The World Health Organization

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 (WHO) ranked the healthcare systems of its 191 member states in its World Health Report

World Health Report

The World Health Report is a series of reports produced regularly by the World Health Organization . First published in 1995, the World Health Report is WHO's leading publication...

 2000. It provided a framework and measurement approach to examine and compare aspects of health system

Health system

A health system can be defined as the structured and interrelated set of all actors and institutions contributing to health improvement. The health system boundaries could then be referred to the concept of health action, which is "any set of activities whose primary intent is to improve or...

s around the world. It developed a series of performance indicators to assess the overall level and distribution of health

Health

Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...

 in the populations, and the responsiveness and financing of health care

Health care

Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...

 services. It was the organization's first ever analysis of the world's health systems, but has been subject to criticism of its usefulness and methodology.

Ranking

Data from 1997 was used in the report.

Ranking	Country	Expenditure Per Capita
1	France France The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...	1
2	Italy Healthcare in Italy For a general article on health in Italy, see health in ItalyHealth care spending in Italy accounted for 9.0% of GDP in 2006 of which about 75% is public, slightly more than the average of 8.9% inOECD countries....	11
3	San Marino San Marino San Marino, officially the Republic of San Marino , is a state situated on the Italian Peninsula on the eastern side of the Apennine Mountains. It is an enclave surrounded by Italy. Its size is just over with an estimated population of over 30,000. Its capital is the City of San Marino...	21
4	Andorra	23
5	Malta	37
6	Singapore Health care in Singapore Healthcare in Singapore is mainly under the responsibility of the Singapore Government's Ministry of Health. Singapore generally has an efficient and widespread system of healthcare...	38
7	Spain	24
8	Oman Healthcare in Oman Omani nationals have free access to the country's public health care, though expatriates typically seek medical care in private sector clinics and hospitals . Generally, the standard of care in the public sector is high for a middle income country. The country now has very low rate of disease once...	62
9	Austria	6
10	Japan Health care in Japan The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%...	13
11	Norway	16
12	Portugal	28
13	Monaco	12
14	Greece	30
15	Iceland Healthcare in Iceland Iceland has universal health care. The health care system is largely paid for by taxes and to some extent by service fees and is administrated by The Ministry of Welfare...	14
16	Luxembourg	5
17	Netherlands Health care in the Netherlands Healthcare in the Netherlands is financed by a dual system that came into effect in January 2006. Long-term treatments, especially those that involve semi-permanent hospitalization, and also disability costs such as wheelchairs, are covered by a state-controlled mandatory insurance...	9
18	United Kingdom Healthcare in England Healthcare in England is mainly provided by England's public health service, the National Health Service, that provides healthcare to all permanent residents of the United Kingdom that is free at the point of use and paid for from general taxation. Since health is a devolved matter, there are...	26
19	Ireland	25
20	Switzerland Healthcare in Switzerland Healthcare in Switzerland is universal and is regulated by the Federal Health Insurance Act of 1994 . Health insurance is compulsory for all persons residing in Switzerland...	2
21	Belgium	15
22	Colombia Health care in Colombia Health care in Colombia refers to the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing, and allied health professions in the Republic of Colombia....	49
23	Sweden Healthcare in Sweden The Swedish health care system is mainly government-funded and decentralized, although private health care also exists. The health care system in Sweden is financed primarily through taxes levied by county councils and municipalities....	7
24	Cyprus	39
25	Germany	3
26	Saudi Arabia Healthcare in Saudi Arabia The healthcare system in Saudi Arabia can be classified as a national health care system in which the government provides health care services through a number of government agencies...	63
27	United Arab Emirates	35
28	Israel Health care in Israel Health care in Israel is universal and participation in a medical insurance plan is compulsory. Health care coverage is administered by a small number of organizations, with funding from the government...	19
29	Morocco	99
30	Canada Health care in Canada Health care in Canada is delivered through a publicly-funded health care system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act. The government assures the quality of care through federal standards...	10
31	Finland Healthcare in Finland Finland has a highly decentralized three level publicly funded system of health care and alongside these, a much smaller private health care system. Responsibility for health care is devolved to the municipalities .-Health standards:...	18
32	Australia Health care in Australia Health care in Australia is provided by both private and government institutions. The Minister for Health and Ageing, currently Nicola Roxon, administers national health policy...	17
33	Chile	44
34	Denmark	8
35	Dominica	70
36	Costa Rica Health care in Costa Rica Costa Rica provides universal health care to its citizens and permanent residents.Costa Rica is also a popular destination for medical tourism.It has three internationally-accredited private hospitals.-References:...	50
