World Health Organization ranking biased, not reliable

A letter in the Wichita Eagle written by Brad Beachy of Wichita makes the case for “so-called socialized medicine” to be brought to the United States. Part of Beachy’s argument relies on a ranking produced by the World Health Organization. That ranking has a number of problems.

The ranking Beachy refers to was produced in 2000, and hasn’t been updated since then. So it’s getting a little old. Worse than that, it contains a number of techniques and biases that work against countries that rely on markets instead of government to provide health care.

A recent paper from the Cato Institute provides some useful analysis of the World Health Organization rankings. (See WHO’s Fooling Who? The World Health Organization’s Problematic Ranking of Health Care Systems)

For example, there are two sets of rankings. As the Cato report explains: “One ranking claims to measure “overall attainment” (OA) while another claims to measure “overall performance” (OP). These two indices are constructed from the same underlying data, but the OP index is adjusted to reflect a country’s performance relative to how well it theoretically could have performed.”

Using the OP rankings, the United States is number 37. But using the OA rankings, the United States is 15.

25% of a country’s ranking is based on “financial fairness,” which is determined by looking at the “dispersion in the percentage of household income spent on health care.” As the reports says “The FF factor is not an objective measure of health attainment, but rather reflects a value judgment that rich people should pay more for health care, even if they consume the same amount.”

The report notes this introduces a bias against countries that rely on market mechanisms for paying for health care.

There’s another problem with FF, too: “Put more simply, the FF penalizes a country because some households are especially likely to become impoverished from health costs—but it also penalizes a country because some households are especially unlikely to become impoverished from health costs. In short, the FF factor can cause a country’s rank to suffer because of desirable outcomes.”

The Cato study goes on to document additional problems with the WHO ranking. Problems with the rankings were noticed earlier, too. An earlier analysis of this report from Cato (We’re Number 37 in Health Care! concluded this:

Overall, the WHO rankings’ mathematical formulations serve only to distract attention from the authors’ underlying distaste for individual choice in health care. The report largely ignores the extraordinary benefits the American marketplace brings to health care worldwide, such as new drugs, advanced diagnostic instruments such as MRIs and CAT scans, and lifesaving therapies for cancer and heart-disease patients. Under a WHO-style health care system, lifesaving research and innovation would be stifled and individual choice would be discarded in favor of collective control. Bureaucrats would decide who receives care — and who does not — on the basis of statistical tallies that devalue the lives of the elderly, the disabled and the chronically ill.

By contrast, a free-market health care system upholds the right of every person to make his own decisions. Patients are given choices, not issued numbers, and doctors are freed from impersonal “expert panels” dictating what care they can and cannot provide. The WHO’s idea of government-provided universal health care is a fantasy that masks a system of dangerous, formula-based rationing. If you value your health, don’t trust the WHO.


12 thoughts on “World Health Organization ranking biased, not reliable”

  1. We just recently addressed these rankings in a class of mine. Here is an article from February 5 of this year from Fox News Orlando. Note that Japan was ranked 10th while the US was ranked 37th overall.

    —————

    A 69-year-old Japanese man injured in a traffic accident died after paramedics spent more than an hour negotiating with 14 hospitals before finding one to admit him, a fire department official said Wednesday.

    The man, whose bicycle collided with a motorcycle in the western city of Itami, waited at the scene in an ambulance because the hospitals said they could not accept him, citing a lack of specialists, equipment, beds and staff, according to Mitsuhisa Ikemoto.

    It was the latest in a string of recent cases in Japan in which patients were denied treatment, underscoring the country’s health care woes that include a shortage of doctors.

    The man, who suffered head and back injuries, initially showed stable vital signs, but his condition gradually deteriorated. He died from hemorrhagic shock about an hour and half after arriving at the hospital, Ikemoto said.

    Ikemoto said the victim might have survived if a hospital would have accepted him more quickly. “I wish hospitals are more willing to take patients, but they have their own reasons, too,” he said.

    The death prompted the city to issue a directive ordering paramedics to better coordinate with an emergency call center so patients can find a hospital within 15 minutes.

    The motorcyclist involved in the Jan. 20 accident was hurt too and was also denied medical care by two hospitals before one accepted him, Ikemoto said. He was recovering from his injuries.

    More than 14,000 emergency patients were rejected at least three times by Japanese hospitals before getting treatment in 2007, according to the latest government survey. In the worst case, a woman in her 70s with a breathing problem was rejected 49 times in Tokyo.

