The United States, which spends more on health care than any other nation, came in 37th. In the analysis published by the World Health Organization which evaluated the health care systems of its 191 members and graded them based on how well each country performs given the resources at its disposal. The study concluded that France has the best health care system in the world, followed by Italy.
Previous assessments have looked just at how healthy people are, "and you're left with the image that the rich (countries) do well because they're rich," said study co-author Dr. Julio Frenk. This new analysis praises health systems "that utilize few resources very well."
The report essentially measures value for money: comparing a population's health with how effectively governments spend their money on health, how well the public health system prevents illness instead of just treating it and how fairly the poor, minorities and other special populations are treated. It also examines how fairly the bill is divided among people.
When each country's measurements were added together, even study co-author Dr. Christopher Murray, a Harvard health economist and the health organization's chief of health policy evidence, was surprised. He had expected Scandinavian countries or Canada to be the world's best, because they're always presented as models. Instead, Norway hit No. 11, Canada 30.
Some health economists raised concerns about the method used to compile the rankings, in which several Mediterranean countries scored unexpectedly high. Tiny countries with few patients to care for - San Marino, Andorra, Malta - crowd onto the surprising best list. Singapore, Spain, Oman and Austria also made the top 10. Japan, which rated top for the health of its people, placed 10th overall.
Americans - while good at expensive, heroic care - are very poor at the low-cost preventive care that keeps Europeans healthy, said Princeton University health economist Uwe Reinhardt. The United States spends a stunning $3,724 per person on health each year. But measuring how long people live in good health - not just how long they live - the Japanese beat Americans by 4 1/2 years, and the French lived three more healthy years. Yet Japan spends just $1,759 per person on health and France $2,125. ``That's a pretty big gap,'' noted Murray. ``For the money we're spending, we should be able to do a lot better!''
At the bottom of the list were Sierra Leone, Myanmar, Central African Republic, Democratic Republic of the Congo and Nigeria. Many of the worst-faring countries are in sub-Saharan Africa. Largely because of the AIDS epidemic, healthy life expectancy for babies born this year in many of those nations has dropped to 40 years or less, the W.H.O. said.
1. The World Health Report 2000 - Health systems: Improving performance. Published by the World Health Organization, Geneva, Switzerland. Reported by: Ross E. Associated Press Medical Writer
July/ August 2000