Published on Wednesday, June 21, 2000 in the Boston Globe
America's Health:
We're #1 In Cost. We're #37 In Care.
by Raja Mishra
The US health care system is inferior to those of most other industrialized nations because it is the most expensive and yet fails to provide adequate care to the poor, according to a survey of the world's health systems released yesterday.

The United States ranked 37th of the 191 systems surveyed by the World Health Organization, behind Japan, most Western European countries, Scandinavia, Canada, and several Middle Eastern nations. France topped the list, while almost every African nation finished in the bottom third. In addition, the survey concluded that health care in both China and Russia deteriorated after those nations enacted free market reforms.

''The US is really three Americas. The top 10 percent here are the healthiest in the world. The middle bulk does mediocre. But it's the bottom 5 or 10 percent, made up of Native Americans living on reservations, the inner city poor, rural blacks, and Appalachia that is a third America,'' said Dr. Christopher Murray, WHO's director of global programs on evidence for health policy. ''They have health conditions as bad as those in sub-Saharan Africa.''

The WHO study examined the quality of care in each country, how well the care was distributed, and how much it cost. The authors conclude that countries with universally available care financed by broad taxes have the best health care.

The United States, which spends a world-leading $3,700 per person on health care every year, ranks lower than its industrialized counterparts because, too often, its indisputably world-class medicine is not available to those without money.

''Given that the US outspends everybody by such a degree, the conclusion is that'' the health care system ''is very inefficient,'' said Murray.

The bottom third of the list is dominated by African countries south of the Sahara Desert, a population that has seen its health go from bad to worse in a decade.

''The HIV epidemic has had an enormous hit on African countries, taking 10 years off life expectancy,'' said Murray.

China and Russia also experienced slides. Both nations recently enacted market reforms - though Russia's were far more radical - that gutted their state-run health systems, said the study's authors. China's rural poor, who once received care as good as that in Beijing or Shanghai, were particularly hard hit, they said.

One nation that surprised researchers was Oman, a tiny Middle Eastern country where one of every four children once died before age 5. It recently enacted a health plan that costs $300 per person and has improved health there dramatically enough to earn the country the No. 8 spot.

And then there are the French, who ranked No. 1, not only because they live longer on average than almost any other people, but because, according to the WHO authors, they consistently enact safety regulations.

''They take into account nontraditional safety measures better than almost anyone else,'' said Dr. Julio Frenk of WHO.