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Thursday, March 05, 2009

No thanks, just bandage me up as best you can and point me towards the airport...

Color me surprised.  According to the World Health Organization, the following countries (listed in order) all have better healthcare systems than Israel:

  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

I'll be honest here (for a change) and admit that I haven't the faintest idea what criteria were used to arrive at this ranking... and frankly I don't care.  Healthcare to me means one thing:  What is the likelihood that they can make you better (and not worse) if you are sick or injured? 

Now,I don't know about you, but if I found myself in need of an operation in more than half of those countries listed above, I'd swipe a mega-dose of painkillers and antibiotics from the medicine closet and pray I survived the flight home.

Oh, and for those of you in the U.S. who might be feeling smug or thinking I'm bigoted for not wanting to accept treatment in more than half of these countries... here are the next bunch of countries on the WHO list... before they got to you:

  28.  Israel

  29.  Morocco

  30.  Canada

  31.  Finland

  32.  Australia

  33.  Chile

  34.  Denmark

  35.  Dominica

  36.  Costa Rica

  37.  United States of America

So how about it?  How about a Colostomy in Costa Rica?  Or perhaps a Mastectomy in Morocco?  Not so much?  I guess we're all a little bigoted when it comes to our own healthcare.  Here's the rest of the list of countries that the WHO thinks are among the 50 best systems in the world:

  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

I think a better ranking system would be to see what countries attract the most medical tourism and illegal aliens seeking treatment.  Supply and demand aren't color-blind... but they sure seem to be spot-on indicators of where the good stuff is. 

But then, what do I know?

Posted by David Bogner on March 5, 2009 | Permalink

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I'm cool with being number 28 as long as we beat Canada.

Posted by: Jehoshaphat | Mar 5, 2009 2:52:04 PM

Here's my list:

1. United States
2. Israel

All the rest are irrelevent.

[Factor in though, that in the US health insurance cost us thousands and here it's less than 100 dollars a month (for a family of 5) for the top tier program of my health carrier.]

Posted by: Baila | Mar 5, 2009 3:21:10 PM

"I haven't the faintest idea what criteria were used to arrive at this ranking..." And I am sure this is at the heart of the matter. I remember reading a while ago that infant mortality rates are higher in the US than in other countries, because of how differently each country reports infant deaths, and what they count as initial signs of life. I am sure that other health-related criteria are also inconsistent. And of course, living in Israel has made me hyper-aware of the tendency of certain world organizations to skew data regarding "the great satan" and "the little satan"; but that is probably unrelated...

Posted by: rutimizrachi | Mar 5, 2009 3:35:54 PM

Israel ranks 14th in life expectancy, tied with Norway. The United States is 30th. The U.S. was recently passed by Jordan and Bosnia-Herzegovina.

Gaza has a higher life expectancy ranking than Egypt, Morocco, Syria and Iran among others. The numbers are from the CIA World Factbook as shown on Wikipedia.

http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

Posted by: lrg | Mar 5, 2009 4:11:41 PM

Sweden 23rd!!??? Ha!

Posted by: Rami | Mar 5, 2009 4:39:25 PM

Why would an American feel smug or think you're bigoted? My dad was stationed in Germany for 2 years a few years ago, and I avoided doctors the entire time we lived there. I won't accept medical care from anyone except American, non-military hospitals-with apologies to Israel, I've never visited and can't comment on the quality of health care. :)

Posted by: Angela | Mar 5, 2009 5:25:59 PM

Hey, if I were one of the eight citizens of San Marino (or Andorra, for that matter), you better believe I'd want some darn good health care. :)

Seriously, though, you're absolutely right. The notion of what constitutes good health care is so subjective that you might as well throw darts at a map of the world to come up with an order. My hunch is that the good folks at the WHO factored in socialized medicine as a positive determining factor, whereas most of us would regard that as a mixed blessing at best.

Posted by: psachya | Mar 5, 2009 9:53:28 PM

My cousin lives in the UK but comes back to France when she has something more serious than a cold.

Posted by: Ilana-Davita | Mar 5, 2009 10:18:22 PM

I traveled to both Puerto Rico, Israel and Ireland last summer with a gallbladder that I was advised to have removed. The only place I felt confident that if emergency surgery became necessary I'd be in good hands, was Israel. Guess the WHO has never heard of Hadassah and Shaare Zedek. P.S. I avoided falafel and shwarma with "chips" and my gallbladder survived the summer...

Posted by: Marsha in Englewood | Mar 6, 2009 2:24:26 AM

It would have been helpful if you had provided a link to your source - then it would be possible to distinguish the criteria for this list. Especially as a list of the 50 best health care systems doesn't sound like something a organization like the WHO would do - they are usually more specific in terms of what they assess.

