Health Care Reform: America’s Health Ranking is Fatally Flawed

Although relying on statistics seems to be a common practice in politics, the U.S. ranking of 37^th in the world for health care requires a closer analysis than has recently been given during the health care debate.

According to a recent article in the Wall Street Journal, “the ranking is dated and flawed, and has contributed to misconceptions about the quality of the U.S. medical system.” Specifically, the ranking comes from a decade old World Health Organization and relies on statistics that are even older and incomplete. The methodology of the report is also problematic for many public-health officials “because it judges health-care systems for problems—cultural, behavioral, and economic—which are not controlled by health care.”

One of the measurements used is child mortality and life expectancy. While the U.S. rankings since 2000 have slipped, “researchers say that factors beyond the control of the health-care system are to blame, such as dietary habits.”

Accordingly, the WHO graded each nation’s health care on five factors: health level, which is roughly the average healthy lifespan of a nation’s residents; and responsiveness, which is a sort of customer-service rating encompassing factors such as the system’s speed, choice and quality of amenities. The other three measure inequality in health-care outcomes; responsiveness; and individual spending.

As the article suggests, some “these last three measures are problematic, because a country with unhealthy people could rank above a healthier one where there was a bigger gap between healthy and unhealthy people.” Another issue with the WHO report was that researchers used what data was available, such as literacy rates and income inequality, to estimate health performance.

Philip Musgrove, the editor-in-chief of the WHO report that accompanied the rankings, calls the figures that resulted from this step “so many made-up numbers,” and the result a “nonsense ranking.” Dr. Musgrove, an economist who is now deputy editor of the journal Health Affairs, even wrote an article in 2003 for the medical journal Lancet criticizing the rankings as “meaningless.”

Even Christopher Murray, who oversaw the ranking for the WHO, says that “the biggest problem was just data” — or the lack thereof, in many cases. He even says the rankings are now “very old,” and contained a lot of uncertainty. WHO would have placed the U.S. 15th overall, based on its performance in the five criteria but, they took the additional step of adjusting for national health expenditures per capita, to calculate each country’s health-care bang for its bucks. As a result, because the U.S. ranked first in spending, that adjustment pushed its ranking down to 37th. This high spending rate however did not degrade the quality of care.

New attempts to rank health care systems must be able to differentiate between the quality of the medical system and other factors, such as diet, exercise and violent-crime rates. Overall indicators of health are not solely affected by the health care system, but are also a reflection of a society’s attempts at improving nutrition, education, exercise or public safety. With that being the case, it should come as no surprise in a country where fast food and unhealthy habits have created a tremendously overweight and obese population.

Ranking our health care system requires more attention to real data such as the breakthroughs pharmaceutical and device making companies have created to help Americans live longer and healthier. Factors such as funding for research, clinical studies, and research breakthroughs and innovations are just as important considerations for the overall quality of America’s health care. A closer look at the data from these areas will show that America truly has the best health care system in the world.