The 37th place ranking of the United States' health care system by the World Health Organization (W.H.O.) is not an assessment of the quality of American health care, but rather expresses the organization's preference for public financing of health care, says Twila Brase, president of the Citizens' Council on Health Care.

• The W.H.O.'s June 2000 report, "The World Health Report 2000-Health Systems: Improving Performance," finds the United States ranked number one, out of 191 countries surveyed, in responsiveness to patient's needs for choice of provider, dignity, autonomy, timely care and confidentiality.

• However, the W.H.O. faulted the U.S. for not requiring mandatory health insurance or offering social welfare programs to all citizens -- thereby failing to meet the WHO's fairness and distribution goals relative to total health-care resources.

• Fifty-six percent of all American health care expenditures are privately financed -- whereas the majority of health care is government-financed in other developed countries.

• The U.S. was also faulted for experimenting with medical savings accounts; W.H.O. says MSAs encourage fee-for-service payments, making it difficult to regulate and control the treatment practices of health care providers and preventing centralized pooling of dollars.

W.H.O., which currently receives $96 million from American taxpayers -- roughly 25 percent of its general budget -- recommends explicit health care rationing policies, centralized prepayment systems for health care based on household income after anticipated food expenses are subtracted, the placement of health at the center of a worldwide development agenda, and equitable development across and within countries.

Source: Twila Brase, R.N., P.H.N. (president, Citizens' Council on Health Care), "WHO's Hidden Agenda," Ideas on Liberty, December 2000, The Foundation for Economic Education, Inc., 30 South Broadway, Irvington-on-Hudson, N.Y. 10533, (914) 591-7230.

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