TORONTO - The primary goal of a health care system in any country is to improve the health of the population. Most national Governments recognize that constant vigilance and health care reform are necessary when facing burgeoning and aging populations combined with spiraling costs.
As a reference point for public policymakers, the World Health Organization (WHO) released a ranking of health care systems of over 190 countries. The ratings generated much debate questioning the methodology used, criteria considered and the conclusions of such publications that the WHO ceased ranking health care systems. Other [regional] organizations did not. Little has changed since the publication of those lists.
Countries’ health care systems are ranked on the basis of various criteria. The first is the improvement in overall health of the population, in terms of levels care provided and accessibility to it.
Another factor in the ranking structure is the level of responsiveness and equality of the health care system. This includes the speed and delivery of service, protection of privacy and quality of amenities.
Quality of health care refers to patients having access to physicians, diagnostic procedures and treatments in a timely, safe and effective manner.
Affordability and reliability are also considered. As expected, this concept of “fair financial contribution” (low income households should not pay a greater share of their discretionary expenditures on health than wealthier households pay), is also in the mix.
With this in mind, we refer to the ranking of health care systems in the countries we have been tracking in our daily Covid-19 updates online (Corriere.com). See the first chart.
Over a number of years, both France and Italy “have competed for” the top spot. These two countries celebrate the excellence of their health care system and routinely rank among the best in the world when considering its overall quality, general health of the population and equity of access.
So why did these countries appear so vulnerable when Covid-19 invaded their lands and infected the population?
The second chart reflects a ranking system where Covid-19 plays a factor, specifically, the rate of fatality among those who test positive for the virus. A moment of caution, this does NOT reflect the percentage of the population infected, just the sad result for those who have been unfortunate enough to be infected.
As in the WHO quality of health care ranking chart, France is in top spot. But this is not a rank anyone vies to achieve. Since the beginning of the pandemic in France, over 30,000 deaths have been attributed to Covid-19, this represents a 17% fatality rate of those who test positive for the virus. This is a sobering fact for a country with the best health care system.
Italy holds the number two spot in the ranking of health care systems. Yet, despite this, Italy was not immune to the effects of Covid-19. It ranks fourth in mortality per confirmed positive for Covid-19, with a 14.3% fatality rate.
Of all the confirmed positive Covid-19 cases in the country, over 35,000 people have died from the virus. It was the hardest hit European country since the start of the pandemic; that is, until the UK started reporting infections and deaths according to the same acceptable protocols.
The national health care system (NHS) in the UK ranks 18th on the list. The British government began to draw criticism for “underestimating” the gravity of the coronavirus crisis. It had been shifting the “burden of disease” (death) to pre-existing, long term health conditions in about 85% of the cases measuring causes of death. Crassly one health official was reported as saying, “they are sick and old and will die anyway”
A chagrined UK now admits to more than 45,000 deaths attributable to the virus, representing a fatality rate of 15.4% - and occupying 2nd place on the Covid-19 ranking system.
In Canada, our health care system ranks 30th, better than the USA, another seven places behind. Despite the ranking, of all the Covid-19 positive cases in Canada, 7.9% proved fatal. The provinces of Ontario and Quebec have suffered substantial loss of lives due to Covid-19, primarily within the long-term-care sector.
During the phase of economic recovery, after months of “lockdown”, people are getting back to work and mingling within their communities while practicing safety measures to minimize contagion.
There is still no cure, no remedy, nor vaccine to provide immunity and protection against Covid-19. How will a potential “second wave” impact our health and the health care system?