Trying to clear up things a little bit, I started to search for the list you provide up there. In their report World Health Statistics 2008 ( http://www.who.int/whosis/whostat/en/ ) there is no such list. Is it from the latest World Health Report ( http://www.who.int/whr/2008/en/index.html )? Neither - it mentions Israel only once, and in a different context. And even after quite a while of playing around with their statistics tool ( http://www.who.int/whosis/data/Search.jsp ) I couldn't come up with a list identical to yours.

That is not to say that such a list never existed - it is just outdated. The last time the WHO published such a list in 2000 - they stopped since due to the tasks complexity (cf http://www.photius.com/rankings/healthranks.html ) And there it is, in the 2000 World Health Report, in the statistical annex on page 200 - filled with estimates for 1997. In its explanatory notes on page 150 it explains the process:
"Overall performance of health systems was measured using a similar process relating
overall health system achievement to health system expenditure. Maximum attainable com-
posite goal achievement was estimated using a frontier production model relating overall
health system achievement to health expenditure and other non-health system determi-
nants represented by educational attainment. Results of this analysis were largely invariant
to model specification. More detail is provided in the corresponding technical paper.32"

This corresponding technical paper can be found at pages.stern.nyu.edu/~wgreene/Statistics/WHO-COMP-Study-30.pdf , if there's any need.

Posted by: Carsten | Mar 6, 2009 5:45:46 AM

*cough* Hi, American here-- and I've got the brains to know that if the WHO says something, you hold on to your wallet and double-check-- then check again, if you can't find something fishy.

The WHO health care rankings result from an index of health-related statistics. As with any index, it is important to consider how it was constructed, as the construction affects the results. WHO’s index is based on five factors, weighted as follows:3
1. Health Level: 25 percent
2. Health Distribution: 25 percent
3. Responsiveness: 12.5 percent
4. Responsiveness Distribution: 12.5 per-cent
5. Financial Fairness: 25 percent
http://www.cato.org/pubs/bp/bp101.pdf

So a 100% socialist country where only the party leaders get any kind of health care would be on the same "ranking" as a country where they charge the identical price to anyone who comes in.

This is before we get into the above mentioned "cooking the books" or "variations in reporting" problem.

Posted by: Foxfier | Mar 6, 2009 9:13:38 AM

Good grief, this list is ridiculous. I would love to know how they got their data. The only one I can agree is NZ. I totally agree with this being near the bottom. Spain No 7 - no way. A UK friend recently nursed her mother in a Spanish hospital (she moved there for 6 months to do it). In Spain the nurses administer drugs, the family nurses the patients (go figure!). An appalling experience by all accounts.
I have observed the Israeli system as a volunteer and found the level of care amazing, considering how underfunded some of the hospitals are. If I got sick and could afford to pick a country to get treatment, I'd be on the next flight to Israel.

Posted by: Noa | Mar 6, 2009 9:17:01 AM

Access to a country's health care system may be part of what WHO factors in, as well as cost.

In light of yesterday's first "Health Care Summit" held at the White House (which included insurance industry reps) this brilliant 16-year old piece by Russell Baker needs to be re-visited:
http://query.nytimes.com/gst/fullpage.html?sec=health&res=9E01E6D91E39F932A35755C0A960958260

It could've been written yesterday...

(If the above doesn't come up as a direct link, just 'Google search' "Harry, Louise, You Lied by Russell Baker" and it'll pop right up).

Posted by: Mike Spengler | Mar 6, 2009 5:13:11 PM

This is an example of a meaningless list. "Quality of Healthcare" is a very nebulous concept. American healthcare is probably the best in the world for those who can afford it, but leaves lower-income people reliant on overcrowded emergency rooms; countries with single-payer systems have fewer MRI instruments per capita, but provide good-to-excellent general care to the entire citizenry. As an employee of a company with a good health care policy, I might be better off than my Canadian counterpart, but were I to be laid off, I'd be SOL if I had some significant medical problems, while my similarly laid-off colleague Up North would just go to his usual doctor.

The advancements in medical care made possible by incredibly dedicated scientists and clinicians are also the source of some of our greatest ethical quandries. How do we allocate finite resources to an infinite need?

Posted by: efrex | Mar 6, 2009 5:54:56 PM

It just exemplifies the intrinsic bias against Israel and the U.S. in nearly every international organization. These 2 countries are the whipping boys for the rest of the world, yet if they imposed strict isolationism upon themselves, their money, their militaries and their technology, it would be a different world altogether!

Posted by: Randy | Mar 6, 2009 7:28:16 PM

Interesting article. Thanks for bringing it up, because I love to read ratings that totally mystify me. :)

As for Canada, I have close friends from there who talk about the extremely poor health.

Posted by: Tim | Mar 7, 2009 4:57:13 AM

No way is the UK NHS better than the Israeli health service.

Posted by: Imshin | Mar 10, 2009 10:40:52 PM

lesee... USA... France... USA?... France? .... hmmm. What a tough decision! I'll let you know after I go out this afternoon, choose a doctor, and make an appointment for next week...

Posted by: Wry Mouth | Mar 17, 2009 11:07:59 PM

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