Wednesday, 10 July 2019

NZ ranks 18th in new ridiculous healthcare ranking

Last month, the New Zealand Herald reported:
New Zealand's healthcare system is ranked 18th place out of 24 countries - lagging behind a number of countries including Japan, Germany and even Australia.
UK healthcare recruiter Medical ID has ranked 24 OECD countries on their healthcare systems.
The ranking was based on the amount of GDP spent on healthcare, the number of doctors and nurses, how many hospital beds they have and the average life expectancy.
New Zealand was ranked 18th with a score of 60/100 and spending 9 per cent of its GDP on healthcare. It has 12,821 hospital beds and 62,843 doctors and nurses and the average life expectancy is 81.45.
It shared its 18th placed ranking with the UK which, despite having the 13th highest spending on healthcare, was brought down by being placed 22nd for the number of doctors and beds per capita.
This shouldn't even be news. Why? Because the ranking method is ridiculous, for a couple of reasons.

First, it is based on a mashup of both inputs (healthcare spending, doctors/nurses, and hospital beds) and outputs (life expectancy). This is basically double-counting, since inputs get turned into outputs. But also it double counts some inputs, since spending on doctors/nurses and hospital beds depends on the number of doctors/nurses and hospital beds.

When you want to know if a health system is good or not, it matters most to you what the output of the system is - does it keep people healthier, for longer? It doesn't matter so much how the health system achieves those outcomes. That is, it doesn't matter how much the health system spends, or what inputs it uses, if all you care about is whether it keeps people healthier. In that case, why not simply look at life expectancy, or even better healthy life expectancy, to work out which health system is better?

Alternatively, you might be interested in how much health outcome you get per unit of inputs (which might be per doctor/nurse hour, per dollar of spending, per hospital bed, etc.), or the amount of health inputs per unit of health outcome (for example, the cost per year of additional life expectancy). In the latter, you would be measuring the cost-effectiveness of the health system. In both cases, more output (using the same amount of inputs) is good, but more inputs (to get the same amount of output) is bad.

In contrast, in this ranking system, if two countries have the same number of doctors/nurses and hospital beds, and the same life expectancy, but one spends more than the other, the country that spends more is ranked higher. WTF? If Country A is spending more but only achieving the same outcome (the same life expectancy) as Country B, then Country A has got a worse health system. It is wasting healthcare resources, relative to Country B.

Second, and related to the previous point, higher health spending is not necessarily better. If that were true, a country could improve its ranking by simply contacting Big Pharma, and offering to pay them double for medicines.

So, it should be easy to see that this is a ranking system that is complete rubbish. I guess that's what happens when it is produced by "UK healthcare recruiter Medical ID", which has a vested interest in having a ranking system where the number of doctors and nurses, and healthcare spending, are indicators of a better healthcare system. In fact, they could instead be indicators that the healthcare system is simply wasteful.

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