US lags in health service ratings

NEITHER Canada nor Japan cracked the top 10, and the US finished a dismal 35th, according to a ranking of healthcare quality in 195 countries released on Friday.

Among countries with more than a million inhabitants, top honours for 2015 went to Switzerland, followed by Sweden and Norway, though the healthcare gold standard remains Andorra, a postage stamp of a country nestled between Spain (in eighth position) and France (15).

Iceland (2), Australia (6), Finland (7), the Netherlands (9) and financial centre Luxembourg rounded out the first 10 finishers, according to a study published in the medical journal Lancet.

Of the 20 countries heading the list, all but Australia and Japan (11) are in Western Europe, where practically every country has some form of universal health coverage.

The US — where a Republican Congress wants to peel back reforms that gave millions of people access to health insurance for the first time — ranked below Britain, which placed 30th.

The Healthcare Access and Quality Index, based on death rates for 32 diseases that can be avoided or effectively treated with proper medical care, also tracked progress in each country compared to the benchmark year of 1990.

Almost all countries showed improvement over that period,

South Africa is one of the continent’s worst health underachievers

but many — especially in Africa and Oceania — fell further behind in providing basic care for citizens.

With the exceptions of Afghanistan, Haiti and Yemen, the 30 countries at the bottom of the ranking were all in sub-Saharan Africa, with the Central African Republic having the worst standards of all.

“Despite improvements in healthcare quality and access over 25 years, inequality between the best- and worstperforming countries has grown,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, and leader of a consortium of hundreds of contributing experts.

Furthermore, said Murray in a statement, the standard of primary care was lower in many countries than expected given levels of wealth and development.

The worst underachievers in Asia included Indonesia, the Philippines, India and tiny Brunei, while in Africa it was Botswana, South Africa and Lesotho that had the most room for improvement.

The regions where healthcare systems underperformed relative to wealth included Oceania, the Caribbean and Central Asia.

Among rich countries, the worst offender in this category was the US, which tops the world in per capita healthcare expenditure by some measures.

Within Europe, Britain ranked well below expected levels.

“The UK does well in some areas, including cerebrovascular disease,” noted co-author Marin McKee, a professor at the London School of Hygiene and Tropical Medicine. “But it lags behind in outcomes of some cancers.”

The gap between actual and expected rating widened over the last quarter century in 62 of the 195 countries examined.

“Overall, our results are a warning sign that heightened healthcare access and quality is not an inevitable product of increased development,” Murray said. — AFP