Biases in International Health Care Rankings

[Toro]

Michael Moore made great sport in his film "Sicko" of pointing out that the World Health Organization (WHO) ranked US health care a lowly 37th in the world, considerably below France and Canada. But, much like Mr. Moore himself, the rankings are far from impartial or empirically sound.

Still, he's not the only one looking beyond America's borders. Presidential hopeful Barack Obama and other policymakers look to Europe for inspiration for reforming America's healthcare. Back in 2003, Mr. Obama said "I happen to be a proponent of a single-payer healthcare program," thereby endorsing the state-controlled health systems of countries such as Norway and Britain.

According to the WHO, Mr. Obama was correct: in its highly influential global healthcare rankings, America scores well below the vast majority of Western European countries and even below the likes of Morocco and Costa Rica. This index is frequently cited by Democratic reformers in their quest to replace the US market system with something a little more Continental. But an examination of the index tells us more about the ideology of the authors than it does about the quality of American healthcare.

The most obvious bias is that 62.5% of their weighting concerns not quality of service but equality. In other words, the rankings are less concerned with the ability of a health system to make sick people better than they are with the political consideration of achieving equal access and implementing state-controlled funding systems.

One of the five factors in the calculations is called "Financial Fairness". This favours systems that charge richer people more health tax, irrespective of how much, or little, health service they use. Colombia comes top. This measure has nothing to do with the quality of healthcare, yet it counts for a quarter of the weighting.

...

Medical Progress Today Newsletter | June 13, 2008

 

[editec]

The most obvious bias is that 62.5% of their weighting concerns not quality of service but equality.

If you can't get service, then the quality of service only SOME people gan get really doesn't much matter when evaluating the health care SYSTEM, now, does it?

All one need to to determine the state of our health care SYSTEM is to measure our morbity and mortality statistics versus how much we pay for those outcomes.

The US health care SYSTEM is a mess if one assumes that the purpose of a health care SYSTEM is to keep the people healthy.

We spend 17% of our GDP on health care. Far more than any other nation on earth both in absolute values, in share of GDP, and in terms of per capita spending.

Yet, our national mortality and morbity stats are terrible compared to nations which spend a far smaller share of the GDP on health care.

Why?

It surely isn't because (as neo-cons like to chant whenever this subject comes up) that we have "the best health care in the world"

Some of us might have the best health care in the world.

the vast majoirity of us have fairly lousy health care in comparison to most industrialized first world nations.

 

[RetiredGySgt]

If you can't get service, then the quality of service only SOME people gan get really doesn't much matter when evaluating the health care SYSTEM, now, does it?

All one need to to determine the state of our health care SYSTEM is to measure our morbity and mortality statistics versus how much we pay for those outcomes.

The US health care SYSTEM is a mess if one assumes that the purpose of a health care SYSTEM is to keep the people healthy.

We spend 17% of our GDP on health care. Far more than any other nation on earth both in absolute values, in share of GDP, and in terms of per capita spending.

Yet, our national mortality and morbity stats are terrible compared to nations which spend a far smaller share of the GDP on health care.

Why?

It surely isn't because (as neo-cons like to chant whenever this subject comes up) that we have "the best health care in the world"

Some of us might have the best health care in the world.

the vast majoirity of us have fairly lousy health care in comparison to most industrialized first world nations.

Bullshit.

 

[editec]

Bullshit.

Such an logically insightful and well documented response as that is somewhat difficult to respond to.

You wouldn't care to expand on that opinion, would you?

 

[manifold]

No offense edi, but I'm with RGS on this one.

IMO, these stats you trumpet speak more to the fact that many Americans simply lead unhealthy lifestyles and have very little to do with the quality and access to medical treatement when required.

 

[RetiredGySgt]

Such an logically insightful and well documented response as that is somewhat difficult to respond to.

You wouldn't care to expand on that opinion, would you?

Your claims are not correct. Simple and straight forward. Nothing to expand on. Anyone in the US can and does get medical care even if they have no money.

Our supposed ranking in the world is a joke and has been shown to be that joke by several threads on this board in the past.

