WHO's ranking of health care systems
Encyclopedia
The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 (WHO) ranked the healthcare systems
of its 191 member states in its World Health Report
World Health Report
The World Health Report is a series of reports produced regularly by the World Health Organization . First published in 1995, the World Health Report is WHO's leading publication...

 2000. It provided a framework and measurement approach to examine and compare aspects of health system
Health system
A health system can be defined as the structured and interrelated set of all actors and institutions contributing to health improvement. The health system boundaries could then be referred to the concept of health action, which is "any set of activities whose primary intent is to improve or...

s around the world. It developed a series of performance indicators to assess the overall level and distribution of health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...

 in the populations, and the responsiveness and financing of health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...

 services. It was the organization's first ever analysis of the world's health systems, but has been subject to criticism of its usefulness and methodology.

Ranking

Data from 1997 was used in the report.
Ranking Country Expenditure Per Capita
1   France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...

 
1
2   Italy
Healthcare in Italy
For a general article on health in Italy, see health in ItalyHealth care spending in Italy accounted for 9.0% of GDP in 2006 of which about 75% is public, slightly more than the average of 8.9% inOECD countries....

 
11
3   San Marino
San Marino
San Marino, officially the Republic of San Marino , is a state situated on the Italian Peninsula on the eastern side of the Apennine Mountains. It is an enclave surrounded by Italy. Its size is just over with an estimated population of over 30,000. Its capital is the City of San Marino...

 
21
4  Andorra 23
5  Malta 37
6   Singapore
Health care in Singapore
Healthcare in Singapore is mainly under the responsibility of the Singapore Government's Ministry of Health. Singapore generally has an efficient and widespread system of healthcare...

 
38
7   Spain  24
8   Oman
Healthcare in Oman
Omani nationals have free access to the country's public health care, though expatriates typically seek medical care in private sector clinics and hospitals . Generally, the standard of care in the public sector is high for a middle income country. The country now has very low rate of disease once...

 
62
9  Austria 6
10   Japan
Health care in Japan
The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%...

 
13
11  Norway 16
12   Portugal  28
13  Monaco 12
14  Greece 30
15   Iceland
Healthcare in Iceland
Iceland has universal health care. The health care system is largely paid for by taxes and to some extent by service fees and is administrated by The Ministry of Welfare...

 
14
16  Luxembourg 5
17   Netherlands
Health care in the Netherlands
Healthcare in the Netherlands is financed by a dual system that came into effect in January 2006. Long-term treatments, especially those that involve semi-permanent hospitalization, and also disability costs such as wheelchairs, are covered by a state-controlled mandatory insurance...

 
9
18 United Kingdom
Healthcare in England
Healthcare in England is mainly provided by England's public health service, the National Health Service, that provides healthcare to all permanent residents of the United Kingdom that is free at the point of use and paid for from general taxation. Since health is a devolved matter, there are...

 
26
19   Ireland  25
20   Switzerland
Healthcare in Switzerland
Healthcare in Switzerland is universal and is regulated by the Federal Health Insurance Act of 1994 . Health insurance is compulsory for all persons residing in Switzerland...

 
2
21  Belgium 15
22   Colombia
Health care in Colombia
Health care in Colombia refers to the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing, and allied health professions in the Republic of Colombia....

 
49
23   Sweden
Healthcare in Sweden
The Swedish health care system is mainly government-funded and decentralized, although private health care also exists. The health care system in Sweden is financed primarily through taxes levied by county councils and municipalities....

 
7
24   Cyprus  39
25   Germany  3
26   Saudi Arabia
Healthcare in Saudi Arabia
The healthcare system in Saudi Arabia can be classified as a national health care system in which the government provides health care services through a number of government agencies...

 
63
27   United Arab Emirates  35
28   Israel
Health care in Israel
Health care in Israel is universal and participation in a medical insurance plan is compulsory. Health care coverage is administered by a small number of organizations, with funding from the government...

 
19
29   Morocco  99
30   Canada
Health care in Canada
Health care in Canada is delivered through a publicly-funded health care system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act. The government assures the quality of care through federal standards...

 
10
31   Finland
Healthcare in Finland
Finland has a highly decentralized three level publicly funded system of health care and alongside these, a much smaller private health care system. Responsibility for health care is devolved to the municipalities .-Health standards:...

