Whenever the quality of the U.S. health care system comes up in discussions the talk very quickly meanders to international comparisons. It’s a logical test. Why not compare the U.S. health outcomes to those of France, England, Australia, Canada, etc. It makes sense, but it has its weaknesses especially when relying on only one comparison. One weakness is that we could compare favorably and still have significant quality gaps, but a second weakness is that health outcomes can be difficult to measure. For example, infant mortality rates, which is a good measure because it includes all sort of quality concerns wrapped into one measure. However. it might capture features of a system that do not necessary reflect quality. The U.S. has a relatively poor infant mortality rate. Why? This is debatable, but two possibilities are that our neonatal technology is so advance that we deliver alive so many more premature babies with high mortality risks that of course a greater percentage of babies will die raising our infant mortality rates. Or is it that many mothers don’t get prenatal care?
So as these quality discussions progress somebody usually brings up the World Health Organization’s rankings in which the U.S. ranks a mediocre 37th right behind Costa Rica and right before Slovenia. Michael Moore’s “Sicko” used this ranking to highlight the U.S.’s lack luster performance (and yes, Cuba ranks behind us at 39th) and popularized this ranking. And so we’ll follow the crowd in our discussion and get this single ranking out of the way. So lets break it down…
First, the ranking uses a very specific set of criteria that have a certain ideological belief in what quality of health care looks like – mainly equity. The WHO holds equality of care very high. Our system is not equitable and we lose some points on that one. Second, just because the ranking stresses equity it does not make the ranking a worthless tool in assessing the quality of our health care.
Ultimately, I don’t find this ranking to be very important (there are better things out there), but I wouldn’t dismiss it either. It is a piece in the puzzle. If equity is important to you than you can give it more weight, but if it is not, then it might lose some of its prowess.