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And below, an article of the NY Times concerning Europe's health care performances
Europeans Perform Highest In Ranking of World Health - New York Times Europeans Perform Highest In Ranking of World Health By PHILIP J. HILTS Published: June 21, 2000 The World Health Organization issued figures yesterday that rank health care systems around the world for the first time. They indicate that European health systems are generally performing best and that the United States is lagging behind, largely because of inequal distribution of health care services. The rankings are contained in the World Health Report 2000. The report measured not just overall spending on health but also how health care was distributed among different groups in each of the 191 nations that are members of the World Health Organization. The countries were judged according to five health-care categories that W.H.O surveys found to be most important to the people in various nations. Until now, argument over how well health systems and policies are working has been based on anecdotes and fractional bits of data, said Dr. Jeffrey Koplan, director of the United States Centers for Disease Control and Prevention. He said the report was the first attempt to put the arguments on a factual footing. According to the report, the five top nations for health care were France, Italy, San Marino, Andorra and Malta. One surprise in the findings, said Dr. David Evans of the W.H.O.'s Global Program on Evidence for Health Policy, was the good rankings for southern European countries such as Italy and Spain. ''People in those countries don't believe their health systems are doing very well,'' he said. Oman ranked No. 8, a surprise because its health care system was in a shambles in the 1970's, with very high infant mortality, and because it has a relatively small budget for health. Its spending per capita on health is one-ninth of that of the United States, for example. Dr. Christopher J. L. Murray, an international health economist from the Harvard School of Public Health, who is one of two leaders of the project, said Oman demonstrates that great changes in a country's health can be produced in a short period of time. Another surprise was China's ranking of No. 144. A little more than a decade ago, China had a public health care system, but it has collapsed, and now people there pay for virtually all their care out of pocket. It was ranked No. 188 in fairness of financing. The United States outspends the world and ranks near the top in average health measures, but fails to deliver good health care to a large proportion of its population and distributes the cost relatively unfairly, according to the report's measures, leaving it at number 37 in the rankings. Using the measure ''health life expectancy'' -- that is, life expectancy minus years of sickness and disability, there are counties in the United States where Native American children at birth can look forward to only about 50 years of health life on average, while some Asian minorities in suburban New York can expect more than 90 years of healthy life, Dr. Murray said. The report demonstrates, Dr. Murray said, ''that no one model is best, but the numbers will give us the means over time to test which innovation in health systems work best and which are failing.'' The new rating system bases national scores on five measures, and in producing a ranking takes into account the financial resources it has available. The five measures used are: overall level of health or life expectancy; health fairness or life expectancy as measured across various populations within a country; responsiveness or how well people rated performance of their health care system; fairness in responsiveness among different groups in the same country; and fairness in financing among different groups, which looked at what proportion of income is devoted to health care.
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