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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Alastair McIntosh who wrote (6820)	5/22/2009 11:41:36 AM
From: TimF	Respond to of 42652

I've seen plenty of alternate views, and I pretty much already said that. I certainly don't try to avoid them. In at least this specific case I would welcome them. The point is the alternate views don't respond to the points in my posts. The ranking of the U.S. is irrelevant The rankings are a, perhaps the, major point of the study, and are the main focus of comments about it in the media, on SI, etc. and not mentioned in the articles I have read supporting the WHO report. An article with the specific purpose of supporting the report would probably not focus on the rankings. It would be hard to work from the rankings to support of the report. Arguments might work the other way, support the report, and then you might feel more confident in the rankings, but "the US is ranked Xth" isn't going to amount to a way to support the report, no matter what X is. (You have to register to read it.) I'm not sure I'd want to, and even if I do others won't. Can you summarize its arguments and logic relevant to the points about how the rankings are constructed? I was going to use bugmenot.com but its currently unavailable to me. I would like to make one modification to an earlier statement. Its not correct to say I haven't seen any argument address these points. I've seen one. That weighing the rankings differently wouldn't change the ranking of most countries. The problem with that argument is that while most countries would not have their rank changed all that much the US's rank would noticeably change. --------- WHO's Healthcare Rankings, Part 3 Posted by Glen Whitman at 1:32 PM This is probably my last post on this topic, but no promises. I want to draw attention to the margins of error associated with WHO’s healthcare rankings, which media reports on the rankings typically neglect to mention. If you look at the study that produced the rankings for “overall health system attainment” (this is the one that ranked France, Canada, and the U.S. 6th, 7th, and 14th, respectively), an 80% confidence interval puts the U.S. rank anywhere from 7th to 24th. France is anywhere from 3rd to 11th, Canada from 4th to 14th. Here is a blown-up section of the study’s Figure 2, which shows the intervals graphically: The U.S. is not named specifically on the horizontal axis, but it is the country just to the left of Iceland. Notably, its interval is a good bit wider than those around it. Obviously, there is considerable overlap among these intervals, and we cannot say with great confidence that the U.S. doesn't rank better than both France and Canada. But these intervals result only from errors associated with random sampling in the construction of the statistics. They do not consider differences that could result from different weightings of the factors that compose the attainment index. As I argued in the two previous posts, there is good reason to think the proper weight for three of these factors is, in fact, zero. The authors of the study did not calculate rankings based on that weighting, but they did consider some other possible factor weights. Here is a blown-up section of the relevant graph (the study’s Figure 5): According to the study, this figure shows that “for only a small number of countries was there any substantive change in rank” as a result of different factor weights. But looking at the section above, one country stands out as having an especially wide interval. That country is the one just to the left of Iceland – once again, the U.S. In other words, the ranking of the U.S. healthcare system is especially sensitive to the choice of weights in the index. And, it should be noted, the rank resulting from any given factor weighting will itself have a margin of error resulting from random sampling. That means the two different sorts of intervals shown above ought to be considered jointly, resulting in yet even wider ranking intervals. More reason, I think, to regard the WHO healthcare rankings as unreliable at best. agoraphilia.blogspot.com

To: Alastair McIntosh who wrote (6820)	5/22/2009 11:57:19 AM
From: TimF	Respond to of 42652

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.