A healthcare systems medal table: USA wins inefficiency gold

It is tricky to compare different countries’ healthcare systems, as well as politically explosive. The World Health Organisation (WHO) last tried in 2000, concluding that France had the best in the world.

The following attempt is very simplistic, but also very easy to understand. It uses WHO data to calculate how much each country spends on each year of average lifespan beyond 45, per year per person in purchasing power parity-adjusted US dollars. 45 is chosen simply because it is slightly below the lowest average longevity, Malawi, of 47 years. In the map below, the darker the shade of green, the more expensive each extra year of life: the figure for each country will pop up when the cursor is over it.

Map removed as Google Fusion Tables no longer works.

Country Life expectancy at birth (years) Per capita spending on health (PPP US$) Health spending per year of life beyond 45 (PPP US$)
1 United States 79 $8,362 $246
2 Equatorial Guinea 53 $1,545 $193
3 Luxembourg 81 $6,743 $187
4 Monaco 82 $5,949 $161
5 Norway 81 $5,426 $151
6 Switzerland 82 $5,394 $146
7 Netherlands 81 $5,038 $140
8 Denmark 79 $4,537 $133
9 Niue 72 $3,574 $132
10 Austria 80 $4,388 $125
11 Germany 80 $4,332 $124
12 Canada 81 $4,404 $122
13 Belgium 80 $4,025 $115
14 France 81 $4,021 $112
15 Ireland 80 $3,704 $106
16 Sweden 81 $3,757 $104
17 South Africa 54 $935 $104
18 United Kingdom 80 $3,480 $99
19 Finland 80 $3,281 $94
20 Australia 82 $3,441 $93
21 Iceland 82 $3,279 $89
22 Andorra 82 $3,254 $88
23 Japan 83 $3,204 $84
24 New Zealand 81 $3,020 $84
25 Swaziland 49 $333 $83

Source: WHO data, final column my calculation. Full table here. Google Map has a bug with showing Russia, which at $43 is equal with Argentina.

To deal with the flaws, average longevity is, obviously, seriously affected by war, famine, natural disasters and environmental factors among others, and as a result the figures are not particularly meaningful for countries further down the list. Also, purchasing power parity (which adjusts dollar prices based on the cost of living across the whole economy) only partially compensates in the case of healthcare, which tends to be disproportionately cheaper in poor countries (partly through necessity) and disproportionately pricier in richer ones.

But for the richer countries nearer the top, this provides a very rough idea of the value for money a nation is getting from its healthcare spending. In this case, the medals are awarded for those getting the fewest extra years for their bucks.

The gold goes to the USA, which spends $8,326 per person per year, 139% more than the UK, and whose citizens die on average a year younger. It spends significantly more per person than the UK just on its government-funded healthcare systems ($4,437), which serve only parts of the population, specifically the elderly, the poor and military families.

Silver goes to Equatorial Guinea, an oil-rich state with a few rich people and lots of poor ones, producing a combination of relatively high average healthcare spending (presumably being spent on the rich) combined with a low average mortality age. Bronze goes to Luxembourg, the first of several smaller European countries (potentially creating diseconomies of scale) which also have generally high living costs.

The performance of the UK (primarily, the NHS) is creditable, at $99 a year for each year of life over 45. This is lower than peers including France, Germany, the Netherlands, Belgium, Canada and Ireland. But it’s worth noting that Australia, New Zealand and Japan do better on this admittedly crude measure. Japan has the longest lifespan of any country (at the time of this research – Hong Kong has taken the lead recently, at least for women) – 83 years compared with Britain’s 79 – yet spends 8% less on healthcare.

The NHS is a wonderful thing, but it is worth noting that citizens of other similar countries live (a bit) longer with (slightly) cheaper healthcare systems. Some, or much, of that is down to relative levels of public health – elderly Japanese benefit from historically good diets, for example. But it is worth knowing that while US healthcare is poor value for money, many other countries do nearly as good a job as ours, and some arguably do it better. I’ve argued recently that the NHS has become a national religion, but that should not make it immune from reform.

UK life expectancy mapped, from Glasgow to Kensington

London 2012: NHS confirmed as national religion