Get back to us when the entire world is graded exactly the same on every facet of the supposed medical world. That is not true now. Not even close.

Yup our system is so flawed people PAY to fly here for medical care from countries that rank higher then us on these supposed independent rankings. They PAY for our medical services rather then get the "free" care in their own countries.

For those without money there are numerous groups and methods to get seen or get money or get free services. And a hell of a lot of the "uninsured" are actually uninsured BY CHOICE.

 

[manifold]

Here's a tiny slice of reality that undermines the entire "ranking" propaganda.

Any lower-middle class American (on up) that has health insurance through his employer, enjoys access to higher quality healthcare than his counterpart in any nation with socialize medicine.

 

[Nate Peele]

No offense edi, but I'm with RGS on this one.

IMO, these stats you trumpet speak more to the fact that many Americans simply lead unhealthy lifestyles and have very little to do with the quality and access to medical treatement when required.

Bingo! The fact that we rank 37th in live births per 1000 right ahead of Croatia shows that this unhealthy lifestyle begins inuteral too. I'm sick and tired of these infants who want everything given to them--try working.

 

[manifold]

Bingo! The fact that we rank 37th in live births per 1000 right ahead of Croatia shows that this unhealthy lifestyle begins inuteral too. I'm sick and tired of these infants who want everything given to them--try working.

Oh right, like the healthiness of the host has nothing to do with the devepment of the fetus.

 

[Nate Peele]

Oh right, like the healthiness of the host has nothing to do with the devepment of the fetus.

I'm sorry buddy. Life begins at conception and so should personal responsibility.

 

[jreeves]

I'm sorry buddy. Life begins at conception and so should personal responsibility.

Are you going to respond to Manifold while being intellectually honest or are you going to skirt around the issue all together with more trollistic tactics?

 

[RetiredGySgt]

Bingo! The fact that we rank 37th in live births per 1000 right ahead of Croatia shows that this unhealthy lifestyle begins inuteral too. I'm sick and tired of these infants who want everything given to them--try working.

And again not a relevant comparison. The other 36 countries ahead of us do not count births the same as us. Here even if a premie is born and has little chance to survive it gets counted. In some of those countries ahead of us on births they do not even count it as a live birth if the baby does not survive x number of days first and they do not count a whole laundry list of conditions we count.

The numbers mean nothing when there is no uniform method for counting the stats and conditions. It is left to the individual countries to determine what is and is not a live birth and every other condition on the list is subject to the host countries determination as to what does and does not count.

 

[Toro]

Your claims are not correct. Simple and straight forward. Nothing to expand on. Anyone in the US can and does get medical care even if they have no money.

I've met people who simply cannot get insurance for their conditions. Thus, they have to pay for it themselves but can't afford it. Many are in bankruptcy because of medical bills.

Some hospitals and clinics are now demanding upfront payments. If patients don't offer the money, then they aren't getting treated.

Hospitals to Underinsured: Pay Upfront - Seeking Alpha
http://online.wsj.com/article/SB120934207044648511.html?mod=hpp_us_pageone

 

[editec]

Your claims are not correct. Simple and straight forward. Nothing to expand on.

My claims are correct, but really there's no sense iin us simply saying yes it is no it isnt.

Your point that the statistics are no exactly computed the same is somewhat valid.

But the question is: are they so invalid as to not be able to evalute the systems in aggregate?

If we are comparing most industrialized nations, then I think the answer to that question is: No, they are not all that different that we cannot compare systems.

Live births, morbidity and motality statistics compiled by other industrial nations, and the percentage of GDP that each nation uses, while not identical, are more than close enough to convince me that we are NOT getting our money's worth compared to those other nations.

The fact that there are some cases (rare, but documentable) where somebody comes here for health care is hardly evidence that our system works better for us than their system work for their populations.

In fact, what that really shows us is those other nations committment to the health of their people. is far and away greater than we have for our people

As to anyone who needs health care being able to get it?

That's sheer hyperbole.

It is a statement so wrong on its face that I marvel at the sheer audacity that you make it.

