Sorry, No Simple Magic Bullet to Fix U.S. Health Care

 Part one of a summary of the World Health Organization The World Health Report 2000.
Tony Saper

The  U.S. spends more on health care than any other country in the world. Yet the U. S. ranked 37   in “overall performance“ in The World Health Report 2000 by the World Health Organization (WHO).   Even Singapore, Spain, and Oman made the top ten. 

But there is no magic bullet solution.  Many U.S. health care activists promote the Canadian health care system as a model for the U.S.  But Canada only ranked 30th.

That is better than the U.S. but hardly a model for change.

What is truly fascinating about the WHO report is its focus upon health systems.  Most health care reform (or even pleas for the status quo) focus upon payment schemes, or levels of technology or training,  or the extent and quality of research, or the modernity and number of health care facilities, or cultural issues including diet and lifestyle, or even the sheer numbers of health care workers.

None of those factors alone can assure the health a population.  All of those factors  combined along with how their benefits are actually delivered to each and every member of the population  determine the level of a  people’s health care. The opening for the WHO The World Health Report 2000 asks the question “Why do health systems matter?”

       “Health systems consist of all the people and actions whose primary purpose is to improve health.  They may be integrated and centrally directed, but often they are not.  After centuries as small-scale, largely private or charitable, mostly ineffectual entities, they have grown explosively in this century as knowledge has been gained and applied.  They have contributed enormously to better health, but their contribution could be greater still, especially for the poor.  Failure to achieve that potential is due more to systemic failings than to technical limitations.  It is therefore urgent to assess current performance and to judge how health systems can reach their potential.” (WHO The World Health Report 2000, Chapter One, Introduction)

Later parts of this summary of the World Health Organization The World Health Report 2000  will take a closer look at the issues, assumptions, design, data, and conclusions of the Report.