Admin Note: Amanda Schaffer, friend of IFI, recently completed a study
on health care in the United States. We are going to have a few posts
from her in the next week or so. Enjoy.
Why does WHO rank the US' health care system as #37?
The World Health Organization’s 2000 ranking of the United States health care system as 37th isn’t what it first appears to be. First, it is important to understand that one of the measures used for such ranking is subjective in nature. Tanner (2008) questioned how the idea of “fairness” translates to a quantifiable measure? For example, the United States is penalized for adopting Health Savings Accounts because according to WHO, patients pay too much out of pocket and this is not fair (World Health Organization, 2000). This one measure, Fairness of Financial, resulted in an U.S. ranking of 54th to 55th in the category and played greatly into the 37th overall ranking (WHO Press Release, 2000).
The Cato Institute (2008) brings to light other questionable aspects of national ranking systems. For example, most national ranking systems measure life expectancy. They argue, however, that life expectancy is a poor measure of a health care system because it does not account for exogenous factors such as violent crime, poverty, obesity, tobacco and drug use, and other issues tied to, but not directly related to health care (Cato Institute, 2008). This argument was supported by the Organisation for Economic Co-operation and Development (2007); “It is difficult to estimate the relative contribution of the numerous non-medical and medical factors that might affect variations in life expectancy across countries and over time.” It is also noted by the American Enterprise Institute (2006), that if you correct for homicides and accidents, the United States rises to the top of the list for life expectancy.
Another relevant point of contention is infant mortality rates, which is evaluated in the WHO report. A 2006 study reports that Americans have the second highest infant mortality rate in the developed world (Green, 2006). This, however, could be due to the fact that the United States has the ability to bring to term and deliver infants with low birth-weight and/or physical limitations (Tanner, 2008). This often results in their death shortly after birth. The abortion rate of a country should also be considered. Countries with high abortion rates potentially eliminate problematic pregnancies, thus lowering infant mortality rates (Tanner, 2008).
The above paradox reveals not the lack of a problem, but the question, “what is the problem?” Is it that we have 47 million uninsured? Or, that 13.9 million people are not taking advantage of provided resources? Are these provided resources efficient, effective, desirable, or accessible? Or, are costs simply too high for some? To question, however, the quality or success of American medicine does not appear supportable. It is essential that the right question is asked and framed in such a way that the best answer results.
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