As COVID-19 continues to cast its shadow over the globe, a timely report sheds light on the performance of the world’s wealthiest countries in providing health care to their citizens.
In releasing its “World Index of Healthcare Innovation” (WIHI), the Foundation for Research on Equal Opportunity (FREOPP) has compiled a first-of-its-kind ranking of the 31 highest-income countries in four categories of health care: quality, choice, science & technology, and fiscal sustainability.
FREOPP evaluated the strengths and weaknesses of the targeted countries’ health-care systems in the four categories, and the top five finishers received an overall score of “excellent.” Switzerland came in first with a score of 59.56, followed by Germany (59.28), the Netherlands (59.14), the United States (54.96), and Ireland (54.48). At the tail end of the list were countries rated “poor”—at the bottom was Italy (37.29), preceded by Poland (34.44) and Japan (31.51).
Improving on Past Indexes
There have been previous attempts to compare health systems worldwide, but their results, as FREOPP points out, “have been hard to square with reality.” For example, an index published by the World Health Organization (WHO) ranked the United States 37th, behind Oman (8th), Colombia (22nd), Saudi Arabia (26th), Morocco (29th), Dominica (35th), and Costa Rica (36th).
Similarly, the Commonwealth Fund has been ranking the health care systems of a small number of high-income countries for two decades. In its latest ranking, published in 2017, the Commonwealth Fund placed the United States last among 11 countries, behind the United Kingdom, Australia, the Netherlands, New Zealand, Norway, Sweden, Switzerland, Germany, Canada, and France. The Commonwealth Fund derived its rankings by examining delivery of health care, affordability and timeliness of care, administrative efficiency, equality of care, and health care outcomes.
Seeking to avoid such dubious outcomes, the FREOPP index ranks countries “not only by traditional measures such as universal affordability and health outcomes, but also by features such as: the degree to which patients have the ability to choose their doctor and their insurer; health care-related patents; scientific impact and Nobel Prizes in Chemistry and Physiology or Medicine; access to new treatments, and health digitalization.
“The Index also measures the fiscal sustainability of countries’ health care systems: that is, how much ability a given country has to sustain its public health care spending without punitive taxes or a debt crisis,” the FREOPP report notes.
FREOPP’s report emphasizes the importance of going beyond the scope of earlier international rankings to get a more accurate picture of health care delivery.
“The Index not only examines the quality of each health care system, but also the ability of that system to improve over time through scientific and medical advances, and the degree to which patients can drive quality improvements by encouraging insurers and health care providers to compete for patients’ patronage,” FREOPP states.
Those market forces explain why several countries, including some relatively affluent ones, finished at or near the bottom. Poland placed last for quality and science & technology, while Finland, a single-payer country, placed last for choice. Japan is affluent and technologically advanced, but has the highest debt-to-GDP ratio in the industrialized world, putting it in last place for fiscal sustainability. For its part, the United States easily captured the top spot in science & technology with a score of 75.14, but saw its overall ranking pulled down by a dismal 27.33 score in fiscal sustainability.
The Role of Innovation
The viability of a country’s health system depends on innovation, FREOPP concludes. Policymakers are increasingly recognizing the value of personal choice and digital technology in providing high-quality, patient-centered health care, and most have come to rely on American research and development for new treatments,
“These goals—sustainable costs, best-in-class therapies, personalized care—can best be achieved through innovation: innovation in the development of cures and vaccines, innovation in the delivery of health care services, and innovation that leads to the economic growth that can fund health care expenditures,” FREOPP states. “While universal health insurance is important, it is just as important to measure the role that innovation plays in improving health outcomes for all people.”
WIHI is an innovative way of analyzing health care freedom, says Avik Roy, president of FREOPP.
“At FREOPP, we support universal, market-based coverage that will be fiscally sustainable for generations to come,” Roy told Health Care News. “WIHI is the first ranking system to incorporate patient choice and medical innovation in its evaluation of global health care systems. We trust that the report will be useful to U.S. policymakers who are considering changes to our health care system at home.”
The FREOPP index is a vast improvement over earlier efforts to rank health systems globally, says John C. Goodman, president and CEO of the Goodman Institute for Public Policy Research, which co-publishes Health Care News.
“This is a refreshingly new look at international health care systems,” Goodman said. “Previous rankings by other organizations have been biased by a political preference for government funding and government control. These rankings are more objective.”
Bonner R. Cohen, Ph.D., (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research.
