World Health System
Ranking Reveals Surprises
Excerpt By Ray Dunne, Reuters Health Writer

LONDON (Reuters Health) - Some of the world's poorest and least developed countries have health systems that are in some ways better run than those in many Western countries, according to a report from the World Health Organisation (WHO).

The comparison of 191 country's health systems, published in the August 11th issue of the British Medical Journal, shows significant variations across the world. Oman has the most ''efficient'' health system in the world in terms of outcome while countries in sub-Saharan Africa have the worst performance records, according the WHO analysis.

It also suggests that countries like Malta, Jamaica and Morocco provide more efficient healthcare than the UK, Canada and the US. The report ranks the UK 24th, Canada at 35 and the US at 72.

The researchers assessed the efficiency of healthcare systems by comparing the amount of money spent with the outcome in terms of improving life expectancy.

The authors suggest that Oman's top ranking could be attributed to the fact that it had drastically reduced child mortality over the past 40 years, cutting rates from 310 to 18 per 1,000 live births.

Similarly, poor health records in countries like Zimbabwe--ranked 191st--Zambia and the Democratic Republic of Congo could be attributed to a record of civil unrest and high rates of HIV and AIDS.

The WHO report notes that improvements in the health of a population can be achieved in a number of different ways, not just by spending more on healthcare. It suggests that the healthy diet of Mediterranean countries is responsible for giving them a high ranking. Mediterranean countries, including Italy and Spain, occupy six of the seven top places.

However, the authors suggest that government spending is an important factor. Writing in the journal, David Evans of the WHO states: ``We found that efficiency is positively related to health expenditure per capita. Performance increased greatly with expenditure up to about $80 per capita a year, suggesting it is difficult to be efficient at low expenditure.''

Evans added that some countries, in particular the US and sub-Sahara African states, could improve the effectiveness of their systems by reallocating money for schemes that are not cost-effective to schemes that provide a good return in terms of improving people's health.

In an accompanying editorial, Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, welcomed the study but warned that it was difficult to make comparisons among individual countries.

``I think the idea of trying to assess the performance of healthcare systems in different countries is a good one and the work done in this paper is a good start,'' McKee said in an interview with Reuters Health.

``But we should be careful reading into individual rankings and I would warn against any comparisons,'' he added. ``But certainly this report is a very good start in terms of enabling us to determine which countries have the most efficient health systems.''

McKee said it was important that countries were given an opportunity to compare their health policies but said more work needed to be done.

``It will enable countries and governments to learn from those that are better. There is a quest for comparison, in the same way as we compare the economic performance or literacy levels of countries.''

SOURCE: British Medical Journal 2001;232:307-310,295-296.

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