|Neither Canada nor
Japan cracked the top 10, and the
United States finished a dismal
35th, according to a much anticipated ranking
of healthcare quality in 195 countries, released May
Among nations with more than a million souls, top honours for 2015 went to Switzerland,
followed by Sweden and
Norway, though the healthcare gold standard remains tiny Andorra, a
postage stamp of a country nestled between Spain
(No. 8) and France (No. 15).
Iceland (No. 2),
Australia (No. 6), Finland (No. 7), the
Netherlands (No. 9) and financial and banking
centre Luxembourg rounded out
the first 10 finishers, according to a
comprehensive study published in the medical journal
Of the 20 countries heading up the list, all but Australia and Japan (No.
11) are in western Europe, where virtually
every nation boasts some form of universal health coverage.
The United States—where a Republican Congress
wants to peel back reforms that gave millions of people access to health
insurance for the first time—ranked below Britain,
which placed 30th.
The Healthcare Access and Quality Index,
based on death rates for 32 diseases that can be avoided or effectively
treated with proper medical care, also tracked progress in each nation
compared to the benchmark year of 1990.
Virtually all countries improved over that period, but many—especially in
Africa and Oceania—fell
further behind others in providing basic care for their citizens.
With the exceptions of Afghanistan, Haiti and Yemen, the 30 countries at the
bottom of the ranking were all in sub-Saharan Africa,
with the Central African Republic suffering the
worst standards of all.
"Despite improvements in healthcare quality and access over
25 years, inequality between the best and worst performing countries has
grown," said Christopher Murray, director of the Institute for Health
Metrics and Evaluation at the University of Washington, and leader of a
consortium of hundreds of contributing experts.
A warning sign
Furthermore, he added in a statement, the standard of primary care was
lower in many nations than expected given levels of wealth and development.
The biggest underachievers in
Asia included Indonesia,
the Philippines, India
and tiny Brunei, while in
Africa it was Botswana,
South Africa and Lesotho
that had the most room for improvement. Regions with healthcare systems
underperforming relative to wealth included
Oceania, the Caribbean
and Central Asia.
Among rich nations, the worst offender in this
category was the United States, which
tops the world in per capita healthcare expenditure
by some measures.
Within Europe, Britain
ranked well below expected levels.
"The UK does well in some areas,
including cerebrovascular disease," noted co-author Marin McKee, a professor
at the London School of Hygiene and Tropical Medicine. "But it lags behind
in outcomes of some cancers."
The gap between actual and expected rating widened over the
last quarter century in 62 of the 195 nations examined.
"Overall, our results are a warning sign that heightened healthcare access
and quality is not an inevitable product of increased development," Murray
Between 1990 and 2015, countries that made the
biggest improvements in delivering healthcare included
South Korea, Turkey, Peru, China and the
The 32 diseases for which death rates were tracked included
tuberculosis and other respiratory infections; illnesses that can be
prevented with vaccines (diphtheria, whooping cough, tetanus and measles);
several forms of treatable cancer and heart disease; and maternal or
Read more at:
(Population 22.32 million, GDP US$1.379 trillion)
The state encourages wealthier individuals to
use a private system by enforcing an additional
1% tax on those who fall above a certain income level
but use the public system anyway. The fruits of the government’s
innovative techniques are evident in Australia’s death rate from conditions
amenable to medical care, which was a startling 50% less than
America’s in 2003 and 25% less than the
Sweden (Population 9.449
million, GDP US$539.7 billion)
Expenditures were as low as US$5,331 per capita in 2011? This
rate can in part be attributed to government initiatives in Sweden that
disincentivize sending patients to specialists when their illnesses can be
treated by general practitioners. The Swedish government’s success
with cost efficiency explains why even though
public funding accounts for 85% of total Swedish health expenditure, this
does not place an unreasonable constraint on taxpayers
or the government.
France (Population 65.43
million, GDP US$2.773 trillion)
Share of GDP spent on health care is 40% than
America's, but its public expenditure still accounts for an
incredible 79.1% of total healthcare spending. The way the
system works there is that a majority of medical bills are taken care of by
the government (funding for this comes from payroll and income taxes) and
the remaining expenses are paid for by the individual’s supplemental private
insurance. Every citizen is entitled to public coverage, and now illegal
immigrants are as well.
United Kingdom (Population
62.74 million, GDP US$2.445 trillion)
The U.S. and the UK may be just
a letter apart by name, but are worlds apart in terms of health care. In the
UK, the National Health Service (NHS) publicly covers various costs,
including preventative services and mental health care. About 88% of
prescriptions there are exempt from charges! Despite
American efforts to increase affordability and equity however,
the UK ranked first on indicators of
efficiency in the aforementioned Commonwealth
Fund study. America could learn a lesson or two
from its successes at cutting administrative costs and
closing loopholes that would otherwise cost the government millions.
Germany (Population 81.8
million, GDP US$3.601 trillion)
With the oldest universal health care system in the world, 90% of Germans
happily use the public system offered there, and just 10% of the population
voluntarily uses the private system.
Moving past the mythical tradeoff between time and cost,
Germany is one of the few countries to have quick access to specialty
services with very little out-of-pocket costs. Germany
spends around half as
much as America does on health care per
capita, with few differences in quality of services between the two
Netherlands (Population 16.69
million, GDP US$836.1 billion)
Interestingly, health insurance coverage is statutory in Holland, but
provided by private insurers competing for
business. Insurers can decide by whom and how the care is delivered, which,
to capitalists' great relief allows the insured to choose between
alternatives based on quality and costs. This system has proven to be
very effective. In 2010, 72% of
Dutch adults saw their doctor the same or next day when they were sick,
compared with only 57% of adults in America.
And, whereas one third of U.S. adults did not
see a doctor when sick, went without recommended care, or failed to fill
prescriptions due to costs, only 6% of adults in the Netherlands faced these
Canada (Population 34.48
million, GDP US$1.736 trillion)
In the realm of health care, America and its
neighbor couldn’t be more different. Canada’s national health care system
consists of a centralized body that sets standards that the 13 Canadian
provinces must follow to receive funding. Hospitals are mainly
private nonprofit organizations with their own
governance structures, lending Canada an interesting balance between
privatization and public ownership.