NCPA - National Center for Policy Analysis

WHO's Wrong On Health? Right.

May 9, 2001

Does the U.S. rank 37th among nations in the world in the quality of health care? Actually, it received that ranking in "overall system performance," in a World Health Organization (WHO) report, "World Health Report 2000: Health Systems -- Improving Performance," which ranked health systems in 191 countries.

But other researchers criticize the WHO report for its eccentric methodology. For instance, its composite index of overall performance includes patient satisfaction and the accessibility of health care to low income and elderly people. But no actual patients or citizens of these countries were surveyed; rather, the report relied on a survey of public health experts, many of whom did not reside in the countries whose responsiveness to patients and the poor they were rating.

And when researchers compared the WHO rankings for 17 industrialized countries with the perceptions of their citizens recorded in a number of surveys, they found there was little relationship between the two measures. For instance,

  • The two countries rated most highly by the public -- Denmark and Finland -- rank at the bottom of the WHO ratings.
  • Italy is ranked second by WHO, but only 20 percent of its citizens say they are satisfied with their health care system.
  • Denmark is ranked 16th in the WHO overall performance measure, yet 91 percent of Danish citizens say they are satisfied with their health system.
  • WHO ranked Spain third among the industrialized countries, but it is 13th in rank measured by the satisfaction of its own citizens.

WHO ranked the U.S. 17th, and Canada 14th, in overall system performance among industrialized countries, while in citizens' satisfaction with health care, surveys show they rank 14th and 12th, respectively. But by another WHO measure, the health system's responsiveness to non-health needs, the U.S. ranks first and Canada 5th.

Source: Robert J. Blendon, Minah Kim and John M. Benson, "The Public Versus The World Health Organization On Health System Performance," Health Affairs, May-June 2001.

For Health Affairs text (free)


Browse more articles on Health Issues