Also sorry on the statistical citing; a more recent report from the World Health Organization has moved the U.S. from #42 to #37--hooray for Obamacare! :) Also, the Commonwealth Fund has named the U.S. the worst provider among 11 prosperous nations--for the fifth time. I'm sure the sources can be disputed...but I'm also pretty sure there isn't a conspiracy involved here. In any case, that's the essence of my 'to' question: how do we close the gap between the level of expenditure and the level of care? - See more at: http://seattlesportsinsider.com/comment/155234#comment-155234
Ok, so I looked into the WHO rankings in detail to refresh my memory so I can point out obvious sources of selective use of stats in order to support a preordained conclusion.
First, as far as I can tell, the last time this study was done was in 2000, and the WHO has declined to put out another set of rankings, presumably because of the complexity of doing a good job and the contententiousness of doing so.
First of all, gross rankings are pretty worthless without context. What is the spread between 1st place and 10th place? Is that spread meaningful?
The US is straddled on that list by Costa Rica and Slovenia, and is only a few slots above Cuba. Now honestly, does that pass the smell test? Or seem even remotely plausible? I find that in nearly all situations that is some conclusion just seems ridiculous there's likely an issue with methodology.
Just look at the methodology. They look at five parameters chosen for the rankings:
Health (50%) : disability-adjusted life expectancy
Overall or average : 25%
Distribution or equality : 25%
Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities
Overall or average : 12.5%
Distribution or equality : 12.5%
Fair financial contribution : 25%
Now, we need to ask why were these particular parameters chosen to rank systems? They seem rather arbitrary, do they not? Do they measure important differences that are independent variables determined mostly by the type/quality of the healthcare system, or are they extremely gross measures that are much more heavily impacted by ethnic, cultural, or nutritional factors?
Are these variables subjective and therefore not really measurable (like responsiveness, protection of privacy, quality of amenities, fair financial contribution)? How do you measure fair financial contribution? With "fairness units"?
The only hard data I see cited is life expectancy, and even half of that contribution is subjective (equality).
Furthermore, measures like life expectancy are very gross/poor ways to measure societal health or the quality of a health system. These numbers are determined much more by ethnic, cultural, and nutritional factors.
Life expectancy can be misleading. It is not the case in ancient times that a life expectancy of 35 years meant that people could expect to live to 35 years and then drop dead. The numbers were kept low by very high infant and childhood mortality, accidents etc.
In the US, there are higher numbers of people that die young because of accidents, drug violence, etc. than in other countries like Japan. This suppresses the life expectancy figures in the US. You can certainly argue that this is an issue for the culture at large but it's pretty hard to pin that on the healthcare system. If you normalize the life expectancy figures for this factor then US life expectancy jumps right up there with the other western democracies and just shy of Japan, despite our much greater ethnic diversity.
Finally, remember that other systems could not perform as well as they do without the US.
*Edited to add that Moe has posted something similar regarding life expectancy as well as important info on cancer survival rates in the US at the bottom of the thread