WHO reports seem to be mostly factual and their policies seem to be based on science.
"Based on science" isn't very meaningful. As for "factual" many of their points are matters of hard fact at all.
As CATO points out
The analysts behind the WHO rankings express the hope that their framework "will lay the basis for a shift from ideological discourse on health policy to a more empirical one." Yet the WHO rankings themselves have a strong ideological component. They include factors that are arguably unrelated to actual health performance, some of which could even improve in response to worse health performance. Even setting those concerns aside, the rankings are still highly sensitive to both measurement error and assumptions about the relative importance of the components. And finally, the WHO rankings reflect implicit value judgments and lifestyle preferences that differ among individuals and across countries.
cato.org
The biggest problem is that their data isn't that relevant to their overall claim. They rank health care systems but the quality of health care systems is not for the most part what they are measuring. (And even if they where, quality is not an issue of hard and simple facts, there is inherently a subjective element in such determinations.)
As Lane3 said in a post on this thread - "If the report was supposed to be about fish counts and the methodology called for giving credit for sea mammals and crustaceans, you don't have to even look at the numbers to report the flaw".
WHO's report gave was 62.5% determined by issues of "fairness" (25% Health Distribution" 25% "Financial fairness", Responsiveness Distribution: 12.5 percent). If things get better for everyone, but they improve most for those with more money, than these parts of the score would drop, even though the overall quality of the system went up.
Only a bit more than a third of the report's conclusions where based on measures of quality (Health Level: 25 percent, Responsiveness: 12.5 percent). And there are problems even with those categories. Health level is determined by many things besides the health care and health insurance systems. If Americans eat too much or don't exercise enough, or are more likely to die in accidents than say the Danish, that isn't an aspect of our health care system.
Responsiveness, depending on exactly how they determine it can be a pretty good measure, but its a measure where the US should do pretty well, but its only weighted 12.5%
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WHO is not measuring the quality of the health care system, but the quality of health care, plus the amount that the country lives up to what WHO thinks is its potential for quality health care, plus the equality of health care (and remember improving health care for some but not for others can make the equality worse, which hurts your score even though it improves your health care system). And if people in some countries have healthier habits than other countries the health care system is blamed as if it had or should have control over people's decisions in life.
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...health level and responsiveness – are direct indicators of health outcomes. Even these are subject to some objections (such as that health level is affected by things like crime and nutrition), but they’re at least relevant. But neither health distribution nor responsiveness distribution properly belongs in an index of healthcare performance.
Why not? Because inequality (that’s what “distribution” is all about) is distinct from quality of care. You could have a system characterized by both extensive inequality and good care for everyone. Suppose, for instance, that Country A has responsiveness ranging from “good” to “excellent,” while Country B has responsiveness that is uniformly “poor.” Then Country B does better than Country A in terms of responsiveness distribution, despite Country A having better responsiveness than Country B for even the worst-off citizens. The same point applies to the distribution of health level.
To put it another way, suppose that a country currently provides everyone the same quality of healthcare. And then suppose the quality of healthcare improves for half of the population, while remaining the same (not getting any worse) for the other half. This is obviously an improvement – some people get better off, and no one gets worse off. But this change would cause the country to fall in the WHO rankings, other things equal.
[UPDATE: Clarification of the above example. As a result of the change, average health quality would rise, but inequality would rise as well. The former effect would tend to increase the country's WHO ranking, while the latter effect would tend to decrease it. The overall effect is ambiguous, even though common sense says the effect should be unambiguously positive.]
Now, it’s not silly to consider the quality of care received by the worst-off or poorest citizens. But distribution statistics emphatically don’t do that! They measure relative differences in quality, without regard to the absolute level of quality. A better approach would include in the index a factor for the health quality of the worst-off individuals. Or you could construct a separate health performance index for (say) the bottom 20% of the income distribution. These approaches would surely have problems of their own, but they would at least be focusing on the real concern. WHO’s current approach, sadly, doesn’t even do that much.
agoraphilia.blogspot.com
...The WHO rankings, by purporting to measure the efficacy of healthcare systems, implicitly takes all differences in health outcomes not explained by spending or literacy and attributes them entirely to healthcare system performance. Nothing else, from tobacco use to nutrition to sheer luck, is taken into account.
To some extent, the exclusion of other variables is simply the result of inadequacies in the data. It is difficult to get information on all relevant factors, and even more difficult to account for their expected effects on health. But some factors are deliberately excluded by the WHO analysis, on the basis of paternalistic assumptions about the proper role of health systems. An earlier paper laying out the WHO methodological framework asserts, “Problems such as tobacco consumption, diet, and unsafe sexual activity must be included in an assessment of health system performance.”
In other words, the WHO approach holds health systems responsible not just for treating lung cancer, but for preventing smoking in the first place; not just for treating heart disease, but for getting people to exercise and lay off the fatty foods.
This approach is problematic for two primary reasons. First, it does not adequately account for factors that are simply beyond the control of a health system. If the culture has a predilection for unhealthy foods, there may be little healthcare providers can do about it; and if the culture has a pre-existing preference for healthy foods, the healthcare system hardly deserves the credit. (Notice the strong ranking of Japan, known for its healthy national diet.) And it hardly makes sense to hold the health system accountable for the homicide rate. Is it reasonable to consider the police force a branch of the health system?
Second, the WHO approach fails to consider people’s willingness to trade off health against other values. Some people are happy to give up a few potential months or even years of life in exchange for the pleasures of smoking, eating, having sex, playing sports, and so on. The WHO approach, rather than taking the public’s preferences as given, deems some preferences better than others (and then praises or blames the health system for them). By doing so, it abandons its claim to objectivity.
agoraphilia.blogspot.com |
