A discussion posted yesterday in the LinkedIn group, International Health Professionals – Certification and Education by the group manager, Scott Schneider, linked to a report by Bloomberg.com that ranked countries by the efficiencies of their health-care systems. The report titled, Most Efficient Health Care: Countries, listed 48 countries from around the world and ranked each country by three criteria:
- Life expectancy (weighted 60%),
- Relative per capita cost of health care (30%); and
- Absolute per capita cost of health care (10%).
The countries were then scored on each criterion; the scores were weighted and summed to obtain their efficiency scores. Relative cost was defined as health cost per capita as a percentage of GDP per capita. Absolute cost was defined as total health expenditure, which covers preventive and curative health services, family planning, nutrition activities and emergency aid. The countries chosen had populations at least five million, GDP per capita of at least $5,000 and life expectancy of at least 70 years of age.
The data was acquired from the World Bank, the International Monetary Fund, the World Health Organization and the Hong Kong Department of Health, and is current through November 2013, according to Schneider.
As seen in the table below, each country is ranked by their efficiency score, and each country’s life expectancy, health-care cost as a percentage of GDP per capita, and their health-care cost per capita are shown as well.
The US is ranked 46th overall, with an efficiency score of 30.8, just below that of Iran (yes, that’s right, Iran – you know, the country that calls us ‘The Great Satan’). US life expectancy is 78.6 years, which places it below Chile and above the Czech Republic, in 23rd place. Health-care cost as a percentage of GDP per capita for the US is 17.2%, which is the highest of all countries listed, so at least in one aspect we are number one, just not in the way most Americans think, especially those in the workers’ compensation industry who have criticized this writer for daring to suggest that medical tourism belongs in workers’ compensation because it promises lower cost health care with equal or better outcomes than what the American system provides currently.
Finally, the US is not number one in health-care cost per capita, but second at $8,608, just behind Switzerland at $9,121. While we are not the most expensive health-care system, we certainly do not get a lot of efficiency from the money we are spending. It is interesting to note that many of the countries with a higher efficiency score than the US are some of the major players or rising stars in the medical tourism industry. One major player that is not mentioned is India and one rising star that is not listed is Costa Rica. In the case of India, their population is certainly greater than five million, but it is likely that GDP per capita is not at least $5,000 and that life expectancy is less than 70 years of age. According to NationMaster.com, Costa Rica’s population was 4.57 million as of 2011, but their GDP per capita was $11,296.06 as of 2010.
So whenever you hear someone say “We’re No. 1”, especially when they are talking about health care, you can tell them, “no, we’re not”, and give them data to back that up. Chauvinism and exceptionalism are dangerous attitudes to hold at any time, but when a person’s health is at stake, and the need for care is not emergent, then perhaps it would be wise and prudent to consider alternatives to expensive surgeries that do not guarantee better outcomes just because they are more expensive. The old adage, “you get what you pay for” does not necessarily apply to health care, and the data bears that out. It is time the workers’ compensation industry admits it.
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