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A Closer Look at Global Heathcare Rankings

Updated on August 27, 2012

A Look Inside the Data

In the year 2000, the World Health Organization (WHO) produced a comprehensive ranking of the health care services by nation. When the report was released it shocked many in terms of where the US was ranked relative to the rest of the world. The ranking was 37 out of about 190 nations. Yet a closer look at this ranking seemed to have a great focus on a view of a political morality, rather than actual results. So let’s take a closer look.

One of the first things to note is that there is actually more than one report produced by the WHO. One such report measures “Overall Attainment” while the other report focuses on “Overall Performance” of the healthcare system. Yet when measuring performance, the US ranks 37th and under the attainment ranking the US is ranked 15th among all nations. In theory the performance ranking should be the least politically biased since it should be driven by results. Yet the measurements used to achieve these rankings were as follows:

Health Level
Health Distribution
Responsiveness Distribution
Financial Fairness

While it would seem that the first and third categories would be suitable to include in a performance ranking of actual results, the other three should be less likely to be measured. For example, financial performance represents the level of household contribution to their health care expenditures as a percentage of household income beyond basic subsistence. Poor people spend a larger percentage of their annual income on healthcare than the wealthy do. Yet as healthcare is recognized as a necessity, it would make sense that as your net worth grew over time, you would spend a smaller percentage of your income on this expense. Using the same measurement, you would likely find that the wealthy spend a smaller percentage of their income on toilet paper. The increase in ones income over time tends to mean more spending on discretionary items and not basic essentials for daily living. The WHO is making a purely subjective values based measurement. While one may have opinions on this topic, it has no bearing on the actual performance results of treatment.

Another highly subjective measurement was that the WHO report penalized the US for having things like Heath Savings Accounts (HSA’s). In addition, the report penalized the US for not having a more progressive tax system in the category of “fairness”. When in fact, the reality is there is actually no historical correlation between a more progressive income tax and actual revenues received by the treasury. See Below Link…


The life expectancy ranking was one of the more distorted rankings within the WHO study. Life expectancy in general is a terrible way to measure a health system for various reasons. The first problem with this measurement is it assumes that all mortalities are the result of someone coming into contact with the health system. In fact that is quite far from the truth. Life expectancy can be affected by various exogenous factors such as victims of violent crimes, auto accidents, airplane crashes, train crashes, obesity, drug abuse and tobacco usage. Many of these reflect personal choices that individuals make, as well as unfortunate accidents. The size, wealth and commercial activity of a nation can greatly affect these statistics. Obesity for example is a serious problem in the US, yet it is hardly a problem in more impoverished nations. In fact when you correct for homicides and fatal accidents, the US has the highest life expectancy rate in the world.

Another way in which life expectancy data is simply manipulated is the category of infant mortality. In the US a low birth to weight baby has a much greater chance of surviving with the latest of medical technology available. Yet some of those premature infants still don’t make it to term. Yet in many of the nations that the WHO ranked higher than the US, those premature infants were excluded from the life expectancy data. In other cases some nations simply have a higher abortion rate. This is often used to address birth defects in many places around the world. Cuba has extremely low infant mortality rates. However they have one of the world’s highest rates of abortion. The OECD ranked the U.S. 18th out of 30 nations in a similar study of life expectancy. Yet similarly, in an extraodinary example of political bias, the infant mortality measure was not used by a universal standard. For just a few examples…

The U.S. includes “all deaths after live birth and defines births as live if newborns show any sign of life, regardless of prematurity”.

However, Australia and Germany include only deaths of infants who weigh at least one pound at birth.

In both Belgium and France, the deaths of infants born after less than 26 weeks of pregnancy are just simpley excluded from the study.