37	United States Health care in the United States Health care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector...	1
38	Slovenia	29
39	Cuba	118
40	Brunei	32
41	New Zealand Health care in New Zealand The healthcare system of New Zealand has undergone significant changes throughout the past several decades. From an essentially fully public system in the early 20th century, reforms have introduced market and health insurance elements primarily in the last three decades, creating a mixed...	20
42	Bahrain	48
43	Independent State of Croatia	56
44	Qatar	27
45	Kuwait	41
46	Barbados	36
47	Thailand	64
48	Czech Republic	40
49	Malaysia Healthcare in Malaysia Healthcare in Malaysia is mainly under the responsibility of the government's Ministry of Health. Malaysia generally has an efficient and widespread system of health care, operating a two-tier health care system consisting of both a government-run universal healthcare system and a co-existing...	93
50	Poland	58
51	Dominican Republic
52	Tunisia
53	Jamaica
54	Venezuela
55	Albania
56	Seychelles
57	Paraguay
58	South Korea
59	Senegal
60	Philippines
61	Mexico Health care in Mexico Health care in Mexico is provided via public institutions, private entities, or private physicians. Health care delivered through private health care organizations operates entirely on the free-market system, i.e., it is available to those who can afford it. This is also the case of health care...
62	Slovakia
63	Egypt
64	Kazakhstan
65	Uruguay
66	Hungary
67	Trinidad and Tobago Health care in Trinidad and Tobago Trinidad and Tobago operates under a two-tier health care system. That is, there is the existence of both private health care facilities and public health care facilities....
68	Saint Lucia
69	Belize
70	Turkey Health care in Turkey Health care in Turkey used to be dominated by a centralized state system run by the Ministry of Health. In 2003 the governing Justice and Development Party introduced a sweeping health reform program aimed at increasing the ratio of private to state health provision and making health care available...
71	Nicaragua
72	Belarus
73	Lithuania
74	Saint Vincent and the Grenadines
75	Argentina Health care in Argentina Argentina’s health care system is composed of three sectors: the public sector, financed through taxes; the private sector, financed through voluntary insurance schemes; and the social security sector, financed through obligatory insurance schemes...
76	Sri Lanka
77	Estonia
78	Guatemala
79	Ukraine
80	Solomon Islands
81	Algeria
82	Palau
83	Jordan
84	Mauritius
85	Grenada
86	Antigua and Barbuda Health care in Antigua and Barbuda In Antigua and Barbuda, four institutions are maintained for the care of the sick and aged. Holberton Hospital, with 135 beds, is the only public acute care facility. The only private hospital is Adelin Medical Center. Other facilities include the Fiennes Institute for the aged, with 100 beds,and...
87	Libya
88	Bangladesh
89	Republic of Macedonia
90	Bosnia and Herzegovina
91	Lebanon
92	Indonesia
93	Iran Health care in Iran Health care in Iran and medical sector's market value was almost US $24 billion in 2002 and was forecast to rise to US $31 billion by 2007. With a population of almost 70 million, Iran is one of the most populous countries in the Middle East...
94	The Bahamas
95	Panama
96	Fiji
97	Benin
98	Nauru
99	Romania Healthcare in Romania Health care in Romania has lower standards than in the rest of the Union. Although everyone in the urban area has access to fast medical assistance, in some rural areas access may be limited. For 2012, the allocated budget spending in the healthcare sector is 12 billion €, or roughly 5% of the GDP....
100	Saint Kitts and Nevis
101	Moldova
102	Bulgaria
103	Iraq
104	Armenia
105	Latvia
106	Kingdom of Yugoslavia
107	Cook Islands
108	Syria
109	Azerbaijan
110	Suriname
111	Ecuador
112	India Healthcare in India Healthcare in India features a universal health care system run by the constituent states and territories of India. The Constitution charges every state with "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties"...
113	Cape Verde
114	Georgia
115	El Salvador
116	Tonga
117	Uzbekistan
118	Comoros
119	Samoa
120	Yemen
121	Niue
122	Pakistan Health care in Pakistan Health care in Pakistan is administered by Ministry of Health. Like other South Asian countries, health and sanitation infrastructure is adequate in urban areas but is generally poor in rural areas...
123	Federated States of Micronesia
124	Bhutan
125	Brazil
126	Bolivia
127	Vanuatu
128	Guyana
129	Peru
130	Russia
131	Honduras
132	Burkina Faso
133	São Tomé and Príncipe
134	Sudan
135	Ghana
136	Tuvalu
137	Côte d'Ivoire
138	Haiti
139	Gabon
140	Kenya Healthcare in Kenya Kenya’s health care system is structured in a step-wise manner so that complicated cases are referred to a higher level. Gaps in the system are filled by private and church run units...
141	Marshall Islands
142	Kiribati
143	Burundi
144	People's Republic of China
145	Mongolia
146	The Gambia
147	Maldives
148	Papua New Guinea
149	Uganda
150	Nepal
151	Kyrgyzstan
152	Togo
153	Turkmenistan
154	Tajikistan
155	Zimbabwe
156	Tanzania
157	Djibouti
158	Eritrea
159	Madagascar
160	Vietnam
161	Guinea
162	Mauritania
163	Mali
164	Cameroon
165	Laos
166	Republic of the Congo
167	North Korea
168	Namibia
169	Botswana
170	Niger
171	Equatorial Guinea
172	Rwanda
173	Afghanistan
174	Cambodia
175	South Africa
176	Guinea-Bissau
177	Swaziland
178	Chad
179	Somalia
180	Ethiopia
181	Angola
182	Zambia
183	Lesotho
184	Mozambique
185	Malawi
186	Liberia
187	Nigeria Health care in Nigeria Health care provision in Nigeria is a concurrent responsibility of the three tiers of government in the country. However, because Nigeria operates a mixed economy, private providers of health care have a visible role to play in health care delivery...
188	Democratic Republic of the Congo
189	Central African Republic
190	Myanmar

