The U.N.’s Calculus of Well-Being
ROME — No one ever holds up Italy’s public hospitals as international models of excellence.
The biggest one, Umberto I Polyclinic in Rome, makes the wrong kind of headlines--as it did when six patients were blinded during routine cataract surgery in 1998. In Naples, emergency room nurses once made news for the unsanitary habit of bringing hot pizza to work in an ambulance.
So when the World Health Organization rated Italy’s state-run health care system second best in a recent 191-country survey, Italians treated the news more like Ripley’s Believe It Or Not than a source of national pride.
The newspaper Corriere della Sera began its report: “Whoever has waited six months for an electrocardiograph . . whoever has had brain surgery postponed twice at the last minute after being wheeled into the operating room . . . they won’t believe it.”
But health care is more than just what goes on in hospitals, and that’s the message of the Geneva-based organization’s first comparative survey of all national health systems.
WHO’s campaign to get policymakers thinking more broadly about how to improve a country’s well-being is as provocative as the survey’s results, which ranked France’s health system first and the United States’ 37th, behind those of such developing nations as Oman and Colombia.
As intended, WHO’s World Health Report 2000 has stirred lively debate among medical specialists on what factors should be weighed--from doctors to drugs to diets--in measuring a country’s health care performance.
Noting the high marks for France, Italy and Spain, “you might deduce that to have an excellent health system, all you needed was to drink lots of red wine and consume a good deal of olive oil,” WHO staff member Thomson Prentice said only partly in jest. Health officials in France and Italy heartily agree that their Mediterranean diet gives those countries an edge.
In fact, WHO’s rating system is complex.
Researchers calculated the average number of years each country’s people live in good health and rated the quality of medical attention according to various “consumer-oriented” criteria. The fairness of each system was gauged by an examination of variations in life expectancy among different social groups and of how much the poor pay out of pocket for medical treatment.
To calculate the efficiency of each country’s health system, researchers then measured its overall health attainment in these categories against per capita spending on health care. France and Italy were judged to produce the best results for the relatively little money they spend.
The United States finished far behind because it fails to deliver good health care to a large proportion of its population and distributes the cost unevenly, according to the survey’s measures.
Critics say WHO’s methodology puts too much weight on life expectancy, thereby overrating the importance of diet, lifestyle and other nonmedical factors that help people live longer. If WHO looked strictly at medical care, these critics note, the United States and the Scandinavian countries would rank higher.
Many doctors in France and Italy say that further improvement will result more from preventive health measures than from any care their profession administers to the sick.
In fact, a joke going around France predicts that if doctors there were to strike for a week, halting all risky medical procedures, the death rate would actually drop.
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Boudreaux reported from Rome and Dahlburg from Paris.
WHO’s World Health Report 2000 is on the Internet at https://www.who.int/whr/2000/en/report.htm