As Michael Tanner, a Senior Fellow and policy analyst with the CATO institute noted on this topic...The main problem is inconsistent measurement across nations. The United Nations Statistics Division, which collects data on infant mortality, stipulates that an infant, once it is removed from its mother and then "breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles... is considered live-born regardless of gestational age." While the U.S. follows that definition, many other nations do not. For example in Switzerland "an infant must be at least 30 centimeters long at birth to be counted as living." This simply excludes many of the most vulnerable infants from Switzerland's infant mortality measure.


Another common critique of the US health system is that we spend far more on care as percentage of GDP or when measured on a per capita basis than any other nation. Much of this increased spending is actually the result of how the Gov’t actively distorts prices in the marketplace. For more information on this, as well as other areas of price distortion read the below link…

Yet is all this excess spending on healthcare entirely bad ??? To a very large extent the reason the US spends more is we as American’s have chosen to. We are the wealthiest nation on the planet and have opted to do this. Americans all across the country take their child to the pediatrician after nearly every little sniffle. I myself have done this with my own children. The result is that we engage in a luxury that many other nations simply don’t have.

Other factors that affect the cost of care is the fact that the US is largely a heterogenous society in terms of race and ethincity. Many forms of illness are statistically isloated to individuals of a certain race or ethnic backround. So as a nation the US needs to spend more on the research of various forms of disease that affect different groups in different numbers. By comparison, testicular cancer for example is largely non-existent in Japan. Whether it is a genetic difference or somehow related to the Japanese diest in somewhat unknown. Since they deal with a very limited number of cases of this disease in Japan, they spend far less on research. This is the case with many forms of illness across ethnic lines. Whereas in the US, as a result of greater cultural diversity we need to be more versatile.


What about accessibility ??? Often we hear that there are more than 45 million uninsured Americans across the U.S. This figure comes from the 2000 US census. Yet even this claim is quite problematic.

Within this data we can see that nearly 10 million, 9.7 of the 45.7 million uninsured are “not a citizen.” That makes every media claim of uninsured Americans higher than 35.9 million innacurate. More than 17 million of the uninsured make at least $50,000 per year (the median household income was $50,233). 8.4 million had incomes between $50,000 to $74,999 per year and 9.1 million make $75,000 or higher. Two economists working at the National Bureau of Economic Research concluded that 25 to 75 percent of those who do not purchase health insurance coverage “could afford to do so.” An Urban Institute study found that 25 percent of the uninsured already qualify for government health insurance programs and simply failed to enroll in them. Furthermore, within this data were those who were simply switching jobs at the time. In fact the Congressional Budget Office said at the time of this study that 45 percent of the uninsured will be insured within four months. The CBO Director at the time this census was released Douglas Holtz-Eakin said the following about the frequent claim of 40+ million Americans lacking insurance, “This claim is an incomplete and potentially misleading picture of the uninsured population.”

The reality is this picture was greatly distorted. Since this study, a new census has been done and the data around the unemployed would have likely worsened in such difficult economic times. However, the statistics are greatly exaggerated for political gain. Nearly 25% of those included were simply not Americans. Many feel we have a responsibility to insure anyone who shows up on our shores in the US, regardless of citizenship or legal status. However, many do not feel that way. At least be informed about the real data.

As it currently stands, it is simply illegal to refuse emergency treatment to anyone in the US. Although, entering the emergency room is not the first preference nor is it the most cost effective one.


What are the actual outcomes ??? In reality the best possible measurement of a health care system should be in my view its ability to achieve success for those who actually come into contact with the system and engage in treatment. When examining the survival rate for the treatment of Cancer, Heart Disease, AID’s, pneumonia and virtually every major illness…The US ranks first.

When the WHO study was completed, it should also be noted that even that study ranked the US #1 in the following specific areas...

Responsiveness to Patient Needs

Choices of Providers



Timely Care


In my view these areas are infintely more important than the political opinion expressed in the study in relation to the US tax code or other political views on fairness. 


