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Where America really ranks in health care and hospitals

December 30, 2009 — By now we’ve focused on a lot of numbers with the health care debate.  How much will it cost?  How many representatives in the House voted for it?  How many Senators does it take to avoid a filibuster over the whole deal?  And how are the president’s “numbers” (in terms of approval ratings) this week?

Often I tell my students in comparative classes that we need something to compare our data to.  We compare America with an earlier time, or states with other states.  And at times, we need to compare countries with other countries.

The most cited data comes from the World Health Organization (WHO) which compares countries’ health systems.  Data comes from preventable deaths, healthy life expectancy, health performance, and health expenditures, as a percentage of GDP over the last decade. 

Unfortunately, the USA doesn’t fare as we would like it to perform.  It currently ranks 37^th in the world, out of 190 countries.  France finished first, followed by Italy (2^nd), Spain (7^th), Japan (10^th), Norway (11^th), United Kingdom (18^th), Colombia (22^nd), Germany (25^th), Saudi Arabia (26 ^th), Canada (30^th), Australia (32^nd) and Costa Rica (36^th).  We’re two spots ahead of Cuba.

I’m not the first person to report these statistics, but few have looked at the individual numbers.  The USA does its best at reducing preventable deaths (14^th), improving upon its number from 1997-98.  We finished 24^th in healthy life expectancy (a measure of life expectancy that adjusts for non-disability in its statistic -- a bedridden person who lives an extra 30 years in such a condition would not be among the healthy life expectancy numbers for those years), and first in health expenditure per capita, but only 72^nd in health performance, which includes the distribution of health care to all people, and the responsiveness of the system.

This might give some the impression that America can't do anything right when it comes to health care.  Nothing could be further from that.  The ranking of the world's hospitals shows the dominance of the USA in this category.  America has eight of the top ten hospitals in the world (with Taiwan possessing the other two) and 16 of the top 20 (with Germany and Japan making the 11-20 list).  The state of Texas alone has three in the top 15 (more than all of Europe), with UTMB in Galveston as number one on the list.

Between numbers 21-30, America claims seven more, along with five more to add to its Top 40 list, for an impressive 70% of the worlds’ top 40 hospitals.  By contrast, France (number one in the WHO), has only two in the top 40.  Clearly, America has strengths and not just weaknesses.

Now I know what you are thinking…some American study ranked America number one, right?  Actually, the ranking is done by Cybermetrics Lab, a research group from Consejo Superior de Investigaciones Cientificas (CSIC) in Spain, attached to its Ministry of Education.

Yet if America owns the category of best hospitals in the world (as graded by a neutral source), but can't cash in on better health care rankings worldwide, there needs to be improvement in the rest of the nation's health care system.  We shouldn't just sit back on the laurels of our best hospitals.  To quote another ambitious health care reformer, former President Bill Clinton “There is nothing wrong with America that cannot be cured by what’s right with America.”