The World Health Organization (WHO) ranked the healthcare systems of its 191 member states in its World Health Report 2000. It provided a framework and measurement approach to examine and compare aspects of health systems around the world.[1] It developed a series of performance indicators to assess the overall level and distribution of health in the populations, and the responsiveness and financing of health care services. It was the organization's first ever analysis of the world's health systems,[2] but has been subject to criticism of its usefulness and methodology by American conservatives.
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Data from 1997 was used in the report.
The rankings are based on an index of five factors:[1]
The WHO rankings have been subject to much criticism by American conservatives (who usually claim that the United States has the best health care system in the world[3] and were furious to see the United States in 37th position) concerning their methodology, scientificity, and usefulness. Dr Richard G. Fessler called the rankings "misleading" and said that tens of thousands of foreigners travel to the United States every year for care. In addition, he claims that the United States leads the world in survival rates for 13 of the 16 most common types of cancer. He also noted that the financial fairness measure was automatically designed to "make countries that rely on free market incentives look inferior".[4] Dr Philip Musgrove wrote that the rankings are meaningless because they oversimplify: "numbers confer a spurious precision".[5]
Journalist John Stossel notes that the use of life expectancy figures is misleading and the life expectancy in the United States is held down by homicides, accidents, poor diet, and lack of exercise. When controlled for these facts, Stossel claims that American life expectancy is actually one of the highest in the world.[6] A publication by the right-wing Pacific Research Institute in 2006 claims to have found that Americans outlive people in every other Western country, when controlled for homicides and car accidents.[7] Stossel also criticizes the ranking for favoring socialized healthcare, noting that "a country with high-quality care overall but 'unequal distribution' would rank below a country with lower quality care but equal distribution."[6]
Glen Whitman claims that "it looks an awful lot like someone cherry-picked the results to make the U.S.’s relative performance look worse than it is." He also notes that the rankings favor countries where individuals or families spend little of their income directly on health care.[8] In an article in The American Spectator, Whitman notes how the rankings favor government intervention, which has nothing to do with quality of care. The rankings assume literacy rate is indicative of healthcare, but ignore many factors, such as tobacco use, nutrition, and luck. Regarding the distribution factors, Whitman says "neither measures healthcare performance" since a "healthcare system [can be] characterized by both extensive inequality and good care for everyone." If healthcare improves for one group, but remains the same for the rest of the population, that would mean an increase in inequality, despite there being an improvement in quality.[9] Dr Fessler echoed these sentiments.[4]
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