Today's Managing Health Care Costs Number is 33 (out of 195) |
The World Health Organization (WHO) ranked countries for their health outcomes in 2000, and at the time the United States ranked 37 - between Costa Rica and Slovenia. Many argued that the WHO methodology was unsound, which it was. Rankings like this were subject to reporting accuracy and definitional differences from country to country! Tiny countries (Andorra anyone) often were advantaged in the ranking! Technology wasn't adequately valued! Rank orders give no sense of significant differences between countries with similar rankings! Could France really be number 1?!
The WHO ranking might have been controversial -but there are a host of purely objectives by which the US lags the rest of the developed world, even as we spend more dollars on health care than any other nation. The New England Journal noted that in 2006 we were 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy. We are the only developed country with rising maternal mortality. Propublica is currently running a series of articles on this.
The WHO backed off - and it's been over a decade and a half and it hasn't tried to repeat this ranking.
The Institute for Health Metrics Evaluation, funded by the Bill and Melinda Gates Foundation, has stepped into the breach in last week's Lancet. IHME reviewed data from the Global Burden of Disease database, using 1995 and 2015 iterations, and evaluated how effective each country is in preventing preventable disease.
The good news is that our score on the Health Access and Quality Index (HAQ) is improved. We have risen about 7 points, and decreased the difference between our observed and the HAQ researchers would expect based on sociodevelopment index. We have moved up to #33 now - between Estonia and Montenegro. Sure, the Scandinavian countries and Western European democracies exceed the US. But we also score lower than Greece (#17) and Slovenia (#16). Lebanon is #34, lagging the US by just a point. And refugees in Lebanon make up a quarter of the population!
Rank orders are always flawed - and a small difference in rank can mean a lot of real difference or very little real difference. But the US is clearly lagging other developed countries in improving access and quality in health care. We're also on the precipice to make health care access dramatically worse. We can certainly do better. This study also only looked at access and quality -and did not look at value. Given our high unit prices and focus on expensive technology, a "value" ranking could easily leave the US out of the top quartile.
H/T to Washington Post for pointing me to the Lancet article, which is not behind a paywall.
 |
| This shows that 1995 score is very closely related to 2015 score - and you can see that developed countries score highest. Note that virtually all countries improved over this 20 year period- as they are to the left of the diagonal line. Note that the confidence intervals are also much larger for the less developed countries. |
 |
| These are the elements where the US scores less than 70. Source of both graphics is the Lancet article |
EmoticonEmoticon