Editorial opinion by Michael A. O’Hanlon
Last month the United Nations World Health Organization issued a 215-page report entitled World Health Report 2000. The report is designed to show the world what is desirable and undesirable about the provision of healthcare services in the UN’s 191 member nations.
What caught the attention of the world’s press when the report was issued were the WHO rankings of these nations in responsiveness, fairness, and health expenditures per capita. The U.S. ranked number one in terms of responsiveness, which is understandable for a nation that will spend approximately 14% of its gross domestic product, or almost $1 trillion, on healthcare this year. However, the U.S. ranked 37th in terms of fairness and equality of healthcare distribution, only slightly ahead of Cuba, which ranked 39th.
What is particularly disturbing about the WHO report is its overall assumption that healthcare requires the "continuous and permanent" responsibility of government. Consider this paragraph: "The ultimate responsibility for the overall performance of a country’s health system lies with government, which in turn should involve all sectors of society in its stewardship."
The report continues: "The careful and responsible management of the well-being of the population is the very essence of good government. For every country, it means establishing the best and fairest health system possible with available resources. The health of the people is always a national priority: government responsibility for it is continuous and permanent. Ministries of health must therefore take on a large part of the stewardship of health systems."
Privatized healthcare is seldom mentioned, but when it is, the underlying assumption is that it is responsible to a government-run bureaucracy. Thus: "The private sector has the potential to play a positive role in improving the performance of the health system. But for this to happen, governments must fulfill the core public function of stewardship."
The report has relatively little to say about high-technology healthcare equipment, except to note that its use tends to be restricted to rich countries, implying that investment in such equipment contributes to the widespread inequality of healthcare resources. However, as Robert B. Helms pointed out in a June 28 article in the Wall Street Journal Europe:
"Each of the six major chapters of the report exhibit a strong ideological preference for health systems that rely on direct government management, an emphasis on quality of delivery and financing, and an absence of direct payment for medical care…. The most serious shortcoming of the report is its failure to recognize the positive effects of market forces -- the effects of competition, market prices, and especially consumer choice."
This is at heart of what's wrong with the WHO report. It assumes that the only viable healthcare system is a government-run system. The National Post of Canada, a country whose government-run healthcare system is subject to lengthy delays, stated in a June 22 article: "Not surprisingly, Canada won praise for its ‘fair’ mechanism of finance; so did Fidel Castro’s Cuba, where medicine is free to all 11 million citizens, even though the socialist state cannot afford to buy enough new bandages…. The fundamental bias of the WHO survey is that it tends to put more stock in equity than liberty or patient care."
The fallacy of an ideal healthcare system
Obviously, the 191 countries whose healthcare systems were studied by the WHO range from very rich to pitifully poor. Because of this, it is incomprehensible why WHO would apply uniform measures of responsiveness and fairness to all these countries. The researchers knew before they began their work that they would be faced with such striking inequalities that their "research" would be meaningless insofar as it could be applied to the real world.
What they did not research, apparently, was the benefits that have been gained over the past generation from high-technology medical equipment. These include imaging equipment that enables physicians to diagnose and treat illnesses noninvasively, thereby cutting back significantly on the most expensive component of healthcare: hospitalization.
The researchers, undoubtedly, would respond that this equipment is limited to the rich countries, and is therefore incidental to their report. But this simply isn’t true. MRI scanners, for example, have been on the market for almost 20 years. The average unit price of an MRI system has plunged from over $2 million to less than $1 million. As MRI scanners and similar medical devices become more modular, prices will fall even more, making them available in almost every country.
What the WHO is telling us is that we cannot have good healthcare until each country has a bureaucracy responsible for the "stewardship" of the country’s health. This bureaucracy will concentrate on intangible values, such as the responsiveness and equality of the country’s healthcare system. Before it makes a decision, the bureaucracy will debate every facet of healthcare. Meanwhile, the bureaucracy will continue to grow, not unlike the UN itself.
About the author
Michael A. O’Hanlon is president and CEO of DVI, Inc., a financial services company in Jamison, PA, that specializes in financing high-technology medical equipment in the U.S., Europe, Asia, and Africa.
July 18, 2000
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