Magazine article Information Today

Healthcare Score Cards Give U.S. Mixed Grades

Magazine article Information Today

Healthcare Score Cards Give U.S. Mixed Grades

Article excerpt

Is there a more complex, contentious, and personally affecting subject than healthcare? Although today's other great problems (e.g., the economy, foreign threats, and the environment) do not touch many of us directly, virtually everyone is affected by the design, performance, and cost of our healthcare system.

The healthcare debate is particularly intense during this time of wrenching transition. The subject is entwined with basic ideological positions on subjects such as the free market and the role of government, as well as deeply held moral values. Arguments on all sides are bolstered by wildly diverging claims and facts: Either the U.S. has the best healthcare in the world, or we are on the same level as developing nations. Healthcare score card databases provide ammunition for all sides in the fight.

The healthcare score card databases do gallant work in organizing this impossibly complex subject. They gather and analyze enormous masses of data and then create quantitative rankings and metrics based on dozens or hundreds of individual indicators. They take into account basic medical care as well as its efficiency, delivery, and costs. Each score card's website has the full text of the report, along with tables, charts, and graphics. Most score cards provide overall country or U.S. state rankings. These must be wielded carefully, because even the best performing healthcare systems have shortcomings. For example, the U.S. provides the best technical care in the world for certain illnesses, but it ranks alongside developing nations for providing comprehensive healthcare across its entire population.

'The World Health Report'

The World Health Organization (WHO) describes its "World Health Report" ( as the "first ever analysis of the world's health systems." This massive project, which covered 191 countries, uses five comprehensive indicators that give weight to the financial and distributive aspects of each country's healthcare, as well as its basic quality. The report's top five countries are France, Italy, San Marino, Andorra, and Malta (among major countries, the top five are France, Italy, Spain, Oman, and Austria). The U.S. is 37th behind Costa Rica and ahead of Slovenia. Most of the lowest ranked countries are in subSaharan Africa.


The report is controversial in the U.S. healthcare debates because of the low overall ranking given to the U.S. This example shows the problem of plucking a single number from a large and highly differentiated aggregation. The report does give the U.S. top ranking in basic healthcare quality, but its overall rank is pulled down because the report factors in a nation's "economic potential." The U.S. does very poorly because its great wealth and world-leading healthcare spending do not produce commensurate outcomes in overall healthcare quality.

Other National Ranking Databases

In 2009, the Organisation for Economic Co-operation and Development (OECD) produced a major score card that concentrated on the 30 members of the OECD, which represent some of the world's wealthiest nations, including several European nations, the U.S., Canada, Australia, and Japan. The results are summarized in Health at a Glance 2009 ( 11/0,3343,en_2649_33929_16502667_1_1_1_1,00.html). This publication does not have single overall country ranking, but it does compare national performance across numerous individual indicators. The publication's overall conclusion is that "no one OECD country provides high quality care in all areas." For example, the U.S. is praised for its exceptional cancer care, but it is criticized for poor primary care for chronic conditions such as asthma and diabetes. Health at a Glance also says that the U.S. is a far outlier in spending, spending 16% of the country's GDP on healthcare. France was in second place with 11%, while the OECD average was 8. …

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