I decided to register using a temporary mailinator address.
Registering and reading the article I see it doesn't really address those points. It argues for the idea that equality is important, but doesn't address the idea that measuring equality is not measuring quality of health care (a country with quality ranging from excellent to fair, would get a lower score on very large part of WHO's rankings, then a country who's quality was uniformly poor).
It also doesn't address the point that how well a country has reached the "potential of" its health system "to achieve more with available resources", isn't a measure of health care quality. It may be an issue worth considering, but its a different thing, and specifically invalidates arguments along the lines of "we spend more, and yet we rank lower", since its already including the fact that we spend more in the rankings. (But to be fair to WHO, its not responsible for other people's arguments, and I'm not sure that its making such an argument itself.)
In his critique, Navarro interprets the WHO index of fairness in financial contribution as merely a measure of the progressiveness of health system payment. However, the WHO index is based on a comparison of the fraction of income, after paying for subsistence needs, that each household contributes to the health system through taxes, social security payments, private insurance, and out-of-pocket payments. Because poor households spend a large share of their income on subsistence needs such as food, the WHO index incorporates a strong element of progressiveness. But two other concerns about the burden of health system payments are important: some households have to pay a catastrophic share of their income (greater than 50%) after paying for subsistence needs; and households in similar circumstances can pay very different shares of their non-subsistence income.
thelancet.com
That's a description of and arguably a defense of how they measure health care fairness/equality in terms of financial burden, but it doesn't address the issue that fairness/equality is not a measure of quality. Also it doesn't make an argument for any of their other fairness/equality considerations other than the relative burden of payments. |