    ——————

    France, which was ranked #1 overall in the 2000 WHO rankings, also has a questionable health care system. When I studied abroad there I was able to access the French health system as a regular citizen with no cost to me. The one time I got sick I had to wait five days to see a doctor who then did nothing for me.

    A friend broke their arm and waited 6 weeks before having it set.

    When I entered the country, we were to be screened for TB. In the US, health care workers are regularly screened for TB with TB skin tests, which is a simple injection under the skin that’s checked 72 hours later. If positive, a follow up chest x-ray will determine if a person has active or latent TB.

    Not so in France. When I arrived I was scheduled for a chest x-ray. Apparently TB skin tests are not used in the French health care system. I arrived in September and wasn’t scheduled to have my chest x-ray done until March. When my next semester class schedule didn’t allow me to go to my appointment, they rescheduled me for July. I left the country in June, never having been checked for TB, potentially having spread it for 9+ months.

    This is NOT the #1 health care system in the world and all of these are prime examples why the WHO rankings are meaningless.

  2. I read your blog, and my reaction was, “So?” You can massage and manipulate statistics all you want in order to change the US health rankings versus the rest of the industrial/First World countries, but the issues remain the same: none of these other countries exclude 16% of its citizens from what should be considered a civil right: reasonable access to basic health care. It is deplorable that the “richest, most powerful nation on earth” has been unable to provide basic universal health care to its population. Why have all the other countries been able to do it? Are they smarter than we are? Are they wealthier than we are? Perhaps the answer is that their people with power are less greedy than we are.

    The conservative “sturm und drang” is relentless and short-sighted: it was the same mantra for Social Security, Medicare, and the Civil Rights Act. Would the citizens of the United States give all these societal advancements back? Again, conservatives are on the wrong side of both history, and of how the world deals with health care.

    What is “The Voice of Liberty’s” answer to this nation’s healthcare issues? Let the “market” deal with it? Oh, wait; that’s right…the “market” did such a bang-up job with sub-prime mortgages and credit default swaps, etc., that they almost created a world-wide depression, didn’t they.

  3. The main point, regaurdless of what you think of the survey and rather or not the US should be 37th or 15th, is that we are not 1st and all the countries ahead of ours have a public option for health care. You can bring up the small examples of failures in these other systems and I can give you countless examples of failure in our own system. Just because there is an instance were someoen died in a certain situation doesn’t mean the whole system is a failure. I don’t have to google examples were people died here because of our healthcare system or lack of access to our healthcare system. Point is if you don’t have insurance you can get it. If you have a pre-existing you can still get it. What about all the people that have to stay at a particular job because they are sick and they need there insurance. If someone wanted to take a better job they couldn’t because they would have a pre-existing. What if you were to get laid off? You couldn’t even go to a individual insurance company if you have been to the doctor for a medical problem before. You are stuck. Our system is broke we all agree. There are better systems out there. Why don’t we learn from theses systems and improve ours. Thats how knowledge works you learn and you improve. If you stop learning you get left behind and that is what America did when it comes to health care, It got left behind the rest of the world. Also the guy that was visiting France, you are not a citizen of france and are not a part of their system. It takes a while to get put into the system I just looked it up on http://www.frenchentree.com/fe-health/. You do have to wait you don’t live there and you have to be put in the system to have access. I also don’t see how you couldn’t tell you professor “Hey I got a doctor’s appointment” and make you appointment. Seriously. Also you are complaining about a TB test that the state provides for visitors. Do you think they can x-ray or even do normal TB test on everyone that comes into France quickly. 10′s of not 100′s of thousands of people visit that place each month. It is hard and that is why that one man from Colorado went all over eruope and canada with TB without anyone knowing. You have to open your mind. Because you may or may not have had a bad experience with that system doesn’t mean you have the knowledge or the right to pass judgment on the whole system. Are there people complaining? No because they are number 1!

  4. When did health insurance become a right? No doubt current health care is too expensive… maybe we should start by getting rid of trial lawyers… Yes the health care system needs to be fixed, but so do the sewers and the boarders.

  5. When referencing the Cato-Institute it should be mentioned that this thinktank is regarded as neo-liberal in its ideology, therefore promoting private/market-economic approaches than more social-equity orientated ones. Evidence for this could be seen in the strong support for G. W. Bush’s partial privatization proposal of the social security in 2005.

    Sources:
    Neo-Liberal
    Dieter Plehwe u. Bernhard Walpen: Buena Vista Neoliberal? In: Klaus-Gerd Giesen: Ideologien in der Weltpolitik, VS-Verlag, 2004, S. 49-88.

