Mises Daily Articles
The WHO’s Bias Against Free-Market Healthcare
One of today’s most commonly referenced statistics against a free-market healthcare system, is the World Health Organization’s ranking of healthcare systems around the world. It places countries with socialized medicine like France (ranked no. 1) at the top, and ranks the United States as low as no. 37. Largely from this verdict by the WHO, many Americans calling for a healthcare reform want a reform in the direction of socialized medicine. This is misguided, and the WHO’s opinion is greatly over-credited by the general population. The statistic itself; that the US ranks no. 37 worldwide in healthcare, is generally well-known. Beyond that though, there is quite a bit of mystery. While many people know the statistic, very few people actually know how it is determined.
A number of various criteria go into how the WHO ranks healthcare systems around the world. Granted, some of these criteria are essential to evaluate in order to determine the direct effectiveness of any nation’s healthcare system. However, it is also true that many of the WHO’s criteria are not only irrelevant to the actual quality or effectiveness of a nation’s healthcare system, but also contribute to bias, and particularly, a bias against more free-market healthcare systems. Specifically, a criterion such as how much patients pay out of pocket, and even a criterion as subjective as “fairness” (in which the United States ranks no. 54 worldwide according to the WHO).
When the WHO reduces the ranking of the United States due to a poor performance in criteria such as those stated above, it effectively assumes for its audience that they would be okay with the actual quality of their medical care being reduced, so long as it was less costly for them. While this may be the case for certain people, it is not the case that all, or even most people would be willing to make this trade. In fact, a somewhat less cited bit of information from the WHO is that even the WHO itself ranks the United States as no. 1 in the world in the areas of responsiveness to patients’ needs in choice of provider, dignity, autonomy, confidentiality, and the very important area of timely care.
The United States is also a leader in medical technology. For example, the United States has double the amount of MRI units, and 25 percent more CT scanners per one million people than Italy, yet Italy still ranks much higher on the WHO’s list than the United States does. According to the Organization for Co-operation and Development, the Unites States has more CT scanners per one million population than any other country in the world, and more MRI units than any country other than Japan.
Certainly the American healthcare system is highly problematic and nowhere near perfect, though it does have a number of virtuous aspects to it as well. For example, wait times for care in the United States are far lesser than in countries with socialized medicine. To provide a few examples: In the United States, the average wait time to see a specialist is nineteen days, far less excessive than Spain’s sixty-five days. In Great Britain, more than half of all patients wait over eighteen weeks (four and a half months) for care. For a hip replacement in the United States, one will wait about three weeks or less, in Canada, slightly more than four weeks. In Italy, one will wait seventy days for an endoscopy, and Norwegian women will wait over two months for a hysterectomy. In addition, the US healthcare system does an exceptional job of assuring patient’s privacy and freedom of choice.
It is also the case that part of what even enables most European and Asian national healthcare systems to be even as effective as they are, is the assistance they receive from their respective private healthcare practices, which in many ways and in many countries are far less regulated by the government than America’s private healthcare market. To see this more clearly, one might notice that Canada, which has a government healthcare system similar in many ways to European and Asian models, ranks far lower than those European and Asian models. This is likely due to the fact that unlike other countries, Canada has gone so far as to actually prohibit private health services, and therefore its government is left on its own when it comes to medical provisions.
When the WHO calculates their figures, they take into account a number of factors that say little to nothing about the real quality of a country’s healthcare system, and in many cases are definitional in being biased against real free-market healthcare. Remove some of these criterion, and the US healthcare system looks far better than it does when considering everything that the WHO uses in its rankings. The WHO is a bureaucracy, and it should be no surprise that as such, it will deem favorable other bureaucracies, such as national healthcare systems. While the US healthcare system relative to other countries does look poor on paper according to the WHO, what the United States would be giving up in order to look better in the eyes of the WHO, many could reasonably claim is of greater value than what would be gained in order to achieve that higher standing: quality in exchange for equality. While nobody wants to put a price on life and a healthy living, even the data presented by the WHO suggests that people in countries that do are likely to be better off than those that do not.