World Health Organization ranking of health systems in 2000 explained

The World Health Organization (WHO) ranked the health systems of its 191 member states in its World Health Report^[1] 2000. It provided a framework and measurement approach to examine and compare aspects of health systems around the world.^[2] It developed a series of performance indicators to assess the overall level and distribution of health in the populations, and the responsiveness and financing of health care services. It was the organization's first ever analysis of the world's health systems.^[3]

Ranking

Country	Attainment of goals / Health / Level (DALE)	Attainment of goals / Health / Distribution	Attainment of goals / Health / Overall goal attainment	Health expenditure per capita in international dollars	Performance / On level of health	Performance / Overall health system performance
	164	0	183	184	150	173
	102	128	86	149	64	55
	44	63	56	24	45	81
	10	25	17	23	7	4
	165	178	181	164	165	181
	48	58	71	56	123	86
	39	60	49	34	71	75
	41	63	81	102	56	104
	2	17	12	17	39	32
	17	8	10	6	15	9
	65	99	103	162	60	109
	109	67	64	22	137	98
	61	72	58	48	30	42
	140	125	131	144	103	88
	53	36	38	36	87	46
	83	46	53	74	116	72
	16	26	13	15	28	21
	94	95	104	88	34	69
	157	132	143	171	136	97
	138	158	144	135	73	124
	133	118	117	101	142	126
	56	79	79	105	70	90
	187	146	168	85	188	169
	111	108	125	54	78	125
	59	42	37	32	76	40
	60	53	74	96	92	102
	178	137	159	173	162	132
	179	154	161	186	171	143
	148	150	166	140	157	174
	156	160	163	131	172	164
	12	18	7	10	35	30
	118	123	126	150	55	113
	175	189	190	178	164	189
	161	175	177	175	161	178
	32	1	33	44	23	33
	81	101	132	139	61	144
	74	44	41	49	51	22
	146	143	137	165	141	118
	150	142	155	122	167	166
	67	92	88	61	95	107
	40	45	45	50	25	36
	38	33	36	56	57	43
	33	41	40	118	36	39
	25	31	28	39	22	24
	35	19	30	40	81	48
	174	174	179	188	185	188
	28	21	20	8	65	34
	166	169	170	163	163	157
	26	35	42	70	59	35
	79	97	66	92	42	51
	93	133	107	97	96	111
	115	141	110	115	43	63
	87	115	122	83	37	115
	152	151	152	129	174	171
	169	167	176	187	148	158
	69	43	48	60	115	77
	182	176	186	189	169	180
	104	112	111	81	110	123
	106	71	78	87	124	96
	20	27	22	18	44	31
	3	12	6	4	4	1
	144	136	141	95	143	139
	143	155	153	158	109	146
	44	61	76	125	84	114
	22	20	14	3	41	25
	149	149	139	166	158	135
	7	6	23	30	11	14
	49	82	68	67	49	85
	129	106	113	130	99	78
	167	166	172	159	160	161
	170	177	180	156	156	176
	98	126	116	109	104	128
	153	152	145	155	139	138
	92	119	129	100	48	131
	62	40	43	59	105	66
	19	24	16	14	27	15
	19	13	121	133	118	112
	103	156	106	154	90	92
	96	113	114	94	58	93
	126	130	124	117	75	103
	27	13	25	25	32	19
	23	7	24	19	40	28
	6	14	11	11	3	2
	155	181	157	153	133	137
	36	87	69	89	8	53
	1	3	1	13	9	10
	101	83	84	98	100	83
	122	52	62	112	135	64
	162	135	142	152	178	140
	125	121	123	103	144	142
	68	54	46	41	68	45
	123	122	135	146	134	151
	147	147	154	157	155	165
	82	56	67	77	121	105
	95	88	93	46	97	91
	171	164	173	123	186	183
	181	191	187	181	176	186
	107	102	97	84	94	87
	63	48	52	71	93	73
	18	22	5	5	31	16
	64	85	89	106	69	89
	172	168	167	190	173	159
	189	187	182	161	187	185
	89	49	55	93	86	49
	130	134	128	76	147	147
	183	180	178	179	170	163
	21	38	31	37	2	5
	121	120	119	80	140	141
	158	163	169	141	151	162
	78	77	90	69	113	84
	55	65	51	55	63	61
	88	64	91	108	106	101
	9	30	18	12	12	13
	131	148	136	145	138	145
	110	111	94	99	17	29
	180	190	185	160	168	184
	139	162	175	136	129	190
	177	173	165	66	189	168
	136	51	75	42	166	98
	142	161	160	170	98	150
	13	15	8	9	19	17
	31	16	26	20	80	41
	117	96	101	104	74	71
	190	184	188	185	177	170
	163	188	184	176	175	187
	85	100	102	127	108	121
	137	145	149	172	153	167
	15	4	3	16	18	11
	72	59	59	62	1	8
	124	183	133	142	85	122
	112	66	63	47	125	82
	47	93	70	53	67	95
	145	157	150	137	146	148
	71	57	73	91	52	57
	105	103	115	78	119	129
	113	50	54	124	126	60
	45	5	34	58	89	50
	29	34	32	28	13	12
	66	55	47	27	53	44
	80	78	72	107	111	99
	91	69	100	75	127	130
	185	185	171	177	181	172
	86	91	98	51	122	100
	54	86	87	86	54	68
	43	89	92	90	38	74
	97	81	82	121	131	119
	11	9	21	21	5	3
	132	139	138	167	117	133
	58	70	61	63	10	26
	151	105	118	143	132	59
	108	73	83	52	83	56
	191	186	191	183	183	191
	30	29	27	38	14	6
	42	39	39	45	88	62
	34	23	29	29	62	38
	127	117	108	134	20	80
	173	179	189	191	154	179
	160	128	151	57	182	175
South Korea^[4]	51	37	35	31	107	58
	5	11	19	24	6	7
	76	80	80	138	66	76
	154	159	148	169	149	134
	77	94	105	72	77	110
	164	140	164	116	184	177
	4	28	4	7	21	23
	8	10	2	2	26	20
	114	107	112	119	91	108
	120	124	127	126	145	154
	176	172	158	174	180	156
	99	74	57	64	102	47
	159	170	156	180	159	152
	75	84	85	73	114	116
	57	75	56	65	79	67
	90	114	77	79	46	52
	73	109	96	82	33	70
	128	131	130	128	152	153
	119	116	120	151	128	136
	50	62	44	35	16	27
	186	138	162	168	179	149
	14	2	9	26	24	18
	70	47	60	111	101	79
	24	32	15	1	72	37
	37	68	50	33	50	65
	100	144	109	120	112	117
	135	127	134	132	120	127
	52	76	65	68	29	54
	116	104	140	147	130	160
	141	165	146	182	82	120
	46	90	95	113	47	106
	188	171	174	148	190	182
	184	98	147	110	191	155

