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.

healthy planet index chart


About The Author

Chrissy Donovan is a guest contributor to the Healthy Travel Blog. She recently graduated from Carleton College in Northfield, Minnesota, where she majored in mathematics. While in school, she spent a semester studying in Budapest. Here, she learned firsthand some of the differences between American and Hungarian health care when she became alarmingly sick one day (but quickly recovered).


  1. Thanks, Kevin. You highlighted a key dimension in understanding how to target investment in healthcare services. At the country level, the existing infrastructure (or lack of it) seems to be a determinant of efficiency. We plan to look more closely at the distribution of doctors and technology within countries. For instance, countries large in area with large rural populations face huge obstacles to delivering care efficiently. The U.S. even falls into this category. Thinking through new models for treating underserved (or overserved U.S.) populations should coincide with any investment in improving a nation’s health.

  2. I like your ‘healthy planet” twist on the happy planet index, looking at the relationship between health and happiness revealed by that index, and I note your logarithmic assessment of health care spending seems valuable. Have you considered these numbers adjusting for spending as a percentage of the typical income of the individual? It seems to me that the “$500” benchmark might tell us something different in that case. For example, in the US, where dollars don’t go far, getting a lot for that first $500 might be a sign of efficiency, while getting much less for the sixth $500 might be attributed to the limits of efficiency; and in a nation where a dollar is worth more, getting the same for that first $500 as in the US (for example) might mean that the system is far less efficient. This might point at increasing efficiency rather than adjusting spending, for example. Kevin

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