NEW STUDY ON WHO RANKINGS: PREMISES ARE UNFAIR

Volume 29, Issue 512 March 31, 2008

Matthew Gever

Every year, the World Health Organization (WHO) publishes a report that analyzes some aspect of the health care systems of countries around the world. The 2000 report ranked the performance of the WHO’s member countries based on such factors as cost and access to care and the United States came up as 37^th among its 191 members.

A new policy analysis from the Cato Institute agrees that there are problems with the U.S. system. Too many Americans lack health insurance and/or are unable to afford the best care, both patients and providers need better and more useful information, and the system is riddled with waste, writes Michael Tanner, director of health and welfare studies at Cato. He agrees that the United States spends far more on health care than any other country. As the first chart below shows, the United States now spends close to 16 percent of gross domestic product on health care, nearly 6.1 percent more than the average for other industrialized countries. But, Tanner points out, health-care spending is not necessarily bad. “To a large degree, America spends money on health care because it is a wealthy nation and chooses to do so,” he writes.

Tanner questions the premises on which the ranking is based. For example, the WHO places a premium on “fairness,” which ends up penalizing the U.S. system for having health savings accounts which require patients to pay more out of pocket than other countries. Additionally, the WHO deducts points from the United States for not having enough social welfare programs.

“Such judgments clearly reflect a particular political point of view, rather than a neutral measure of health care quality,” Tanner says. He points out that the United States is ranked by the study as No. 1 in the world for responsiveness to patient needs in choice of provider, dignity, autonomy, timely care and confidentiality. Other positive measures include the world’s longest survival rates for cancer patients as well as leading the world in research and development of new technologies. “Of course, it is a matter of hot debate whether other countries have too little medical technology or the Unites States has too much. Some countries, such as Japan, have similar access to technology. Regardless, there is no dispute that more health-care technology is invented and produced in the United States than anywhere else.”

The report goes on to examines the health-care systems of other countries to see what lessons they may hold for reforming the U.S. system.

Total Expenditure on Health Care as a Percentage of GDP

Total Expenditure an Health Care as a Percentage of GDP

Number of MRI Units and CT Scanners per Million People

Source: Michael Tanner, The Grass Is Not Always Greener:A Look at National Health Care Systems Around the World, Cato Institute Policy Analysis No. 613, Washington, D.C., March 18, 2008.