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UN: WHO Analyzes Disparities In World's Health Systems

The World Health Organization, known as the WHO, released a report today that for the first time ranks the world's health systems according to criteria such as availability and payment schemes. The study finds some surprising disparities and a need for many countries to spend money more efficiently on health services. RFE/RL's UN correspondent Robert McMahon talks with a co-author of the report about the findings.

United Nations, 21 June 2000 (RFE/RL) -- The World Health Organization has made its first comprehensive examination of how health care is provided worldwide, and found some surprises.

The United States, for example, pays more per capita on health care than any other country, yet in overall quality its care ranks 37th in the world.

Colombia ranks as the fairest country in the world in regard to financial contribution to health care, but is number 74 in a measurement of how long people live in good health there.

And Oman, which spends only about $330 per person on health care, achieved the ranking of number 8 in quality of care.

The WHO launched the study in part to go beyond the rich country versus poor country comparisons on health care and understand how the best systems function. Our correspondent talked to one of the co-authors of the report, Dr. Julio Frenk. He said the study looks at basic areas of health care, including effectiveness of treatment and how fairly the poor and minorities are treated.

Frenk said the report shows that there is no single blueprint for providing health care. But it does show that simply spending more money does not always ensure better health care.

"What we see all over the world is that there is enormous variation. Countries spending the same amount of money are getting very different results in terms of these five things. There is a gap between the best that can be achieved with existing resources and what we're actually getting now."

The countries of the former Soviet Union and communist Eastern Europe in general rank near the middle of the world's nations on providing quality health care (see the full WHO report at

Slovenia and the Czech Republic rank 34 and 35 among the 191 nations rated in terms of how long people live in good health -- on average 68 years in each country.

Turkmenistan ranks number 128, with people on average living 54 years in good health. Tajikistan, Kazakhstan, and Kyrgyzstan are close by, with average citizens living 56 to 57 years. On a separate measuring stick, Russia rates as having one of the least fair systems of financial contributions to health care, ranking 185.

The report notes that the problems faced by former centrally-planned countries began before they sought to reform their systems. It says publicly subsidized production of health care items such as pharmaceuticals and medical equipment often leads to low quality, lack of innovation, and inefficient production. It says this was especially the case in the former Soviet Union, where most countries have fallen behind in productivity and the necessary technology to produce medical supplies.

Now that supplies in some areas are improving, Frenk says, the new trouble is how to pay for them.

"The one thing that we do see in many of the former communist societies was that in the attempt to reform the economy, generally in a very positive direction, some of the financial mechanisms in the health sector were also dismantled. It's not on the provision side that we see the main problem. It's mostly on the financing side."

Frenk said in general it is much better to separate the moment of paying from the moment of using health services. A pre-payment plan chosen before a person becomes sick often contributes to better, less stressful health care.

"It's in the nature of health expenditures to be uncertain. No one knows when they'll be hit. It is because of that that pre-payment and creating a broad pool of risks is in general a good idea, such that the healthy in any given point in time help to pay for the care of the sick."

The WHO is hoping that the report, which will now become an annual survey, will provide a guide for countries to learn from each other what works and what doesn't work.

One potential model was this year's surprise -- Colombia. In 1993, Frenk says, Colombia instituted broad health care reforms that included universal insurance. He said it seems to be working well.

"Basically, the reform extended insurance to everyone, including poor people, peasants, people in the informal sector of the economy from a system that really had no protection for those people. And now Columbia is actually number 1 under one criterion for fairness of financial contribution."

Frenk says the WHO is seeking to stress the importance of the concept of stewardship, in which governments make the regulation of health care a central function. He says good stewardship includes the licensing of health care providers and the safeguarding of prescription drugs. If this is handled properly, he said, it is not important whether health is care is private or public.