Methodology

The rankings are based on an index of five factors:^[2]

• Health (50%) : disability-adjusted life expectancy
  • Overall or average : 25%
  • Distribution or equality : 25%
• Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities
  • Overall or average : 12.5%
  • Distribution or equality : 12.5%
• Fair financial contribution : 25%

Criticism

The WHO rankings are claimed to have been subject to many and varied criticisms since its publication. Concerns raised over the five factors considered, data sets used and comparison methodologies have led health bodies and political commentators in most of the countries on the list to question the efficacy of its results and validity of any conclusions drawn. Such criticisms of a broad endeavour by the WHO to rank all the world's healthcare systems must also however be understood in the context of a predisposition to analytical bias commensurate with an individual nation's demographics, socio-economics and politics. In considering such a disparate global spectrum, ranking criteria, methodology, results and conclusions will always be an area for contention.

In over a decade of discussion and controversy over the WHO Ranking of 2000, there is still no consensus about how an objective world health system ranking should be compiled. Indeed, the 2000 results have proved so controversial that the WHO declined to rank countries in their World Health Reports since 2000, but the debate still rages on. With burgeoning and ageing populations, spiralling costs and the recognition by most national governments that constant vigilance and periodic healthcare reform are necessary, the appetite for a means of measuring national performance in broader world contexts is ever increasing and all the more relevant. With this in mind, and in lieu of any further ranking information from the WHO since 2000, there are many analytical bodies now looking at national healthcare delivery in global contexts and publishing their findings. Bloomberg finds "the U.S. spends the most on health care on a relative cost basis with the worst outcome"^[5] and notes Cubans live longer than Americans, but Americans pay more than fourteen times as much for less effective health care. The Commonwealth Fund ranked seven developed countries on health care, the US ranked lowest^[6] (AU, CA, DE, NL, NZ, UK, US^[7]).

See also

• Health systems – explains in some depth the concept of healthcare and its delivery on national and international scales
• International comparisons of health systems – a section of the above article specifically about international comparisons
• Healthcare subjects – a list of subjects detailing the complexities behind global healthcare delivery
• List of countries by quality of healthcare

External links

• The World Health Organization's ranking of the world's health systems, by Rank

Notes and References

1. Web site: World Health Report 2000. . 2009-08-26 . 2013-01-17 . https://web.archive.org/web/20130117071348/http://www.who.int/whr/2000/en/whr00_en.pdf . live .
2. World Health Organization. World Health Report 2000. Geneva, 2000.
3. Web site: World Health Organization Assesses the World's Health Systems . 7 February 2000 . . 2011-06-23 . 2013-01-17 . https://web.archive.org/web/20130117085525/http://www.who.int/whr/2000/media_centre/press_release/en/index.html . live .
4. Web site: Measuring Overall Health System Performance For 191 Countries . Ajay . Tandon . Christopher JL . Murray . Jeremy A . Lauer . David B . Evans . GPE Discussion Paper Series: No. 30 . . https://web.archive.org/web/20110805022057/http://www.who.int/healthinfo/paper30.pdf . 2011-08-05 . live.
5. Web site: Most Efficient Health Care: Countries - bloomberg.com. Bloomberg News. 2017-03-12. 2014-09-06. https://web.archive.org/web/20140906224923/http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries. live.
6. Web site: U.S. Ranks Last Among Seven Countries on Health System Performance Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives - June 23, 2010. March 8, 2014. January 22, 2014. https://web.archive.org/web/20140122180211/http://www.commonwealthfund.org/News/News-Releases/2010/Jun/US-Ranks-Last-Among-Seven-Countries.aspx. live.
7. Web site: Overall Rankings - commonwealthfund.org. 2014-03-08. 2015-09-23. https://web.archive.org/web/20150923205947/http://www.commonwealthfund.org/News/News-Releases/2010/Jun/~/media/Images/Publications/Fund%20Report/2010/jun/MM2010l.gif. live.