In this category the US ranks number one in new technology. The vast majority of Nobel Prize winners in the field of medicine are either US citizens or foreigners who have come to the US to work and engage in our technological advancement. This is more likely a result of our economic system and some of the freedoms we enjoy. The US leads the world in innovation to such a great extent that organizations like the Mayo Cinic, Cleveland Clinic, Johns Hopkins and M.D. Anderson see literally thousands of foreign visitors each year flying to the US for the necessary expertise. Many travel great distances from around the world to do so.

In summary I would suggest to you that the US does not have a problem with technology, innovation, or accessibility to the extent that is often portrayed. Rather we have nothing more than a cost issue. The rate of inflation on healthcare is far greater than that of baseline inflation. There is only one way to bring down cost and still maintain quality of service or perhaps even improve it. The only solution is to do away with many of the underlying price distortions that Gov’t intervention has created. Since the creation of many of these programs, the cost of healthcare has risen far faster. More Gov’t intervention, while possibly well intended, has begun to create shortages of medical professionals and increased cost… not decreased it. This is an economic problem, not a medical problem. It must be dealt with through proper economic incentives rather than trying recreate many of the past mistakes of other nations as well as our own.


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    • LandmarkWealth profile image

      LandmarkWealth 5 years ago from Melville NY

      The issue of the uninsured, may be true. Is that any better in those with insurance wo are simply denied care routinely. I recall about ten years ago about 3000 people in one summer died in France fom heat stroke just because there were too many doctors on vacation. Imagine that...Vacation. Dr's in the US don't take vacations in the middle of a crisis. They come back to work. You make the common mistake of assuming that insurance means care. It does not. Not even in the US. Try finding a US Dr that accepts Medicaid and is simply willing to work for free.

    • LandmarkWealth profile image

      LandmarkWealth 5 years ago from Melville NY

      On the Cost side I have already explained this in numerous ways. One area not touched on was the lack of tort reform in the US. That is also an issue. I have an immediate family member who is a surgeon. His annual malpractice insurance is in excess of 200k. This is because he performs surgery in high risk procedures.

      With regard to the UK/US comparison on cost...As I mentioned earlier, it is a result of increased technological availability. The US has 3 times the number of MRI machines available per million of the population. If you have more technology built, it cost more money. That just one aspect.

    • LandmarkWealth profile image

      LandmarkWealth 5 years ago from Melville NY

      Maternalistic deaths can be manipulated just as the infant mortality was. For example if a women dies during birth in a high risk pregnancy it is often a result of the fact that the pregnancy was attempted rather than terminated. Whereas in Cuba they would have simply aborted the child earlier as they have one of the highest abortion rates on earth. Why do people flee Cuba on hand made rafts to float through shark invested waters to get to the USA. Because of the wonderful care they get ??? LOL

      In the case of AIDS, it is virtually non exsistent in Cuba. So it's impossible to get a statistical baseline of an accuracy there because the occurence rate is so low relative to the population. That rate of occurence of a disease like aids is very low in many parts of the world as a result of social behavior. People traveling to cuba for health treatment is a fantasy. They may travel from Venezuala to Cuba. They're not traveling from germany to get care in Cuba.

      When US citizens leave the US to get care elswhere, it is usually for fairly routine procedures that are simply more costly in the US. When individuals come by the thousands each year to the Mayo and Cleveland clinic, or sloane kettering, they do so to get treatment that is completely unavailable and undeveloped or simply denied by the rationing bodies of their Govt's. A Cardiac Ablation is an outpatient procedure in the US. Try getting one in Cuba.

      What possible motivation would groups like the OECD, WHO and the UN have for allowing different groups to report infant mortality under such different standards if there trying to produce unbiased results ??? I Wonder ???

      Lastly the proof in our success around life expectancy is the results in pension liability. The single biggest problem facing US retiree's is the fact that people are living too long. That is the primary reason why private companies as well as many municipalities have moved in large #'s from Defined Benefit Plans to Defined Contribution Plans. Based on the longer life spans, the benefits have been required to be altered.

