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Table 1

WHO Health Care Rankings

Country

Rank

Country

Rank

France

1

Switzerland

20

Italy

2

Belgium

21

San Marino

3

Colombia

22

Andorra

4

Sweden

23

Malta

5

Cyprus

24

Singapore

6

Germany

25

Spain

7

Saudi Arabia

26

Oman

8

United Arab Emirates

27

Austria

9

Israel

28

Japan

10

Morocco

29

Norway

11

Canada

30

Portugal

12

Finland

31

Monaco

13

Australia

32

Greece

14

Chile

33

Iceland

15

Denmark

34

Luxemburg

16

Dominica

35

Netherlands

17

Costa Rica

36

United Kingdom

18

United States

37

Ireland

19

Slovenia

38

Source: World Health Organization, "The World Health Report 2000" (Geneva: WHO, 2000).

ical and medical factors that might affect

States is due to its ranking of 54th in the cate-

variations in life expectancy across countries

gory of fairness. The United States is actually

and over time."21 Consider the nearly three-

penalized for adopting Health Savings

Accounts and because, according to the WHO,

year disparity in life expectancy between

patients pay too much out of pocket.19 Such

Utah (78.7 years) and Nevada (75.9 years),

despite the fact that the two states have

judgments clearly reflect a particular political

essentially the same health care systems.22 In

point of view, rather than a neutral measure of

health care quality. Notably, the WHO report

fact, a study by Robert Ohsfeldt and John

ranks the United States number one in the

Schneider for the American Enterprise

world in responsiveness to patients' needs in

Institute found that those exogenous factors

choice of provider, dignity, autonomy, timely

are so distorting that if you correct for homi-

care, and confidentiality.20

cides and accidents, the United States rises to

the top of the list for life expectancy.23

Difficulties even arise when using more

neutral categories of comparison. Nearly all

Similarly, infant mortality, a common mea-

When you

cross-country rankings use life expectancy as

sure in cross-country comparisons, is highly

compare the

one measure. In reality though, life expectan-

problematic. In the United States, very low

outcomes for

cy is a poor measure of a health care system.

birth-weight infants have a much greater

Life expectancies are affected by exogenous

chance of being brought to term with the latest

specific diseases,

factors such as violent crime, poverty, obesity,

medical technologies. Some of those low birth-

the United States

tobacco and drug use, and other issues unre-

weight babies die soon after birth, which

lated to health care. As the Organisation for

boosts our infant mortality rate, but in many

clearly out-

Economic Co-operation and Development

other Western countries, those high-risk, low

performs the rest

explains, "It is difficult to estimate the rela-

birth-weight infants are not included when

of the world.

infant mortality is calculated.24 In addition,

tive contribution of the numerous nonmed-

4