Ranking of World Health

The World Health Organization issued figures on June 20, 2000 that rank health care systems around the world for the first time. They indicate that European health systems are generally performing best and that the United States is lagging behind, largely because of unequal distribution of health care services.

The rankings are contained in the World Health Report 2000. The report measured not just overall spending on health but also how health care was distributed among different groups in each of the 191 nations that are members of the World Health Organization. The countries were judged according to five health-care categories that W.H.O surveys found to be most important to the people in various nations.

Until now, argument over how well health systems and policies are working has been based on anecdotes and fractional bits of data, said Dr. Jeffrey Koplan, director of the United States Centers for Disease Control and Prevention. He said the report was the first attempt to put the arguments on a factual footing.

According to the report, the five top nations for health care were France, Italy, San Marino, Andorra and Malta.

One surprise in the findings, said Dr. David Evans of the W.H.O.’s Global Program on Evidence for Health Policy, was the good rankings for southern European countries such as Italy and Spain.

”People in those countries don’t believe their health systems are doing very well,” he said.

Oman ranked No. 8, a surprise because its health care system was in a shambles in the 1970’s, with very high infant mortality, and because it has a relatively small budget for health. Its spending per capita on health is one-ninth of that of the United States, for example.

Dr. Christopher J. L. Murray, an international health economist from the Harvard School of Public Health, who is one of two leaders of the project, said Oman demonstrates that great changes in a country’s health can be produced in a short period of time.

Another surprise was China’s ranking of No. 144. A little more than a decade ago, China had a public health care system, but it has collapsed, and now people there pay for virtually all their care out of pocket. It was ranked No. 188 in fairness of financing.

The United States outspends the world and ranks near the top in average health measures, but fails to deliver good health care to a large proportion of its population and distributes the cost relatively unfairly, according to the report’s measures, leaving it at number 37 in the rankings.

Using the measure ”health life expectancy” — that is, life expectancy minus years of sickness and disability, there are counties in the United States where Native American children at birth can look forward to only about 50 years of health life on average, while some Asian minorities in suburban New York can expect more than 90 years of healthy life, Dr. Murray said.

The report demonstrates, Dr. Murray said, ”that no one model is best, but the numbers will give us the means over time to test which innovation in health systems work best and which are failing.”

The new rating system bases national scores on five measures, and in producing a ranking takes into account the financial resources it has available.

The five measures used are: overall level of health or life expectancy; health fairness or life expectancy as measured across various populations within a country; responsiveness or how well people rated performance of their health care system; fairness in responsiveness among different groups in the same country; and fairness in financing among different groups, which looked at what proportion of income is devoted to health care.

PHILIP J. HILTS

http://query.nytimes.com/gst/fullpage.html?sec=health&

World Health Organization’s ranking of the world’s health systems.

Source: WHO World Health Report –

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
40 Brunei
41 New Zealand
42 Bahrain
43 Croatia
44 Qatar
45 Kuwait
46 Barbados
47 Thailand
48 Czech Republic
49 Malaysia
50 Poland
51 Dominican Republic
52 Tunisia
53 Jamaica
54 Venezuela
55 Albania
56 Seychelles
57 Paraguay
58 South Korea
59 Senegal
60 Philippines
61 Mexico
62 Slovakia
63 Egypt
64 Kazakhstan
65 Uruguay
66 Hungary
67 Trinidad and Tobago
68 Saint Lucia
69 Belize
70 Turkey
71 Nicaragua
72 Belarus
73 Lithuania
74 Saint Vincent and the Grenadines
75 Argentina
76 Sri Lanka
77 Estonia
78 Guatemala
79 Ukraine
80 Solomon Islands
81 Algeria
82 Palau
83 Jordan
84 Mauritius
85 Grenada
86 Antigua and Barbuda
87 Libya
88 Bangladesh
89 Macedonia
90 Bosnia-Herzegovina
91 Lebanon
92 Indonesia
93 Iran
94 Bahamas
95 Panama
96 Fiji
97 Benin
98 Nauru
99 Romania
100 Saint Kitts and Nevis
101 Moldova
102 Bulgaria
103 Iraq
104 Armenia
105 Latvia
106 Yugoslavia
107 Cook Islands
108 Syria
109 Azerbaijan
110 Suriname
111 Ecuador
112 India
113 Cape Verde
114 Georgia
115 El Salvador
116 Tonga
117 Uzbekistan
118 Comoros
119 Samoa
120 Yemen
121 Niue
122 Pakistan
123 Micronesia
124 Bhutan
125 Brazil
126 Bolivia
127 Vanuatu
128 Guyana
129 Peru
130 Russia
131 Honduras
132 Burkina Faso
133 Sao Tome and Principe
134 Sudan
135 Ghana
136 Tuvalu
137 Ivory Coast
138 Haiti
139 Gabon
140 Kenya
141 Marshall Islands
142 Kiribati
143 Burundi
144 China
145 Mongolia
146 Gambia
147 Maldives
148 Papua New Guinea
149 Uganda
150 Nepal
151 Kyrgystan
152 Togo
153 Turkmenistan
154 Tajikistan
155 Zimbabwe
156 Tanzania
157 Djibouti
158 Eritrea
159 Madagascar
160 Vietnam
161 Guinea
162 Mauritania
163 Mali
164 Cameroon
165 Laos
166 Congo
167 North Korea
168 Namibia
169 Botswana
170 Niger
171 Equatorial Guinea
172 Rwanda
173 Afghanistan
174 Cambodia
175 South Africa
176 Guinea-Bissau
177 Swaziland
178 Chad
179 Somalia
180 Ethiopia
181 Angola
182 Zambia
183 Lesotho
184 Mozambique
185 Malawi
186 Liberia
187 Nigeria
188 Democratic Republic of the Congo
189 Central African Republic
190 Myanmar

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