Don’t bank on the rank

The United States ranks 37th in the world in health care, according to the World Health Organization (WHO). Google the key words, and you find 3.7 million instances, with numerous mentions in recent months as the debate on health care reform heated up. What you won’t find are many articles questioning whether the statistic is true.

Enter the Wall Street Journal’s “Numbers Guy,” Carl Bialik, to deconstruct this damning statistic. First, it is based on a report released almost ten years ago. Second, this very report is based on out-of-date statistics that are incomplete and inaccurate.

The WHO ranking is composed of five criteria – life expectancy, responsiveness in providing diagnosis and treatment, inequality in health-care outcomes, inequality in responsiveness, and individual spending. The latter three proved to be the most controversial.

One huge issue was that the required data was not readily available for every nation; therefore, Bialik explains, WHO researchers would calculate the relationship between the five factors and whatever available numbers they could find. This means that literacy rates were sometimes used to approximate the quality of health care.

It is also difficult to create a ranking based on life expectancy when it is affected by a variety of factors outside of the heath-care system, such as diet and exercise habits, poverty, and homicide rate.

But wait, there’s more! According to an article from the Cato Institute, the data for each factor was collected from individual agencies and ministries. This creates inconsistencies in definition, reporting and methodology.

When individual spending is removed, the U.S. actually ranked much higher on the list. Bialik writes:

“…the WHO took the additional step of adjusting for national health expenditures per capita, to calculate each country’s health-care bang for its bucks. Because the U.S. ranked first in spending, that adjustment pushed its ranking down to 37th. Dominica, Costa Rica and Morocco ranked 42nd, 45th and 94th before adjusting for spending levels, compared to the U.S.’s No. 15 ranking. After adjustment, all three countries ranked higher than the U.S.”

Click here to see a chart from the Wall Street Journal that shows health care rankings when spending is removed.

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