 

[Diuretic]

Here's a tiny slice of reality that undermines the entire "ranking" propaganda.

Any lower-middle class American (on up) that has health insurance through his employer, enjoys access to higher quality healthcare than his counterpart in any nation with socialize medicine.

Interesting claim. How do you reach that conclusion?

 

[Diuretic]

As for the source, biased much?

MedicalProgressToday is a web magazine devoted to chronicling how market-friendly public policies drive life-saving medical innovations and make health care more affordable and accessible for all Americans.

Market-friendly. That's fine, just need to know where they're coming from. The magazine, part of the Manhattan Institute, a right wing free-market think tank. So, I'd hardly expect to see a promotion of single payer health care schemes from this source.

 

[Toro]

Another part of the problem with this survey is that the United States develops a disproportionate amount of medical breakthroughs and new treatments compared to the rest of the world. This is not included in any of the surveys.

The medical system in the US allows for the development of these new treatments that other countries then buy from American companies. Thus, without the US, all other medical systems would be worse off. Of course, that is true for the US as well since it also imports medical services from elsewhere. However, the US creates and exports more in new technological health services than either its population or its relative economic standing in the world would imply.

One big difference is that in many countries, people are denied drugs such as Avastin because Avastin increases life expectancy by months. Governments with rationed services don't want to pay for the treatment because it is enormously expensive. But they pay for it in the US.

That initial market is enormously important to the development of new treatments. Like most other products, the cost declines once the product gets out of initial stages. At that point, when cost declines, other countries start buying the new product. However, without the initial treatment stage, which is often very expensive, you cannot get to the later stages when the efficacy of the product is better known and it becomes more efficient to produce and distribute. Other countries therefore benefit from the American system.

 

[manifold]

Here's a tiny slice of reality that undermines the entire "ranking" propaganda.

Any lower-middle class American (on up) that has health insurance through his employer, enjoys access to higher quality healthcare than his counterpart in any nation with socialize medicine.

Interesting claim. How do you reach that conclusion?

Personal experience and observation. I personally fit the category I described and I have family and friends in Canada, UK, Ireland and Australia that also fit said category. Based on their personal experiences, which they've relayed to me, I'm convinced I have it better. I understand this is only anecdotal, however I've yet to see any research studies that come anywhere close to challenging this claim.

If someone wants to argue in favor of socialized medicine on moral and ethical grounds, I'm willing to listen. Of course they'd also need to convince me of it's feasibility in a manner that does not worsen my status quo. Not an easy sell. However, I find it intellectually insulting when somebody brandishes misleading statistics allegedly "proving" that the healthcare I currently enjoy is worse than in 36 other countries. That is simply absurd.

 

[Toro]

I have lived in Canada, the UK and the US. I have seen both sides, the good and the bad. I find there are incorrect stereotypes on both sides.

I am fortunate in that I have a good plan and have zero complaints. I would rather live in America in my current situation. However, I have talked to people without a plan, or cannot get coverage or have gone bankrupt. Having listened to their stories, if I were them, they would be better off elsewhere.

 

[Diuretic]

Personal experience and observation. I personally fit the category I described and I have family and friends in Canada, UK, Ireland and Australia that also fit said category. Based on their personal experiences, which they've relayed to me, I'm convinced I have it better. I understand this is only anecdotal, however I've yet to see any research studies that come anywhere close to challenging this claim.

If someone wants to argue in favor of socialized medicine on moral and ethical grounds, I'm willing to listen. Of course they'd also need to convince me of it's feasibility in a manner that does not worsen my status quo. Not an easy sell. However, I find it intellectually insulting when somebody brandishes misleading statistics allegedly "proving" that the healthcare I currently enjoy is worse than in 36 other countries. That is simply absurd.

Sampling error - your experience is singular and subjective. I doubt if that amounts to a valid critique either way. As for arguing for "socialised medicine", you give yourself away using a term that, in American political terms, is loaded. Universal health care is a neutral term and because it is I prefer it as it take some of the partisanship out of the argument. This is a subject that should be above ideology and partisan politics, unfortunately for some reason in these forums, it becomes exactly that.