• We’re #1?

    From Healthwatch:

    Politicians love to claim the U.S. has “the best healthcare system in the world,” though experts argue otherwise.

    But a new index that purports to measure a nation’s prosperity — not just wealth, but health, personal freedom and other measures — concludes that lawmakers might be on to something.

    After crunching the World Bank’s world development indicators and survey data from the 2010 Gallup World Poll, the London-based nonprofit Legatum Institute concludes that the U.S. in 10th overall for prosperity — but first for health.

    I did a two-week series on the quality of the US health care system, so you can imagine I was interested in the results.

    The “study” was done by the Legatum Institute, a non-partisan institute that nonetheless seems to have the tagline, “Free Markets, Free Minds, Free Peoples”. The methods of the analysis are a bit vague. But here’s what I can figure out:

    The Health sub-index assesses countries by outcomes that are made possible by a strong health infrastructure, such as rates of immunisation against diseases and public health expenditure. Countries are also assessed on outcomes such as life expectancy, rates of infant mortality and undernourishment. The sub-index also includes measures of satisfaction with personal health and the health effects of environmental factors such as water and air quality, and even environmental beauty.

    As you can imagine, we do pretty meh in things like life expectancy and infant mortality (I can’t speak to variables like “environmental beauty”). But don’t take my word for it. Here are the results (emphasis mine):

    US citizens have a life expectancy of 70 years, when adjusted for healthy years lived, which ranks the country 27th, on this variable. Below average rates of infant mortality and undernourishment rank the United States 36th and fourth, respectively. Government health expenditure per capita is the highest in the world; this high level of spending, however, results in only average provision of hospital beds, but above average rates of immunisation for infectious diseases and measles, and the world’s second lowest incidence of tuberculosis. It also means that the entire US population has access to improved sanitation facilities. However, the US places 60th for its comparatively high incidence of respiratory disease. In 2010, around 90%* of respondents were satisfied with the quality of water in their area. Public perceptions of health vary; while 86%* of the population was content with their personal health in 2010, an above average 33%* had felt worried for a significant amount of the day before being surveyed. Perhaps consequently, the United States ranks 50th with regard to the share of the population that feels well-rested. However, the fact that only 21%* reported debilitating health problems in 2010 indicates a more positive situation. Also, a high level of satisfaction with the beauty of the immediate environment places the United States 20th*, on this variable

    So how do you get to #1? Well, check out the variables and weights applied to them. It seems that one of the variables included in the analyses was expenditure on health. As you can imagine the United States is clearly going to win that one. But I’m not sure why that would be a variable to measure “health”. If I’m reading the weights correctly, they also made health expenditure count more than infant mortality, life expectancy, undernourishment, water quality, sanitation, and deaths from respiratory disease (where we were 60th, remember). They also included things like “satisfaction with environmental beauty”, and if I’m again reading the weights correctly, they made that variable more important than any of the basic health outcome or infrastructure variables in the “Wellbeing” category.

    My favorite part of the Healthwatch piece is this, though:

    So, why didn’t France, the leader in healthcare rankings by the World Health Organization because of its universal healthcare system and top-notch prevention efforts, end up 7th?

    Thirty percent of French people “report feeling worried during the previous day, well above the global average,” the index reports. And despite the 35-hour work week, “a relatively low 67 percent reported being well-rested.”

    So France was 7th because 30% of people were worried during the previous day (except for the fact that 33% of US people felt that way) and because only 67% of people were well-rested (except for the fact that only 50% of people in the US felt that way). In other words, when trying to defend this odd outcome, the two examples the Healthwatch reporter chose were ones where we still performed worse than France.

    And yet, we were #1. Color me skeptical.


    Comments closed
    • While your criticisms of Legatum’s rankings seem spot on, I’m a bit surprised you take the WHO’s rankings so seriously.

      They also give large weights to quite a few factors which are only peripherally related to healthcare quality – for example, inequality in the marginal cost of additional care [1] actually receives the same weight in their rankings that actual health does.

      I’d suggest it would be worthwhile to apply the same level of skepticism you apply to Legatum to the WHO.


      [1] I think they measure it as sum_{all individuals} (cost of care(individual) – average cost of care) ^ 3, but I haven’t checked in a while.

      • I’m not pushing the WHO (although I think their methodology is a little more defensible). That’s why I did a 10-part series on quality, so I could go into the detail I thought it deserved. Happy to discuss that.

    • If you want to find out who “Legatum Institute” really is, this tidbit found in a Forbes article noted on the Legatum website my offer a clue or three:

      “A few years ago the directors of the Legatum Institute (part of billionaire Christopher Chandler‘s Dubai-based Legatum Group)…”

      And from legatum.com

      “The Legatum Group

      Legatum is a private investment group…”

      So it appears that “Legatum Institute” is actually a mouthpiece for a billionaire and his investment firm.

    • I’ll just make a guess here, but I bet the Legatum Group is investing long in U.S. healthcare, what with the baby-boomers and all, and Legatum Institute is a fancy scientific sounding way to talk their book in the media and muddy the waters on reforming the system. I know, Dubai-based billionaire hedge fund managers wouldn’t stoop to something like that, they’ve got more important things to do.