Here at HTB we’ve taken an interest in what we’re calling comparative healthcare with an eye toward what we can learn from lifestyles and cultures around the globe. Now that the healthcare reform debate in Congress is reaching a crescendo, we think it’s a good time to ask this: “How do you measure the effectiveness of a healthcare system?”
We think there are two fundamental dimensions that should be considered. While there is no doubt about the importance of physical health, “well-being” includes happiness too. To gauge the strength of a healthcare system, we need to somehow measure both. A population’s health can be gauged by life expectancy, but we have to look harder to find a measure of a population’s happiness.
For this reason, we literally took a page from The Happy Planet Index which respected economists have devised to measure and rank how efficiently (in terms of environmental impact) nations produce “the good life.” This ranking relies on life expectancy figures and surveys of life satisfaction, as well as a country’s carbon footprint. We focused on the first two numbers to isolate what they call “Happy Life Years” of the citizens in each country. The result is a ranking of countries that emphasizes a basic human goal: long, happy years of life. The accompanying chart shows the results for 25 of the 141 countries we evaluated. (Happy life years are determined by multiplying life expectancy and satisfaction with life.)
There are some surprises: Costa Rica heads the list; the U.S. comes in 14th with Mexico not far behind. China and Egypt rank far ahead of Turkey and Russia. But we were even more surprised when we tried to find variables that correlate with Happy Life Years.
A quick scan of the chart confirms our statistical analysis that there is very little correlation between Happy Life Years and the number of doctors per capita. This finding calls to mind Voltaire’s maxim that the role of a doctor is “to amuse the patient while nature takes its course.” Of course, the geographic distribution of doctors and medical technology (i.e., access to care, maybe the sheer size of the country) must play a very large role.
Likewise, government’s share of spending on healthcare exhibits almost no correlation with Happy Life Years. Even when the dependent variable is reduced to life expectancy, the results still indicate that there is no relationship between how involved the government is and how healthy the people are. Clearly there are no simple conclusions to be drawn and rationally applied to cool the heated discourse that is unfolding in Congress.
We did find something worth remembering when we looked at total healthcare spending per capita. Here the relationship between Happy Life Years and how much is spent per person is not what one might expect. There is a positive correlation with the Happy Life Years; however, the relationship is logarithmic, rather than linear. This means that there are rapidly diminishing returns on spending. Our analysis shows that spending $1,000 per person per year rather than $500 can have a huge effect, but spending $3,000 per person rather than $2,500 is not very meaningful. This finding calls into question the benefits of increased spending — certainly at the levels the U.S. has attained ($6,714 per person). Are these costs truly necessary? If not, what are we paying for that is not as essential as we think?
There is, of course, a moderate correlation with Gross Domestic Product (GDP), but that’s not the end of the story. We’ll continue to wrestle with this topic to gain more insight into how important variables such as environment (air and water quality) and culture (drinking, smoking, obesity, hunger, attitudes toward work, leisure, prison population, size of military force) affect a country’s score. In the meantime, let’s consider how redistributing some healthcare spending might raise the planet’s health quotient. As we’ve seen, $500 spent on the have-nots goes a long, long way. For some, it’s a drop in the bucket, for others, it’s the whole kitchen sink.
The latest investigation into happiness by destination comes from Andrew Oswald of the University of Warwick (UK) and Stephen Wu of Hamilton College (NY) who have ranked all fifty states and DC using two data sets. One from the Centers for Disease Control compiles responses from 1.3 million Americans who were asked this: “How satisfied are you with your life?” The other is research conducted at the University of Southern California on indicators of quality of life such as sunshine, crime and environmental health. Surprisingly, Louisiana came out on top even in the aftermath of the Katrina disaster. And Mississippi is in the top six. At the bottom of the list? New York and Connecticut. There’s clearly little or no correlation with income per capita. The authors found a high degree of correlation between the subjective survey responses and the more objective indices. They speculate that “liberal angst” might be playing a role.
An important new contribution to the health care reform debate adds some much needed global perspective to the pervasive political rancor. Author T.R. Reid’s newly published book, The Healing of America, has been 
In other timely world news, the 
Healthy travel usually requires some understanding of how health care systems work in different parts of the world. This post is the first in a new series to help broaden our understanding by looking at practices outside the U.S. Of course, the current health care reform efforts in the United States make this information more topical than usual and help to increase awareness about instructive differences between countries.
