The FREOPP World Index of Healthcare Innovation is a unique, one-of-a-kind ranking system that improves upon prior models of healthcare comparison. In 2000, the World Health Organization ranked 191 countries based on overall health performance. The United States ranked 37th but was widely criticized due to severe inconsistencies with the data and ranking distribution. For example, Oman ranked 8th, Colombia 22nd, and the Dominican Republic 35th. Former editor-in-chief Philip Musgrove has publicly renounced the ranking system due to faulty methods and internal biases. The Commonwealth Fund has long published rankings of OECD country healthcare systems. Their markers include delivery of healthcare, affordability, inequality of care, and outcomes. The issue with these rankings, however, is that they rely only on OECD countries and self-reported data. For example, Hong Kong, Taiwan, and Singapore are not OECD countries yet they make up the 1st, 4th, and 9th rankings of GDP-per-capita purchasing power among all countries. The FREOPP World Index of Healthcare Innovation seeks to address these issues to provide a more comprehensive, unbiased ranking system.
How did they conduct their ranking system? I will not bore you with the details, but I do highly recommend looking at their website to see how it was done. It gives a great insight into their approach, is easy to understand, and gives the ranking system validity. The rankings are broken down into 4 major categories: quality, choice, fiscal sustainability, and science & technology. These categories were then subsequently broken down into smaller categories, with different overall weights. A diagram from their website is shown below. Again, I would highly encourage you to browse their website and interact with their charts. It is quite interesting to see the breakdowns by category.
The question then arises, “Well, how did the United States measure up?!” Dead last? Top spot? See for yourself below! Again, directly from their website.
As you can see, the United States ranked 6th overall out of 31 countries. Switzerland, Netherlands, Germany, Ireland, and Israel make up the top 5 places respectively. There are two aspects that immediately stood out to me about the US ranking: 1) our science and technology score and 2) our fiscal sustainability score.
Our technology score absolutely walloped the competition. The US scored a resounding 73.93. The next highest score was Switzerland at 53.92, a full 20 points behind the US (scores 0-100). For context, the biggest differential between the other categories was “Choice” with the Netherlands scoring the highest 73.31 and Germany scoring a second 70.25, for a difference of 3.06 points. The science and technology sector of the US healthcare system should, and is, our pride and joy. It isn’t even close in terms of other countries’ capabilities.
In stark contrast to our technology sector, our fiscal sustainability was abysmal. We ranked 29th out of 31 countries. Only France and Japan were behind the US. Perhaps this is not surprising for some, but it is quite evident that our fiscal sector needs massive reform. An interesting rating was that the US scored a 54.53 in “Choice,” earning a place of 20/31. I was surprised at how low of a score this was, but perhaps it makes sense with coverage being “in-network” versus “out of network.”
The question then arises, what is the best healthcare system? Single payer? Private insurance? A key goal of any system is achieving universal coverage. Unfortunately, many do not understand what this term means. In the US, we resoundingly associate “universal coverage” with “single-payer.” This is simply not the case, and these terms are not the same. Universal coverage refers to each citizen having insurance, while “single-payer” refers to the government exclusively funding the universal coverage. It is interesting, then, to note that the top 5 countries all have universal coverage with private insurance. The highest-ranking “single-payer” system is the United Kingdom at #10. Other countries achieve “universal coverage” with a combination of public-private systems. The United States falls under this category.
I often find myself irritated with the sentiment that US healthcare is overall terrible. The most cited arguments are our lack of coverage, cost, and “equal” outcomes. While these arguments have merit, they do not tell the entire story. The US healthcare system is incredible; it is just not sustainable. For the US to fix our healthcare issues, we must understand where the issues are. Our number one issue is cost. Let us fix it.
Aaron Dowell is a member of the University of Arizona College of Medicine-Phoenix Class of 2024. He graduated from the University of Evansville in 2020 with a degree in Neuroscience. He plans on obtaining his MD/MBA dual degree and is interested in reducing physician burnout, leadership, and healthcare-market trends. In his free time he enjoys hiking with his wife, weightlifting, training Brazilian Jiu-Jitsu, and bowhunting. Contact information: aarondowell@email.arizona.edu