Sicko Revisited

[mrick]

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Well I'm convinced. No room for subjectivity here.

[/ QUOTE ]Well I presume you are being sarcastic. So let me quote what the criteria are all about and you make the call :


DALE : straightforward data.

Distribution of same : straightforward stat application.

Responsiveness : includes two major components. These are (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). (BTW, the United States got top marks in this category.)

Distribution of same : straightforward stat application.

Fairness in financial contribution : based on the fraction of a household’s capacity to spend (income minus food expenditure) that goes on health care (including tax payments, social insurance, private insurance and out of pocket payments).

Health expenditure per capita in international dollars : straightforward data.

For more information, check out the links:

W.H.O. rankings spreadsheet
W.H.O. Statistical Annex : Explanatory notes (in .pdf)

[xorbie]

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Well I'm convinced. No room for subjectivity here.

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It must be convenient to set impossible standards and disregard anything that doesn't meet them...

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Well if you can prove logically that state healthcare inevitable is worse than non state healthcare and the only "evidence" against this comes from subjective nonsense lists I don't see where the problem is. Why is it bad to have objective proof as a standard? We're talking about Hundreds of billions of dollars of stolen money here why can't we be certain before we advocate such widescale theft?

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What would constitude "objective proof"? We can't have it because it doesn't exist; any seriously meaningful criteria of healthcare is going to have some subjectivity.

[TomCollins]

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BTW, here are the 8 criteria for the World Health Organization rankings :

- Disability-adjusted life expectency (DALE) level
- DALE distribution among the population
- Level of system's responsiveness
- Distribution of same
- Fairness in financial contribution
- Health expenditure per capita in international dollars
- Performance on level of health
- Overall health system performance

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When you rig a rating system such that socialized systems will automatically come out on top, you can guess the results. The WHO ranking means about as much to me as the BCS computer rankings do to people who actually know about college football.

[adios]

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[ QUOTE ]
BTW, here are the 8 criteria for the World Health Organization rankings :

- Disability-adjusted life expectency (DALE) level
- DALE distribution among the population
- Level of system's responsiveness
- Distribution of same
- Fairness in financial contribution
- Health expenditure per capita in international dollars
- Performance on level of health
- Overall health system performance

[/ QUOTE ]

When you rig a rating system such that socialized systems will automatically come out on top, you can guess the results. The WHO ranking means about as much to me as the BCS computer rankings do to people who actually know about college football.

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Right a rating system IMO isn't really a good way to evaluate the pros and cons of a heathcare system. However, we shouldn't be too quick in defending the U.S. healthcare system. I went to an emergency room about a year ago or so for a minor injury to make sure it wasn't more serious than it was (get an xray for possible broken bones). My perspective was that my being a paying customer (I have health insurance) wasn't all that common but much appreciated. I was told by one of the people treating me that the system was totally broken. Didn't pursue it too much. I got the impression that the laws in the U.S. requiring people showing up in emegency rooms to be treated irregardless of their ability to pay was a major contributing factor. Could be convinced otherwise though.

[tolbiny]

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BTW, here are the 8 criteria for the World Health Organization rankings :

- Disability-adjusted life expectency (DALE) level
- DALE distribution among the population
- Level of system's responsiveness
- Distribution of same
- Fairness in financial contribution
- Health expenditure per capita in international dollars
- Performance on level of health
- Overall health system performance

[/ QUOTE ]

When you rig a rating system such that socialized systems will automatically come out on top, you can guess the results. The WHO ranking means about as much to me as the BCS computer rankings do to people who actually know about college football.

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Just to make it clear why "fairness of financial contribution" is such a horrible metric imagine this. Imagine I am king of a small island and set up a "health care system" where the rich pay a large % and the poor pay a small percent. The entire health care system is nothing more than a handful of offices where every single health care complaint is denied. This would be a system under which there was zero medical assistance provided, and yet Our system could score full points in at least one section, and depending on how they measure distribution as long as there were enough offices denying claims we could actually design a health system that scores perfectly in two categories without actually having a single doctor, nurse or shaman living on the island.

If you think this is far fetched here are the rankings for the US v Columbia

Dale (l) - US 24, C 74
Distribution - US 32, C 44

REsponsiveness- US 1, C 82
Distribution - US 3-38, C 93-94

Fairness of financial contribution
US 54-55
C 1

Overall goal attainment
US 15
C 41


US final rank- 37, Columbia-22. Thats right, the US ranks higher is responsiveness, distribution, life expectancy, and overall goal achievement, and is RANKED 15 PLACES LOWER because Colombia's system has better "fairness of financial contribution" according to the WHO.