    • Josak profile image

      Josak 5 years ago from variable

      Even Cuba has better AIDS results than us, the maternal death statistic was chosen because there are no variations in how it is measured and if someone dies during childbirth there is little confusion about when and how they died.

      As for cost our results are very mediocre for three times the price compared to the UK or ten times the cost compared to Cuba. There are very few things where we are ahead. Not to mention that 45 000 Americans die every years (according to Harvard study) because they don't have insurance, a problem other countries do not face.

      Our health tourism is really not very impressive. The US is a massive country and the richest in our region, people from Mexico come here and so do those from parts of central America because their countries are much poorer but we don't have a very attractive system. Consider this, Cuba get's from a third to half the number of health tourists yearly that we do even though they are a tiny Island which people from the nearest country are not allowed to go to... As a health tourism destination we have nothing to brag about at all.

    • LandmarkWealth profile image

      LandmarkWealth 5 years ago from Melville NY

      Let me rephrase that, I meant the number of people that travel to the US for procedures that are more complex and simply not available in other parts of the world. Not to remove a planters wart from their foot.

    • LandmarkWealth profile image

      LandmarkWealth 5 years ago from Melville NY

      It is not as simple as that...If you actually read the entirety of the studies you are citing and how they derived these results rather than just repeat a result you would see numerous exclusions were made. Frankly to many to list in a brief response.

      As a result of working with actuaries who have an uncanny ability to predict mortatilty within different groups of people, I have been forced to read the details. When an actuary gets it wrong it costs the company money, so they have no reason to be bias in their conclusions. You left out Heart Disease AID's and numerous other diseases. One of the few that we do not have the highest success rate in is end stage renal failure. Coincidently that is an immediate qualifier for medicare regardless of age, which makes it the primary form of coverage. With the large number of Dr's leaving the program as a result of the lack of compensation they get, it limits the treatment for many of those patients in terms of quality of care. This is one example of distortion in the marketplace.

      I have already addressed the difference in costs in numerous ways. Partially it is a result of the fact that we due not ration care, which is good thing. Our over usage of healthcare is a postive in that we have resources that many nations do not do our wealth. we have for example dramatically more machines for MRI & CT scans per citizen than most other nations. I'd like to keep those resources. The difference in a heterogenous society vs a homogenous society additionally adds to research costs and development of treatments. For Example the Chinese do not spend many resources on sickle cell anemia. But mostly it's a function of distorted prices through gov't intervention. Every Dr in the US knows exactly what I mean.

      Would you like to compare statistics of the number of Americans who leave the US for care relative to the number of foreigners whom come to the US for care.

    • Josak profile image

      Josak 5 years ago from variable

      No No and No

      infant mortality was a problem yes because the US had a different reporting method than the standardized UN one but maternal mortality is as simple did the mother die? which is why I used it.

      The us has mediocre survival rates on everything except cancer, for example we have one of the highest diabetes amputation rates in the first world even when scaled against our obesity not to mention that out care costs several times more than the care of the nations we are being compared to.

    • LandmarkWealth profile image

      LandmarkWealth 5 years ago from Melville NY

      Clearly you didn't finish the article. If you had you'd see that the OECD showed their political bias once again by failing to apply the same standards in their ranking as well. They simply allowed different nations to report things such as infant mortality with very different metrics. That is just one example. The same was done in other areas of mortality. We also have lower mortality in most every major disease beyond cancer treatment.

    • Josak profile image

      Josak 5 years ago from variable

      *sigh* the highest life expectancy in the world study has been thoroughly debunked, and even the OECD released a statement showing that the study was completely untrue, that in fact even without those factors the US came it 17 out of the 25 OECD nations.

      The fact that healthcare in the US is lousy is shown by maternal mortality (how often the mother dies in childbirth) a measure unaffected by violence, and largely unaffected by lifestyle (to a greater extent than other measures) here the US ranks worse than 50th in the world.

      The only area of our healthcare system which is good is cancer treatment because it has been specifically targeted.


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