Methodology

The rankings are based on an index of five factors:

• Health level (25%): disability-adjusted life expectancy
  Life expectancy
  Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
  
  
• Responsiveness (12.5%): speed of service, protection of privacy, and quality of amenities
• Financial fairness (25%): inequality in percentage of household income spent on healthcare
• Health distribution (25%): inequality in health level
• Responsiveness distribution (12.5%): inequality in responsiveness

Criticism

The WHO rankings have been subject to much criticism concerning their methodology, scientificness, and usefulness. Dr Richard G. Fessler called the rankings "misleading" and said that tens of thousands of foreigners travel to the United States every year for care. In addition, the United States leads the world in survival rates for 13 of the 16 most common types of cancer

Cancer

Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

. He also noted that the financial fairness measure was automatically designed to "make countries that rely on free market incentives look inferior". Dr Philip Musgrove wrote in the New England Journal of Medicine

New England Journal of Medicine

The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...

 that the rankings are meaningless and misleading because they oversimplify: "numbers confer a spurious precision".

Journalist John Stossel

John Stossel

John F. Stossel is an American consumer reporter, investigative journalist, author and libertarian columnist. In October 2009 Stossel left his long time home on ABC News to join the Fox Business Channel and Fox News Channel, both owned and operated by News Corp...

 notes that the use of life expectancy

Life expectancy

Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...

 figures is misleading and the life expectancy in the United States

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 is held down by homicides, accidents, poor diet, and lack of exercise. When controlled for these facts, Stossel claims that American life expectancy is actually one of the highest in the world. A study published in 2006 found that Americans outlive people in every other Western country, when controlled for homicides and car accidents. Stossel also criticizes the ranking for favoring socialized healthcare, noting that "a country with high-quality care overall but 'unequal distribution' would rank below a country with lower quality care but equal distribution."

Economics professor Glen Whitman claims that "it looks an awful lot like someone cherry-picked the results to make the U.S.’s relative performance look worse than it is." He also notes that the rankings favor countries where individuals or families spend little of their income directly on health care. In an article in The American Spectator

The American Spectator

The American Spectator is a conservative U.S. monthly magazine covering news and politics, edited by R. Emmett Tyrrell Jr. and published by the non-profit American Spectator Foundation. From its founding in 1967 until the late 1980s, the small-circulation magazine featured the writings of authors...

, Whitman notes how the rankings favor government intervention, which has nothing to do with quality of care. The rankings assume literacy rate is indicative of healthcare, but ignore many factors, such as tobacco use, nutrition, and luck. Regarding the distribution factors, Whitman says "neither measures healthcare performance" since a "healthcare system [can be] characterized by both extensive inequality and good care for everyone." If healthcare improves for one group, but remains the same for the rest of the population, that would mean an increase in inequality, despite there being an improvement in quality. Dr Fessler echoed these sentiments.

See also

• Comparison of Canadian and American health care systems
• Health care systems#Cross-country comparisons