    A starting point for the social insurance deabte:
    http://en.wikipedia.org/wiki/Social_Security_debate_(United_States)#Bush.27s_proposal

  6. So you are recommending that we take the health care industry in the United States word for it.

    I will accept the W.H.O. rankings before I will accept that of the C.E.O. rankings.

    Basically France is ranked at the top. The WHO does NOT even consider whether a plan is a socialized, single payer, or privately administered system. And the French national health system is administered by private health care insurers, the French equivalent of Blue Cross/Blue Shield.
    The difference is that the insurers have absolutely ZERO say in what will be paid for. By law, anything a doctor orders for a patient must be paid for.

    However the insurance companies got the right to sell add on policies that pick up the patients portion of their medical bill.

    Health care is a right. You would most certainly see those who have employer provided health care whining about that if the solution to health care was to simply make it illegal for an employer to provide it, and made it totally a personal responsibility.

    America’s ranking as a world economic superpower has declined as the cost of health care has risen.

    Which area of the world is now in first place. The European Union has the worlds largest economy, is the worlds largest exporter and the worlds largest manufacturer. Germany is in second place. China, third and the U.S. comes in 4th place.

    The public health systems have allowed Germany to hang onto many manufacturing jobs because the employers do not have to pay these costs.

    In the United States most of the health system is already paid for by the public sector. Private dollars only make up about 21 percent of what is spent in our health care system.

    The free market has had almost 60 years to create a working system. It has failed dismally and no amount of tweaking this private system has had any success in solving the problem or even remotely fixing an extremely broken system.

    The best ranked portion of the American health care system is not its private sector portion but its publically financed portions. VA, Medicare and of course the terribly taxpayer funded insurance that is given to Presidents, Congressmen, Senators and public employers are all ranked far better than the average health insurance given to the average employee by their employer.

  7. Yet another blog written by someone with little understanding of market theory. For example, “By contrast, a free-market health care system upholds the right of every person to make his own decisions. ”

    No. A free market permits a participant to express their choice, to the extent that the participant can afford, among the market available alternatives. Note that the available alternatives are a result of rational responses to market incentives. Here is the rub, exactly who is exerting the pressure within the market, creating those incentives (that is, who has the capability to exert more force within the market) – it is the INSURANCE companies, not the average individual. That is to say that an individual’s choices within this market are largely limited to that which the insurance companies are willing to have paid for in the past (or, rationally predicted in the future).

    However, this isn’t rocket science. I believe Arrow (spelling?) wrote something like this years ago.

  8. Bob, I believe that the only people that would take your rationale are as ignorant as you. I won’t even waste my time discrediting CATO. The United States is DEAD LAST in health care as compared to ALL other industrialized countries on this planet.

    I’m sure that people A LOT SMARTER than YOU have sat down and determined HOW TO IMPROVE health care cost and outcome in the FUTURE. I think your next article should be ‘Why black people should not hold public office in the United States’. Oh, and maybe try offering an alternative in your future pea-brain articles……never mind…..that requires thinking.

  9. @Mace: Clearly Black. Its easier to insinuate racism then it is to make a rational thought huh? Ignorance like this is the real problem with this country.

  10. Healthcare is NOT a right. Housing is NOT a right. Food is NOT a right. Higher education is NOT a right.

    Capitalism has built-in incentives and freedoms in it that have made America great. In America you have choices and freedoms to shape your own destiny, and one of them is the freedom to fail.

  11. As an American living in Australia, I’ve experienced both health care systems firsthand. When my wife and I had our son here in Sydney, it wasn’t smooth. First I found out I might be a carrier of CF. I had genetic testing, as did my wife. She had regular checkups with doctors and midwives throughout her pregnancy, as well as the usual sonograms. 4 weeks before her due date she had an abruption and had an emergency c-section. We spent five days in a private room at the hospital as she recovered. A lactation consultant visited my wife regularly to help her with breastfeeding. Our son had a bit of jaundice and received treatment for a week. After reviewing family medical history the hospital also gave my son x-rays to check his hips. Five days after arriving home a midwife visited us to see how we were all doing.

    After all of this, we did not pay a cent. It was all covered by Medicare. It’s available to everyone and the government is certainly not bankrupt. And I’m more than happy to pay my share of taxes, based on my income, to keep that going.

    My father is a doctor in the US and a pretty staunch republican supporter, and even he has told me that healthcare needs a major overhaul in the US. Doctors should have the final say on what needs to be done to care for patients.

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