Commentary

We’re Number 37 in Health Care!

By Julie Chan
July 5, 2000
Feeling ill? If so, you might consider catching the next plane out of here, because the World Health Organization (WHO) says your health is best served by countries like Andorra, Cyprus or even Colombia. Each outperforms the U.S. health care system on the WHO’s recently issued World Health Report 2000.

The WHO rankings of 191 health systems worldwide placed the United States 37th, trailing countries like Malta and Oman and barely edging out dilapidated Cuba. Predictably, “ClintonCare” champions are using the report in their battle cry for reviving the movement toward government-controlled medicine. But the WHO study is much like the annual magazine rankings of colleges: It grabs plenty of headlines but rests on questionable analysis. A closer look at the WHO health care study reveals startling assumptions, critical lapses in statistical judgment, and a clearly predetermined political agenda.

Breaking “new methodological ground,” the WHO report rates national health care performance according to five trendy flavors of the month: life expectancies, inequalities in health, the responsiveness of the system in providing diagnosis and treatment, inequalities in responsiveness, and how fairly systems are financed.

First, consider the study’s data. Health statistics for each country were collected from individual agencies and ministries, assuring wide disparities in definition, reporting technique and collection methodology. Indeed, the report concedes that “in all cases, there are multiple and often conflicting sources of information,” if sources at all. For the many nations that simply do not maintain health statistics, the WHO “developed [data] through a variety of techniques.” Without consistent and accurate data from within a single country, how can meaningful comparison be made among 191 different countries?

Second, the report places undue weight on statistical devices like disability-adjusted life expectancies (DALEs), which measure how long a person can expect to live in good health. The problem is, all the resources a country spends helping disabled people live longer and more comfortably do nothing to help its DALE score, so countries aiming for a good WHO ranking have no reason to spend more helping the disabled. DALEs assume that disabled people’s lives have less value than those of people without disabilities, and they make similar discounts on the lives of the elderly. Should the United States stop spending money on its disabled? On its seniors? The WHO’s criteria would give granny the boot.

Finally, on the basis of those flawed statistical measures, the WHO unleashes an emotional assault on free markets, saying that governments must hold the “ultimate responsibility” in “defining the vision and direction of health policy, exerting influence through regulation and advocacy, and collecting and using information.” WHO dismisses markets as “the worst possible way to determine who gets which health services,” arguing that “fairness” requires the highest possible degree of separation between who pays for health care and who uses it.

Overall, the WHO rankings’ mathematical formulations serve only to distract attention from the authors’ underlying distaste for individual choice in health care. The report largely ignores the extraordinary benefits the American marketplace brings to health care worldwide, such as new drugs, advanced diagnostic instruments such as MRIs and CAT scans, and lifesaving therapies for cancer and heart-disease patients. Under a WHO-style health care system, lifesaving research and innovation would be stifled and individual choice would be discarded in favor of collective control. Bureaucrats would decide who receives care — and who does not — on the basis of statistical tallies that devalue the lives of the elderly, the disabled and the chronically ill.

By contrast, a free-market health care system upholds the right of every person to make his own decisions. Patients are given choices, not issued numbers, and doctors are freed from impersonal “expert panels” dictating what care they can and cannot provide. The WHO’s idea of government-provided universal health care is a fantasy that masks a system of dangerous, formula-based rationing. If you value your health, don’t trust the WHO.

Julie Chan is a research assistant at the Cato Institute.