EDIT: One sec, I am unclear as to what they do with $/capita

[tame_deuces]

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[ QUOTE ]
BTW, here are the 8 criteria for the World Health Organization rankings :

- Disability-adjusted life expectency (DALE) level
- DALE distribution among the population
- Level of system's responsiveness
- Distribution of same
- Fairness in financial contribution
- Health expenditure per capita in international dollars
- Performance on level of health
- Overall health system performance

[/ QUOTE ]

When you rig a rating system such that socialized systems will automatically come out on top, you can guess the results. The WHO ranking means about as much to me as the BCS computer rankings do to people who actually know about college football.

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The US spends more per capita on healthcare than any other nation, and yet you claim these highlights are in favor of the socialized healthcares?

Its true that the financial fairness number will skewer the statistics in favor of universal health care, but The US also scores low on efficiency and quality and generally report poorer health overall for the populace than many other first world nations. There are some brilliant hospitals over there, and the elite of your medicine academical groups are the best in the world so lack of skill is obviously not the issue.

[tolbiny]

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Its true that the financial fairness number will skewer the statistics in favor of universal health care, but The US also scores low on efficiency and quality and generally report poorer health overall for the populace than many other first world nations. There are some brilliant hospitals over there, and the elite of your medicine academical groups are the best in the world so lack of skill is obviously not the issue.

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I replied to this study a few months ago in a longer post and will summarize here and try to find it later.

Most of the the things used as criteria don't actually measure health care quality directly. I already did the fairness of financial contribution above.

- Disability-adjusted life expectency (DALE) level

Someone else noted in this thread that life expectancy is based upon so many things other than health care quality. The murder rate, size of cars on the road, smoking habits, how infant mortality is calculated, obesity levels, climate conditions, pollution levels, genetic predisposition of the populace, immigration patterns, water quality, do I need to go on? Is it really a surprise that you get higher life expectancy in a near ideal climate like Spain's when compared to Norway?

Distribution. If you look at the basic description you would come to the conclusion that a country with a life expectancy breakdown of 81/77/73 for the Upper, middle and lower classes would score worse than one that had a 73/72/71 break down. Does this have to do with the health care system itself? What about the breakdown of economic status in the country as a whole? There are three sections of scoring that depend entirely upon the WHO's definition of "fair", and add nothing to the "quality of health care" issue.

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Level of system's responsiveness

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Responsiveness includes two major components. These are (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider).

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OK, this is the first metric that attempts to directly measure a health care system, its not prefect, but lets call it a start. Do you want to guess what country is number 1 here?

[xorbie]

tolbiny,

I agree that responsiveness should be given a much higher weighting than the others (although I'm not sure whether it measures responsiveness for ALL people or just those who actually receive care - a crucal distinction). Do you agree that it isn't the only measure?

I'd say the US should probably be higher in the list obviously, but #1 is not accurate either.

[TomCollins]

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BTW, here are the 8 criteria for the World Health Organization rankings :

- Disability-adjusted life expectency (DALE) level
- DALE distribution among the population
- Level of system's responsiveness
- Distribution of same
- Fairness in financial contribution
- Health expenditure per capita in international dollars
- Performance on level of health
- Overall health system performance

[/ QUOTE ]

When you rig a rating system such that socialized systems will automatically come out on top, you can guess the results. The WHO ranking means about as much to me as the BCS computer rankings do to people who actually know about college football.

[/ QUOTE ]

The US spends more per capita on healthcare than any other nation, and yet you claim these highlights are in favor of the socialized healthcares?

Its true that the financial fairness number will skewer the statistics in favor of universal health care, but The US also scores low on efficiency and quality and generally report poorer health overall for the populace than many other first world nations. There are some brilliant hospitals over there, and the elite of your medicine academical groups are the best in the world so lack of skill is obviously not the issue.

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Usually its viewed as a negative by these people- the less you spend the better. If it is the opposite, I highly doubt the US would have finished so low.

Imagine if I wanted to prove that having low taxes was better for the economy than having high taxes. I cite a study that ranks economies and it uses the criteria "Tax rate" as a major factor. Does this not seem asinine?

This is even worse since it labels it as health care quality, not "my subjective opinion on what makes good health care". Fairness is a loaded word as well in this case. There is no universal concept of what is fair here. Some people may think fair is only if everyone pays the same rate as someone else. Someone else might think fair is if poor people get their health care paid for by someone else. Per Capita spending is useless unless you compare it to what you get. Its easy to drop this down by just not spending ANY money on health care and imprisoning all doctors. Do you really think this is a better system because per capita spending is down?

[tolbiny]

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I agree that responsiveness should be given a much higher weighting than the others (although I'm not sure whether it measures responsiveness for ALL people or just those who actually receive care - a crucal distinction). Do you agree that it isn't the only measure?

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Yes I agree. The point is though that this is the only metric in the study that attempts to measure the quality of health care directly, while the other metrics either don't measure health care at all or don't include any discussion of attempts to normalize for different populations, economic distribution, cultural factors, climate or any of a hundred different things that could alter results. Because of this I consider the overall conclusions and final rankings of this report to be not at all indicative of the quality of health care in these countries.