed? Why?

(You might want to review my post where I talked about the difference between a medical system and what medical care might be available for many individuals.)

 

[Nords]

Meantime, others may have caught up. I wouldn't be terrified of getting my appendix out in most developed countries.

My concern with rankings is the "shortstop error rate".

Baseball shortstops generally start out with high error rates because they keep trying for the balls that are nearly out of reach. If it tips their glove, no matter how hard they tried, it's an error. As the shortstops get more experienced, though, their error rate goes down. It's not because they're diving faster or farther-- it's because they're not chasing everything. They've learned what balls are worth chasing and what should be left to the outfielders.

Do we want doctors (let alone surgeons) who only tackle the "safe" cases to preserve their high rankings? Or do we want fearless bulldog competitors who'll take on any challenge, no matter how desperate?

Up through the early 20th century, doctors frequently gave up on premature or unresponsive infants. They just weren't deemed worthy of the time or the effort. However the author of the book "Better" claims that the situation began to turn around when Dr. Apgar popularized her score. She didn't bring any dramatic new insights or superior intellect or eye-popping technology to the issue. She merely created a scorecard against which obstetricians (and their newborn patients) could be ranked. Whereas before "weak babies" were not always aggressively brought back to health, now any doctor who couldn't turn around an Apgar of 5 or 6 in this highly competitive business was deemed to be an embarrassing loser.

So I believe that rankings tend to both reward and punish initiative, and there has to be a way to account for both ends of the spectrum. There are times when overaggressive medical care is not a good thing. However I'd rather be in the position of having to settle down a [-]shortstop[/-] who doesn't know what he can't do rather than have to energize an overly cautious (or uninspired) physician.

 

[Rich_by_the_Bay]

But, help me understand, given you have good insurance and good knowledge of procurring care, where would you prefer to have your appeddix removed? Why?

(You might want to review my post where I talked about the difference between a medical system and what medical care might be available for many individuals.)

Maybe I did misread your post - sorry.

What I meant to say was that it is natural to want to receive care on your home turf. You speak the language, know the rules, and are, after all, at home. But that doesn't mean the care is necessarily better here, just more comfortable in many ways.

I would choose to part with my appendix here. In fact, here in Tampa. But if I were traveling in France and needed it out, the quality of my care would not be a concern, just the inconvenience, language issues and other travel-specific matters.

In the end, it's a little difficult for anyone to acknowledge that overall care is just as good in many other places, and much, much less expensive.

On a more philosophical note, I would also be more comfortable with the good ol' US of A's system if I knew that I would never lose access to health coverage because I was between jobs, too sick to work for a long time, or was too poor (not everyone qualifies for Medicaid) or FIREd. I don't have the answers and am very skeptical about Socialized Medicine, but a national safety net using the best of existing practices and some oversight to ensure fairness and appropriateness would be nice.

 

[Nords]

What I meant to say was that it is natural to want to receive care on your home turf. You speak the language, know the rules, and are, after all, at home. But that doesn't mean the care is necessarily better here, just more comfortable in many ways.

Would that be a laparoscopic scar or a traditional ol' scapel? Do I have to stay overnight or can I recuperate in a recovery room and get the heck outta there with some prescription painkillers? What's the hospital's infection rate, especially from MRSA?

I can't help but notice that sometimes the familiarity breeds more fear than comfort...

 

[youbet]

I would choose to part with my appendix here.

Me too. I'm insured and I think I could do a good enough job researching where to get it done to maximize the possiblility for success. So, why head someplace else...........like the Canadian politician recently did, coming here to get what she considered the best and most timely cancer treatment.

I had a significant medical intervention while I was in Singapore three years ago. Got sick in Germany. Got on the airplane anyway thinking that by the time the 14 hour flight was over I'd be OK. I wasn't and required treatment upon arrival in Singapore. Everything was excellent, top notch, and I had nothing but praise for their docs when I got home. But if the same thing happened today, I'd be just as comfortable getting the same treatment here, even if the Singapore "system" is ranked higher than the US system in the article. But that's because I have insurance, could find a way to pay even if I didn't, and am therefore a "system insider."

I think our problem is getting everyone inside the system.

 

[layla17]

That's a great way of putting it youbet. Getting inside the system is everyone's best bet.

 

[DangerMouse]

I've live in a few countries and have had medical treatment in a number of them. Australia, US, Switzerland, France I would say are on par, however I am saying that as someone with the medical coverage to pay for said treatment. Surprisingly my medical treatment in Mexico was very good and I would not hesitate to go there if need be. What has to be remembered is a lot of Drs from Mexico train in the US and they don't turn into instant idiots the moment they cross the border.

My worst medical experience was actually in the UK. I found the standard of care to be very poor that I am shocked to see them ranked so high. If you weren't feeling depressed before, you would soon be after stepping foot inside a British hospital. This was not from a single experience of the NHS but from 5 years of living in England and multiple medical encounters.

 

[kcowan]

WHO Heath Care Rankings

The World Health Report says the main failings of many health systems are:

• Many health ministries focus on the public sector and often disregard the frequently much larger private sector health care.
• In many countries, some if not most physicians work simultaneously for the public sector and in private practice. This means the public sector ends up subsidizing unofficial private practice.
• Many governments fail to prevent a "black market" in health, where widespread corruption, bribery, "moonlighting" and other illegal practices flourish. The black markets, which themselves are caused by malfunctioning health systems, and low income of health workers, further undermine those systems.
• Many health ministries fail to enforce regulations that they themselves have created or are supposed to implement in the public interest.

PR-2000-43/ WORLD HEALTH ORGANIZATION : ASSESSES THE WORLD'S HEALTH SYSTEMS

If you just look at the few key countries:

So you can see how life expectancy dragged Thailand down. US is most responsive but gets nailed by costs, life expectancy, and unfair financial contribution.

 

[lets-retire]

US is most responsive but gets nailed by costs.....and unfair financial contribution.

I find this part of the WHO's ranking interesting when considered in conjunction with the page Rich posted from the American College of Physicians position paper, which indicates there ae only four countries that pay less out of pocket than we do.

http://www.annals.org/cgi/reprint/0000605-200801010-00196v1.pdf

 

[RetireeRobert]

Good point. And as well, looking at the percentages of out-of-pocket expenses paid by patients in some countries:

US----------13%
Australia-----20%
Portugal-----21%
Italy---------21%
Spain--------24%
Switzerland--32%
Greece------45%

Then looking at how those same countries ranked on WHO's overall score, it seems everyone of these countries with much higher patient out-of-pocket expense than US, nonetheless ranked higher in WHO's overall score (despite the "financial fairness" criterion of WHO):

World Health Organization’s Ranking of the Most Effective Health Systems

1. France
2. Italy
3. San Marino
4. Andorra
5. Malta
6. Singapore
7. Spain
8. Oman
9. Austria
10. Japan
11. Norway
12. Portugal
13. Monaco
14. Greece
15. Iceland
16. Luxembourg
17. Netherlands
18. United Kingdom
19. Ireland
20. Switzerland
21. Belgium
22. Colombia
23. Sweden
24. Cyprus
25. Germany
26. Saudi Arabia
27. United Arab Emirates
28. Israel
29. Morocco
30. Canada
31. Finland
32. Australia
33. Chile
34. Denmark
35. Dominica
36. Costa Rica
37. United States of America
38. Slovenia
39. Cuba
40. Brunei
41. New Zealand
42. Bahrain
43. Croatia
44. Qatar
45. Kuwait
46. Barbados
47. Thailand
48. Czech Republic
49. Malaysia
50. Poland

Source: WHO World Health Report 2000