Are you aware of the claimed bias and flaws with the World Health Organizations Rankings?
You know, those rankings that came with the "World Health Report 2000".
The oft cited report that ranks France as first, Spain as Seventh, Japan as Tenth and the United States as Thirty-seventh?
I ask because even though they are from 2000, they seem to get thrown out a lot in discussions of health-care to try and substantiate, and in support of, more government involvement and control.
When in all reality, the Rankings were flawed and outright biased from the start.
So I am wondering if you were aware that the claims were flawed and biased?
Please read the following information and answer two of the poll questions.
The Worst Study Ever?
Scott W. Atlas — April 2011
In fact, World Health Report 2000 was an intellectual fraud of historic consequence—a profoundly deceptive document that is only marginally a measure of health-care performance at all. The report’s true achievement was to rank countries according to their alignment with a specific political and economic ideal—socialized medicine—and then claim it was an objective measure of “quality.”« The Worst Study Ever? Commentary Magazine
But even if you dismiss all that, the unreliability of World Health Report 2000 becomes inarguable once you confront the sources of the data used. In the study, WHO acknowledged that it “adjusted scores for overall responsiveness, as well as a measure of fairness based on the informants’ views as to which groups are most often discriminated against in a country’s population and on how large those groups are” [emphasis added]. A second survey of about 1,000 “informants” generated opinions about the relative importance of the factors in the index, which were then used to calculate an overall score.
The report’s margin of error is similarly ludicrous in scientific terms. The margin for error in its data falls outside any respectable form of reporting. For example, its data for any given country were “estimated to have an 80 percent probability of falling within the uncertainty interval, with chances of 10 percent each of falling below the low value or above the high one.” Thus, as Whitman noted, in one category—the “overall attainment” index—the U.S. could actually rank anywhere from seventh to 24th. Such a wide variation renders the category itself meaningless and comparisons with other countries invalid.
And then there is the plain fact that much of the necessary data to determine a nation’s health-care performance were simply missing. The WHO report stated that data was used “to calculate measures of attainment for the countries where information could be obtained . . . to estimate values when particular numbers were judged unreliable, and to estimate attainment and performance for all other Member States.”
About the Author
Scott W. Atlas is a senior fellow at the Hoover Institution and professor of radiology and chief of neuroradiology at the Stanford University Medical Center.
World Health Organization ranking of health systems
The rankings are based on an index of five factors:
- Health (50%) : disability-adjusted life expectancy
- Overall or average : 25%
- Distribution or equality : 25%
- Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities
- Overall or average : 12.5%
- Distribution or equality : 12.5%
- Fair financial contribution : 25%
[...] Dr Richard G. Fessler called the rankings "misleading" and said that tens of thousands of foreigners travel to the United States every year for care. In addition, he claims that the United States leads the world in survival rates for 13 of the 16 most common types of cancer. He also noted that the financial fairness measure was automatically designed to "make countries that rely on free market incentives look inferior". Dr Philip Musgrove wrote that the rankings are meaningless because they oversimplify: "numbers confer a spurious precision".[...]
Journalist John Stossel notes that the use of life expectancy figures is misleading and the life expectancy in the United States is held down by homicides, accidents, poor diet, and lack of exercise. When controlled for these facts, Stossel claims that American life expectancy is actually one of the highest in the world. A publication by the right-wing Pacific Research Institute in 2006 claims to have found that Americans outlive people in every other Western country, when controlled for homicides and car accidents. Stossel also criticizes the ranking for favoring socialized healthcare, noting that "a country with high-quality care overall but 'unequal distribution' would rank below a country with lower quality care but equal distribution."
Glen Whitman claims that "it looks an awful lot like someone cherry-picked the results to make the U.S.'s relative performance look worse than it is." He also notes that the rankings favor countries where individuals or families spend little of their income directly on health care. In an article in The American Spectator, Whitman notes how the rankings favor government intervention, which has nothing to do with quality of care. The rankings assume literacy rate is indicative of healthcare, but ignore many factors, such as tobacco use, nutrition, and luck. Regarding the distribution factors, Whitman says "neither measures healthcare performance" since a "healthcare system [can be] characterized by both extensive inequality and good care for everyone." If healthcare improves for one group, but remains the same for the rest of the population, that would mean an increase in inequality, despite there being an improvement in quality. Dr Fessler echoed these sentiments.
World Health Organization ranking of health systems - Wikipedia, the free encyclopedia
Health Care System Rankings
N Engl J Med 2010; 362:1546-1547 April 22, 2010
To the Editor:
In their Perspective article (Jan. 14 issue),1 Murray and Frenk review a number of indicators of the relatively poor state of the population's health in the United States. Most, if not all, of this information is well known to readers of the Journal, and the authors' use of it is not objectionable. However, Murray and Frenk begin their discussion by referring to the World Health Report 2000, Health Systems: Improving Performance, from the World Health Organization (WHO), which ranked the U.S. health care system 37th in the world, and this is objectionable. (I was editor-in-chief of the World Health Report 2000 but had no control over the rankings of health systems.) Fully 61% of the numbers that went into that ranking exercise were not observed but simply imputed from regressions based on as few as 30 actual estimates from among the 191 WHO member countries. Where the United States is concerned, data were available only for life expectancy and child survival, which together account for only 50% of the attainment measure. Moreover, the “responsiveness” component of attainment cannot be compared across countries, and the estimates of responsiveness for some countries were manipulated. This is not simply a problem of incomplete, inaccurate, or noncomparable data; there are also sound reasons to mistrust the conceptual framework behind the estimates, since it presupposes a production function for health system outcomes that depends only on a country's expenditure on health and its level of schooling, ignoring all cultural, geographic, and historical factors.2
The number 37 is meaningless, but it continues to be cited, for four reasons. First, people would like to trust the WHO and presume that the organization must know what it is talking about. Second, very few people are aware of the reason why in this case that trust is misplaced, partly because the explanation was published 3 years after the report containing the ranking. Third, numbers confer a spurious precision, appealing even to people who have no idea where the numbers came from. Finally, those persons responsible for the number continue to peddle it anyway. To quote Wolfgang Pauli's dismissal of a theory opposed to quantum mechanics, “Not only is it not right, it's not even wrong!” Analyzing the failings of health systems can be valuable; making up rankings among them is not. It is long past time for this zombie number to disappear from circulation.
Philip Musgrove, Ph.D.
, Bethesda, MD
Health Care System Rankings - NEJM
Why the U.S. Ranks Low on WHO's Health-Care Study
By John Stossel
August 22, 2007
So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways.
The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.
Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.
RealClearPolitics - Articles - Why the U.S. Ranks Low on WHO's Health-Care Study
Trouble in the Ranks
How the World Health Organization unfairly evaluates national health care systems
Associate Professor of Economics
California State University
- “The WHO rankings include factors that are arguably unrelated to actual health performance, some of which could even improve in response to worse health performance.”
- “To use the existing WHO rankings to justify more government involvement in health care is to engage in circular reasoning because the rankings are designed in a manner that favours greater government involvement.”
- “There is good reason to account for the quality of care received by a country’s worst-off or poorest citizens. Yet the Health Distribution and Responsiveness Distribution factors do not do that.”
Trouble in the Ranks
How the World Health Organization unfairly evaluates national health care systems