VANCOUVER, Washington — The functionality of a country’s healthcare system is dependent on both the competency of the providers and the conditions that impact the medical well-being of the citizens.
The world’s best systems make healthcare available and affordable for all, while the worst lack the funding and organization to supply sufficient services. What countries are the best and the worst at providing healthcare around the world and what factors affect their rankings?
In a 2000 report, the World Health Organization released its ranking of the health systems in 191 countries. WHO made its decision based on what it identifies as the “three intrinsic goals” of a health system. Simply put, the goals are (1) improvement of health, (2) responsiveness of providers, and (3) fairness in financing of healthcare. Additionally, the quality of the services, equity in their provision, and the efficiency of the overall system were deciding factors.
The top five countries were France, Italy, San Marino, Andorra and Malta. The United States ranked much lower at number 37.
According to the American Journal of Public Health, French politicians believe that their system maintains “an ideal synthesis of solidarity and liberalism.” The French system consists of both universal coverage “with a public-private mix of hospital and ambulatory care, higher levels of resources, and a higher volume of service provision than in the [U.S.].”
All French citizens are enrolled in health insurance programs based on their occupations; however, many purchase additional health insurance to cover additional issues. Under the National Health Insurance (NHI) the expenses of patients are covered regardless of whether the cost of services rises. Additionally, citizens do not have to pay deductibles, much unlike the U.S. Medicare system.
The health systems in Italy, San Marino, Andorra and Malta are all similar, but with slight variations. Universal health care dominates in Italy, where the entire population receives aid from the local and central governments. San Marino has a state-funded system. However, citizens are also able to choose private coverage instead. Andorra also uses a state-funded system. Malta taxes its citizens to fund the insurance program. All top five countries utilize some degree of state-run, universal health coverage.
Conversely, what are the worst countries for healthcare? Nigeria, the Democratic Republic of the Congo, the Central African Republic, Myanmar, and Sierra Leone rank 187th through 191st in the WHO report. Sierra Leone, coming in dead last, faces dire circumstances that prevent the country from maintaining a passable healthcare system. According to Health Poverty Action, maternal and pediatric care is abysmal.
Sierra Leone has one of the highest maternal mortality rates, as many women die during childbirth, a quarter of the country’s children are malnourished, and the average life expectancy is just 55 years.
Malaria, HIV and tuberculosis all present a huge burden to the health system in Sierra Leone. Civil war has left the country in shambles, primarily relying on emergency aid from humanitarian groups and non-governmental organizations. However, organizations like Health Poverty Action and the British Red Cross are attempting to create community-based programs that would help build a more sustainable system. Education on health topics and maintaining a volunteer base has helped stabilize the area.
While a French healthcare system is currently unattainable and unrealistic for countries like Sierra Leone, establishing a system that works for the specific needs of the country’s population should remain the ultimate goal.
– Bridget Tobin