 
18
32   Australia
Health care in Australia
Health care in Australia is provided by both private and government institutions. The Minister for Health and Ageing, currently Nicola Roxon, administers national health policy...

 
17
33  Chile 44
34  Denmark 8
35  Dominica 70
36   Costa Rica
Health care in Costa Rica
Costa Rica provides universal health care to its citizens and permanent residents.Costa Rica is also a popular destination for medical tourism.It has three internationally-accredited private hospitals.-References:...

 
50
37   United States
Health care in the United States
Health care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector...

 
1
38   Slovenia  29
39   Cuba  118
40  Brunei 32
41   New Zealand
Health care in New Zealand
The healthcare system of New Zealand has undergone significant changes throughout the past several decades. From an essentially fully public system in the early 20th century, reforms have introduced market and health insurance elements primarily in the last three decades, creating a mixed...

 
20
42  Bahrain 48
43  Independent State of Croatia 56
44   Qatar  27
45  Kuwait 41
46  Barbados 36
47   Thailand  64
48   Czech Republic  40
49   Malaysia
Healthcare in Malaysia
Healthcare in Malaysia is mainly under the responsibility of the government's Ministry of Health. Malaysia generally has an efficient and widespread system of health care, operating a two-tier health care system consisting of both a government-run universal healthcare system and a co-existing...

 
93
50   Poland  58
51  Dominican Republic
52  Tunisia
53  Jamaica
54   Venezuela 
55  Albania
56  Seychelles
57   Paraguay 
58   South Korea 
59   Senegal 
60   Philippines 
61   Mexico
Health care in Mexico
Health care in Mexico is provided via public institutions, private entities, or private physicians. Health care delivered through private health care organizations operates entirely on the free-market system, i.e., it is available to those who can afford it. This is also the case of health care...

 
62  Slovakia
63   Egypt 
64   Kazakhstan 
65  Uruguay
66  Hungary
67   Trinidad and Tobago
Health care in Trinidad and Tobago
Trinidad and Tobago operates under a two-tier health care system. That is, there is the existence of both private health care facilities and public health care facilities....

 
68  Saint Lucia
69  Belize
70   Turkey
Health care in Turkey
Health care in Turkey used to be dominated by a centralized state system run by the Ministry of Health. In 2003 the governing Justice and Development Party introduced a sweeping health reform program aimed at increasing the ratio of private to state health provision and making health care available...

 
71  Nicaragua
72  Belarus
73  Lithuania
74  Saint Vincent and the Grenadines
75   Argentina
Health care in Argentina
Argentina’s health care system is composed of three sectors: the public sector, financed through taxes; the private sector, financed through voluntary insurance schemes; and the social security sector, financed through obligatory insurance schemes...

 
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
Health care in Antigua and Barbuda
In Antigua and Barbuda, four institutions are maintained for the care of the sick and aged. Holberton Hospital, with 135 beds, is the only public acute care facility. The only private hospital is Adelin Medical Center. Other facilities include the Fiennes Institute for the aged, with 100 beds,and...

 
87   Libya 
88   Bangladesh 
89  Republic of Macedonia
90  Bosnia and Herzegovina
91  Lebanon
92   Indonesia 
93   Iran
Health care in Iran
Health care in Iran and medical sector's market value was almost US $24 billion in 2002 and was forecast to rise to US $31 billion by 2007. With a population of almost 70 million, Iran is one of the most populous countries in the Middle East...

 
94  The Bahamas
95  Panama
96  Fiji
97  Benin
98  Nauru
99   Romania
Healthcare in Romania
Health care in Romania has lower standards than in the rest of the Union. Although everyone in the urban area has access to fast medical assistance, in some rural areas access may be limited. For 2012, the allocated budget spending in the healthcare sector is 12 billion €, or roughly 5% of the GDP....

 
100  Saint Kitts and Nevis
101  Moldova
102   Bulgaria 
103   Iraq 
104  Armenia
105  Latvia
106  Kingdom of Yugoslavia
107  Cook Islands
108   Syria 
109  Azerbaijan
110  Suriname
111  Ecuador
112   India
Healthcare in India
Healthcare in India features a universal health care system run by the constituent states and territories of India. The Constitution charges every state with "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties"...

