Publication date: 
January 6, 2010

Health reform needs to address preventable risk factors, local health disparities, and ongoing performance analyses to lift the country’s health system from its rank of 37th globally

January 6, 2010–Health reform in the US could fall far short of its promise if critical steps aren’t taken to make improvements that are measureable, impactful, and local, say the authors of a groundbreaking study that ranked the US health care system 37th in the world.

The US is falling behind many countries in infant mortality and overall life expectancy, according to Dr. Christopher J.L. Murray, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and Dr. Julio Frenk, IHME Chair of the Board and Dean of the Harvard School of Public Health. In a commentary published in the Jan. 14 issue of the New England Journal of Medicine, Ranking 37th – Measuring the performance of the US health care system, Murray and Frenk note that countries such as Australia have demographics similar to the US but better health outcomes.

Murray and Frenk argue the health care reform debate has been too focused on insurance alone. There are fundamental policy changes that also need to be addressed to improve the life expectancy of Americans. A recent study by IHME and Harvard researchers showed that lowering the amount of salt in Americans’ diets would save more than 100,000 lives annually – twice the number that universal health insurance might save. Smoking kills a half-million people, and obesity accounts for one out of every 10 deaths.

“The problems of incomplete insurance coverage are very real, but as we enter the next phase of health reform and start turning law into regulations, we need to design interventions that are tailored to local realities,” Murray said. “Health disparities in the US are shocking. Some counties have life expectancies similar to some of the poorest parts of the world.”

While working at the World Health Organization, Murray and Frenk authored the World Health Report 2000, which placed the US health care system at 37th globally, well behind other major world economies such as France and Germany. That report has been quoted, and criticized, throughout the health reform debate because it remains the only comprehensive ranking of world health systems. IHME currently is conducting research that will lead to a new assessment of health systems worldwide.

“If you see your country performing poorly in a ranking, you can either ignore it or you can evaluate your system and fix what isn’t working,” said Frenk, who served as Minister of Health in Mexico from 2000 to 2006. “Mexico decided it could do better, and, most importantly, it built into its health reform an ongoing analysis that allowed it to monitor its progress and continually make improvements.”

Tracking and evaluating health care reform in the years to come is critical to understanding what is working and not working and will allow the US government to adjust accordingly, the authors write.

“However much we end up spending on health reform, we want to make sure we are getting our money’s worth,” Murray said. “As the reform legislation is crafted into rules and administrative policies, periodic evaluations would help guide the reform to make sure it is having the greatest impact.”