| They're lying to you, you know |
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| Written by Tim Worstall | |
| Sunday, 15 June 2008 | |
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We tend to take international statistics as being both fair and true: those nice international bureaucrats are not subject to the stresses and strains of our nasty, brutish domestic politics after all. So if the OECD says that we should do something about poverty, or the UN Human Rights Commission says we must be more careful, then that's taken almost as being a statement which cannot be argued with in any way. That the OECD at times defines poverty as relative and thus they might be talking about inequality, or the UNHRC might be talking about positive liberties rather than negative, both of which subjects are very much part of our domestic political debate, seems to pass many by. Glenn Whitman has done a lot of work looking at one of these particular pronuciamentoes by such an international bureaucracy: the WHO's rankings of various health care systems. A brief overview here, the full paper here. These rankings are the ones that, for example, say that the US, for all the money it spends on health care, only ranks 37th in the world. France is rated best and our own dear NHS at 18th (that's from the 2000 version). The problem, as he explains it, is that the rankings are making a number of highly questionable value judgements rather than actually measuring anything so simple as the quality of the health care system at delivering treatment. The most obvious bias is that 62.5% of their weighting concerns not quality of service but equality. In other words, the rankings are less concerned with the ability of a health system to make sick people better than they are with the political consideration of achieving equal access and implementing state-controlled funding systems. The US does indeed have inequalites of access and of funding: but that's what this ranking method is measuring, not whether it makes sick people better or not. It's not much of a surprise really, when an index which is designed to make egalitarian systems look good makes inegalitarian ones look bad, now is it? But the really alarming thing is, our own dear NHS ticks all of the right boxes about equality of financing and of access. All and every one of them. So how come it's only 18th on the list? Is the actual service it provides really that appallingly bad by international standards? Sadly, I think we do have to say yes there. Comments (3)
Faults with Life Expectancy Figures
written by Julian H, June 16, 2008
Owen,
Life expectancy figures are not a reasonable measure of healthcare services as they are affected by factors exogenous to healthcare - such as drug consumption (including tobacco and alcohol), diet and even homicide rates. Thus one study corrected the life expectancy figures to allow for distortions in homicide and accident rates - and found that the USA then came out top. This is acknowledged by the OECD which refers to "numerous nonmedical factors ... that might affect variations in life expectancy across countries". The Guardian reported on a further correction done on the rankings due to over-reliance on life expectancy, this time by the London School of Hygiene and Tropical Medicine. The article said: "...the World Health Report received much criticism, with many saying it was misleading to look at deaths from all causes, no matter what the causes were." It continued: "Many said it would be more appropriate to look only at those deaths that were avoidable through timely and effective healthcare, such as some cancers and diabetes." Looking only at causes of death related to healthcare, the report showed "substantial" changes in the findings, with the lead Dr on the report describing the WHO rankings as "fragile". There exist much better means of evaluating healthcare systems such as disease-specific five-year survival rates. Julian
Citations written by Julian H, June 16, 2008
Sorry, that post was intended to come with links but they failed work. In order, the references are as follows:
Homicide & Accidents Study - http://www.aei.org/publication...detail.asp OECD Quotation - http://www.ingentaconnect.com/...8/8105171e Guardian article - http://www.guardian.co.uk/soci...eandhealth Write comment
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I've not seen much use made of the WHO rankings that are criticised here.
But life expectancy at birth does seem to be quite a good way of looking at the impact of health care systems, and there is no dodgy "equality" weighting there. The data are here:
http://www.oecd.org/document/30/0,3343,en_2649_37407_12968734_1_1_1_37407,00.html
The US spends more than twice the OECD average on health care and has a life expectancy below the OECD average. The UK spends a bit below the OECD average on health care and registers life expectancy above the OECD average, though behind France, Italy and Spain (all of which spend more, I believe).
To my mind, that suggests that there is something more effective about the UK system at turning money into health results than there is about the US system.
Owen