World Health Organization ranking of health systems
The World Health Organization (WHO) ranked the health 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. 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.
The rankings are based on an index of five factors:
- 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%
||The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. (November 2012)|
The WHO rankings have been subject to criticism concerning their methodology, scientificity, and usefulness. Dr Philip Musgrove wrote that the rankings are meaningless because they oversimplify: "numbers confer a spurious precision".
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. A publication by the 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. 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."
However, another study on the effects of firearms on life expectancy by Jean Lemaire  of the Wharton School concluded that only 0.28 years of the 2.29 life expectancy gap between the US (76.9 years) and the other 33 richest countries (79.19 years) can be attributed to firearm deaths. The author also points out that this conclusion does not calculate for a substitution effect. Some successful firearm suicides might have used other means in the absence of firearms. Though other methods of suicide are not as effective as firearms, they cannot be expected to have been zero. Therefore, simply adjusting a life expectancy calculation by subtracting all suicides due to firearms will tend to overstate average life expectancy.
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. 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. Dr Fessler echoed these sentiments.
- World Health Organization. World Health Report 2000. Geneva, 2000.
- World Health Organization Assesses the World's Health Systems.
- Musgrove, P (2010). "Health Care System Rankings". New England Journal of Medicine 362 (16): 1546–7; author reply 1547. doi:10.1056/NEJMc1001849. PMID 20410524.
- Stossel, John (22 August 2007). "Why the U.S. Ranks Low on WHO's Health-Care Study". Real Clear Politics. Creators Syndicate. Retrieved 29 September 2011.
- Pipes, Sally C. (October 2008). "Top Ten Myths of American Health Care". Pacific Research Institute. p. 133. Retrieved 1 October 2011.[unreliable source?]
- Lemaire, Jean. "The Impact of Firearm Deaths on Life Expectancies in the United States". Retrieved 16August 2012.
- Whitman, Glen (1 July 2007). "WHO's Healthcare Rankings, Part 1". Agoraphilia. Blogspot. Retrieved 29 September 2011.
- Whitman, Glen (10 March 2008). "WHOm Are They Kidding?". The American Spectator. Retrieved 29 September 2011.
- Fessler, Richard G., MD, PhD (1 June 2009). "Popular Ranking Unfairly Misrepresents the U.S. Health Care System". Smart Girl Nation. Archived from the original on 22 August 2010. Retrieved 30 September 2011.[self-published source?]