 
113   Cape Verde 
114   Georgia 
115  El Salvador
116  Tonga
117   Uzbekistan 
118   Comoros 
119  Samoa
120   Yemen 
121  Niue
122   Pakistan
Health care in Pakistan
Health care in Pakistan is administered by Ministry of Health. Like other South Asian countries, health and sanitation infrastructure is adequate in urban areas but is generally poor in rural areas...

 
123  Federated States of Micronesia
124  Bhutan
125   Brazil 
126   Bolivia 
127  Vanuatu
128  Guyana
129  Peru
130   Russia 
131  Honduras
132  Burkina Faso
133  São Tomé and Príncipe
134   Sudan 
135   Ghana 
136  Tuvalu
137  Côte d'Ivoire
138   Haiti 
139  Gabon
140   Kenya
Healthcare in Kenya
Kenya’s health care system is structured in a step-wise manner so that complicated cases are referred to a higher level. Gaps in the system are filled by private and church run units...

 
141  Marshall Islands
142  Kiribati
143  Burundi
144   People's Republic of China 
145  Mongolia
146  The Gambia
147  Maldives
148  Papua New Guinea
149   Uganda 
150   Nepal 
151   Kyrgyzstan 
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  Republic of the 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
Health care in Nigeria
Health care provision in Nigeria is a concurrent responsibility of the three tiers of government in the country. However, because Nigeria operates a mixed economy, private providers of health care have a visible role to play in health care delivery...

 
188   Democratic Republic of the Congo 
189  Central African Republic
190   Myanmar 

Methodology

The rankings are based on an index of five factors:
  • Health level (25%): disability-adjusted life expectancy
    Life expectancy
    Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...

  • Responsiveness (12.5%): speed of service, protection of privacy, and quality of amenities
  • Financial fairness (25%): inequality in percentage of household income spent on healthcare
  • Health distribution (25%): inequality in health level
  • Responsiveness distribution (12.5%): inequality in responsiveness

Criticism

The WHO rankings have been subject to much criticism concerning their methodology, scientificness, and usefulness. Dr Richard G. Fessler called the rankings "misleading" and said that tens of thousands of foreigners travel to the United States every year for care. In addition, the United States leads the world in survival rates for 13 of the 16 most common types of cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

. He also noted that the financial fairness measure was automatically designed to "make countries that rely on free market incentives look inferior". Dr Philip Musgrove wrote in the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...

 that the rankings are meaningless and misleading because they oversimplify: "numbers confer a spurious precision".

Journalist John Stossel
John Stossel
John F. Stossel is an American consumer reporter, investigative journalist, author and libertarian columnist. In October 2009 Stossel left his long time home on ABC News to join the Fox Business Channel and Fox News Channel, both owned and operated by News Corp...

 notes that the use of life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...

 figures is misleading and the life expectancy in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 is held down by homicides, accidents, poor diet, and lack of exercise. When controlled for these facts, Stossel claims that American life expectancy is actually one of the highest in the world. A study published in 2006 found that Americans outlive people in every other Western country, when controlled for homicides and car accidents. Stossel also criticizes the ranking for favoring socialized healthcare, noting that "a country with high-quality care overall but 'unequal distribution' would rank below a country with lower quality care but equal distribution."

Economics professor Glen Whitman claims that "it looks an awful lot like someone cherry-picked the results to make the U.S.’s relative performance look worse than it is." He also notes that the rankings favor countries where individuals or families spend little of their income directly on health care. In an article in The American Spectator
The American Spectator
The American Spectator is a conservative U.S. monthly magazine covering news and politics, edited by R. Emmett Tyrrell Jr. and published by the non-profit American Spectator Foundation. From its founding in 1967 until the late 1980s, the small-circulation magazine featured the writings of authors...

, Whitman notes how the rankings favor government intervention, which has nothing to do with quality of care. The rankings assume literacy rate is indicative of healthcare, but ignore many factors, such as tobacco use, nutrition, and luck. Regarding the distribution factors, Whitman says "neither measures healthcare performance" since a "healthcare system [can be] characterized by both extensive inequality and good care for everyone." If healthcare improves for one group, but remains the same for the rest of the population, that would mean an increase in inequality, despite there being an improvement in quality. Dr Fessler echoed these sentiments.

See also

  • Comparison of Canadian and American health care systems
  • Health care systems#Cross-country comparisons
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