On health systems

Reader's View
OECD Observer

Sir, Your piece on France’s economy (Observer 223) makes the point that the French probably enjoy the best health system in the world. Costly, but very good nonetheless. Your article mentions the World Health Organisation’s study on which this claim is based, a study which ranks Italy, San Marino, Andorra, Malta and Singapore immediately behind France.

But on what grounds was this ranking made? Was it the absence of (or the success rate of curing) certain serious diseases? Or the low incidence of suicide, fatal accidents or alcoholism? No, none of these criteria were used for the study. Rather, apart from some notion of the equitable availability of health services, the WHO study leaned on mortality rates at birth and in old age, and a survey of user satisfaction.

It is astonishing that such a basic criterion as old-age mortality should have been used, at least for a developed country. Is absence of death the best indicator of a health system’s quality? It is certainly not a difficult one to measure. But as for user satisfaction, well, this indicator tells us very little in the end.

For France, for instance, 66% of respondents were satisfied; for second-place Italy just 20% were satisfied. Are the Italians likely to be more objective than the French on matters concerning their health? Surely we need a more rigorous study than this, one that compared expenditure with real results. Incidence of cancer, liver disorders from excessive drinking, heart disease, road casualties, mental illness, stress-related disorders, even the by now infamous hospital bug – surely measuring criteria such as these would be the right way to decide how good or bad a health system really is.

Ariel Alexandre,

Vence, France

©OECD Observer No 225, March 2001 

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