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A Project of The Annenberg Public Policy Center

37th in Health Performance?

The Wall Street Journal‘s "Numbers Guy," Carl Bialik, takes a deeper look at a well-worn statistic: that the U.S. ranks 37th in the world in health system performance. His conclusion:

WSJ’s Bialik, Oct. 21: Among all the numbers bandied about in the health-care debate, this ranking stands out as particularly misleading.

The No. 37 figure comes from a 2000 World Health Organization report that attempted to grade nations’ health care according to five factors and assign an overall ranking to each. One problem is that the report is nine years old and hasn’t been updated since – though it was an ambitious, perhaps overly so, undertaking. WHO couldn’t gather all the appropriate data for all nations, so its researchers had to make some assumptions and calculations using other bits of information, such as literacy rates and income. Bialik quotes the editor in chief of the report, Philip Musgrove, as saying that the figures that resulted from these assumptions are "so many made-up numbers." Musgrove, deputy editor of Health Affairs, calls the end result "nonsense ranking" and the very attempt to rank health care systems "a fool’s errand."

WHO researchers looked at, according to the group itself, "overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs)."

The U.S. did come in first place in the responsiveness category, but didn’t do as well in other categories, such as who pays the costs and level of health, which was based on disability-adjusted life expectancy. Bialik also notes that the U.S. ranked much higher – 15th on "overall goal attainment"– before WHO factored in health care spending per capita. As we’ve written before, the U.S. spends much more per capita than other nations; in fact, it captured the No. 1 spot from WHO in that category. This cost-conscious measure dropped the U.S. to 37th.

Among the other stats on how the U.S. health care system and health stacks up internationally: A 2007 Commonwealth Fund report ranked the U.S. last out of six industrialized countries in health system performance, which included measures on quality, access, efficiency, equity of care and healthy lives. "Access" and "equity" measures are affected by the lack of universal health care. On life expectancy, the U.S. ranks 50th and below France, Canada, the U.K. and the European Union average, according to the CIA World Factbook. Infant mortality is also higher in the U.S. than all of those countries and more. A 2006 report on infant mortality by the nonprofit Save the Children showed the U.S. tied for next to last among industrialized countries.

(Full disclosure: We have cited this statistic a few times among other figures on U.S. health care. We’ve updated our earlier articles to acknowledge criticisms of the WHO study.)