Saturday, March 7, 2020

Ranking Health Care Systems By Country

As promised earlier, I am going to provide several lists of rankings of nations by the supposed quality of their health care systems. For only one of these do I have a breakdown for specific aspects.  Given that the US generally does not do well on any of these, I do note that studies have shown the US is especcially good for certain cancers, especially colon, wiith France and Japan its main rivals on that one. We are also tops for various unusual elective surgeries that are expensive.

Also for this list I note that pretty much all of the nations appearing have universal coverage except the US.  UK has full-blown socialized mediicine with health care workers central government employees.  Canada and Taiwan are supposedly single payer, with South Korea having close to such a system.  Several Nordic nations have single payer for service, but not a full system.  But then Canada does not have a full system with all the private supplemental insurance there.  The rest are all some public/private mixe, with several major nations having it about three to one public to private.

The most widely cited ranking, and the most complete, is that of the World Health Organization.  But it is also now 20 years old. Anyway, here are its top ten, with Canada coming in 21st, Denmark 34the, US 35th, and Cuba, 36th:

1. France
2. Italy
3. San Marino (yes, this is a thorough list)
4. Andorra
5. Malta
6. Singapore (this one is actually 3 to 1 private to public, but has universal coverage)
7. Spain
8. Oman
9. Austria
10. Japan (which has the world's longest life expectancy)

Then we have a list from International.Insurance.co, with only 11 nations listed:

1. UK
2. Australia
3. Netherlands
4. New Zealand and Norway
6. Sweden and Switzerland
8. Germany
9. Canada
10. France
11. US

World Population Review lists the following nations as having good systems, but does not say that this llist's order indicates anything, and the following discussion starts with Switzerland first and then moves to Finland, which is not on the list, so unclear what is what, although this one does have Canada at the front of the list whose meaning is unclear. Anyway, no numbers, but here is the list in order, for what that is worth, which does not include the US:

Canada
Qatar
France
Norway
New Zealand
Germnay
Hong Kong
Netherlands
Switzerland
Singapore
Luxembourg
Japan
Sweden

Here is a list from Numbeo, clearly ranked, a  long list that I shall only show the top 10 for, with Canada at #24 and the US not even on the list.  This one is more Asia-centric:

1. Taiwan (which has handled the coronovirus especially well by many reports)
2. South Korea
3. Japan
4. Denmark
5. France
6. Spain
7. Austria
8. Thailand
9. Australia
10. Finland

Here is a list of the top 10 from the Cigna insurnce company (again, no US):

1. Denmark
2. Sweden
3. Canada
4. UK
5. Germany
6. Netherlands
7. Australia
8. France
9. Austria
10. New Zealand

Finally I show one from soething calling itself Health Care Tracking, which shows top 10 for both ovwrall as well as some specific cattegories.  I show the overall and then mention thr tops and bottome for a few categories:

Overall
1. Netherlands
2. Australia
3. Sweden
4. Japan
5. Austria
6. Comparable Countries
7. Germany
8. France
9. UK
10. US (only list where US beats Canada apparently, although maybe it is in #7)

For lab delays, The US is the worst and Canada is third worst.  Best three are Germany, France, and Netherlands.

For quick access to a physician (which many in the US thinik we are great at), Canada is the worst (10th), followed by Sweden, and then the US (8th worst out of 10).  The best Netherlands and Australia.

Finally we have amount of use of emergency rooms. On that Canada is tops followed by the US. Least use is Germany, Australia, and the Netherlands.

So, hard to come to any conclusoins on this.  Again, the US does pretty badly on many things. Canada easily ahead of it except for curiously these last two items and generally a pretty good performer (possibly #1 foro World Populaton Review and definitely #3 according to Cigna), but there are also some systems that are usually ahead of it, easily figured out from looking at these lists.

Taiwan may be evidence of serious success with single payer (I do not know details of system there), and the socialized medicine of UK gets wildly different rankings, tops on two lists but then substantially lower on others.  I suspect those where it is tops are looking at expenses for patients where those are especially low in UK.  Costs are ovrall lower there, with lower health care worker pay.  In UK health care spending is only 8% of GDP while it ranges between 10-12% for most of the European nations on these lists as well as Canada, while the US is way ahead of the others at our ridiculous 17%. 

What we clearly need is universality and lower costs, with it unclear that either the Bernie or Biden plans bring us both of those, although both improve on our current system, which is also better than the pre-Obama system, which it seems Trump is trying to take us back to with the GOP-states lawsuit against ACA backed by the Trump DOJ now sitting at the SCOTUS.

Barklley Rosser

7 comments:

2slugbaits said...

I have a niece who is a Navy surgeon at Bethesda Naval & Walter Reed Army hospitals. Those are not only single payer, but single provider. I've always found it interesting that those who sing the praises of America's private insurance and private practice approach to medicine aren't also advocating that same approach for patients at Bethesda and Walter Reed.

Bill H aka run75441 said...

2slugs:

They are attempting to privatize Tricare and the VA system by having veterans and active duty family go to commercial healthcare facilities. I can get into the VA faster than see my PCP.

rosserjb@jmu.edu said...

My second daughter is a psychiatrist in the VA system, so I am very aware that this is a part of the US system that resembles the UK system, as well as that many GOPsters including Trump are trying to privatize it. It is m understanding that it runs much better now than it did some years ago, although I may have biased sources on this.

BTW, I note that I had nothing to do with this Zaure ad that is now in the middle of my post. I have complained previously about the fact that somehow we are getting all these ads, which I would rather not see. Since I have complained about this, nobody has stepped forward to fess up to being responsible for them. In any case, if someboddy around here is making money off this, it is not me, and I wish these ads would go away and not appear anymore.

Whoever is responsible for this is a fucking creep.

rosserjb@jmu.edu said...

BTW, on the matter of the ads, Dan Crawford over at Agry Bear, where there are lots of ads, way more than here, defended them to me as a way to "cover costs" of running a blog. But, near as I can tell, that mostly amounts to time of people involved. I have no problem with him (or somebody else) over there getting paid something for what they do, but there has been no discussion and no agreement here about anything of the sort, and I remain mystified as to how and why these bloody things are showing up, with this one popping up right in the middle of one of my posts especially annoying. They are bad enough in the margins, but in the posts themselves is worse.

Anonymous said...

How the Taiwan system was designed and by whom:

http://prescriptions.blogs.nytimes.com/2009/11/03/health-care-abroad-taiwan/

November 3, 2009

Health Care Abroad: Taiwan
By Anne Underwood

2slugbaits said...

I suspect that one reason politicians feel more comfortable about privatizing VA or Tricare is that many of the ailments they treat tend to be more like the kinds of problems you might find in the general population even though the ailment is supposed to be service related in the case of the VA. But with Bethesda and Walter Reed you see some pretty horrific cases of young soldiers. News media stories about those soldiers coming back from combat but unable to get coverage because of some financial concern just isn't the kind of story that any politician wants to talk about. Political opposition ads of a crying wife standing over her severely burned husband because you voted to privatize Walter Reed aren't helpful towards your reelection. And of course those are the very hospitals where we send our political leaders because nothing is too good them.

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