The Newest Rankings

If you are like me you like rankings. I like their simplicity and clarity. I like to know who is first and second. Who is in and who is out. Black and white. During college basketball season I find my eyes scanning down the polls weekly from first to 25th to see how the Big East is doing – and most importantly where Connecticut ranks.

Health care has its own rankings. They aren’t done weekly or even annually at times, but they are done. On paper they provide that clarity that I seek. But as any college football fan knows rankings can be a little muddy. Can you say BCS?

So the latest health care rankings are out and as one scans down the list of 19 OECD (developed countries) countries you will find that it takes some time before the U.S. shows up. It takes until the 19th spot. Yes, dead last.

That’s some clarity!

Further as the rest of the countries posted on average a 16% improvement since 1998 we posted a meager 4% improvement (by far the worse). If we as a country lowered our amenable mortality rates to the average of the top three countries (France, Japan, and Australia) we could prevent 101,000 deaths annually.

Yes, the international comparisons have their faults and weaknesses. They are muddy, but this study is a bit different than the one most commonly used. The World Health Organization (WHO) has its rankings (used famously in Sicko) that are heavily weighted for equality. The U.S. does poorly as it is does not provide universal coverage. See my discussion here. This latest ranking does not use equality directly, but measures the amount of deaths in a country that typically could be prevented through health care intervention. They call it amenable mortality. Of course it is hard to determine what deaths are “amenable” to health care.

Further, using the population statistic (used here) to measure the one-on-one doctor/patient relationship is a difficult thing to do. I appreciate that. But at some point we as a country have to become responsible for the health of our country – for the health of our neighbors. Ranking after ranking we fall to the bottom. Whether it is based on doctor and patients surveys, or from the WHO, or this latest ranking we do not come to play.

Our system is broken. We have amazing doctors, schools, and cutting edge technology, but we do not have the best health care. The rankings tell some portion of the truth. Some will attack the rankings as unfair, biased, or just useless. And some of the criticisms are justified, but at the same time the rankings (especially in mass) point to problems that we as a nation need to address.

The rankings come out Health Affairs. A synposis can be found at the Commonwealth Fund.


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