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is it appropriate to use health indicators to compare countries

According to U.S. Department of Health & Human Services (HHS) (2012), health indicators describe the health of a population (e.g., group of people in a community, state and country, etc.). Some common health indicators which are used to evaluate health care system performances are per capita health expenditure, disease incidence rates, life expectancy, infant mortality, and acute care days (World Health Organization, 2000). Health indicators are normally numbers and statistics. They are very useful to monitor the health care system and help decision makers to make decisions about health policies based on good evidence. Health indicators also provide a basis for comparison and can be used to show a population’s health changes over time or be used to compare populations to see which ones are healthier (HHS, 2012). However, cautions should be taken while using health indicators to compare countries. For example, in terms of health expenditure, U.S. spent twice as much on health care than any other industrialized nations per capita, however, the other health indicators such as life expectancy and infant mortality showed modest health care performance for U.S. (Harrington & Estes, 2008, p. 385). Why? Because using some of the most popular health indicators, such as life expectancy and infant mortality, to evaluate the effectiveness of a health care system is debatable and those measurements are sometimes claimed to be flawed or unreliable. According to Wenger’s study (2009), there is no relationship between life expectancy of a population and the number of physicians or hospitals available to them. Many people die in auto accidents, homicide, disasters, or other sudden death, which have limited interaction with health care system (Wenger, 2009).

There is also no relationship between life expectancy and health care expenditures in the industrialized countries. In U.S., only 10 percent of premature deaths in the U.S. are related to the health care system. The great majority (85 percent) of premature deaths are related to human behavior, genetic predisposition, and social circumstance (Wenger, 2009). Hogberg (2006) argued that life expectancy is more related to one’s socio-economical status, which includes wealth, education, employment, living environment, etc. People’s life style or culture will influence their life expectancies. Wenger (2009) provided one example: Japanese-Americans living in the U.S. have an average life expectancy similar to Japanese living in Japan, even though average American life expectancy is few years shorter than that of Japanese. Infant mortality rate (IMR) is another example of less reliable health indicator to be used to evaluate a health care system. First, there is inconsistency among nations on how to measure the infant mortality rate. According to Hogberg (2006, p. 6), U. S. defines live-born as “breathes or shows any other evidence of life such as beating of the hearts, pulsation of the umbilical cord, or definite movement of voluntary muscles…regardless of gestational age”, however, “an infant must be at least 30 centimeters long at birth to be counted as living” in Switzerland. This criterion would lower Switzerland’s infant mortality rate because it excludes many of the most vulnerable infants (Hogberg, 2006). Also, using infant mortality rate as indicator of a whole population’s health is problematic. A country could target and lower the infant mortality rate as it becomes the principal focus of that country’s health policy. However, the whole population’s health could remain unchanged or even decline while ignoring the rest of the population (Reidpath & Allotey, 2003). As we can see from the above examples, health indicators are sometimes unreliable or even flawed. Many health indicators are driven by a variety of other factors in addition to health care system itself, thus cannot correctly reflect the performance of a country’s health care system. References:

Harrington, C., & Estes, C. L. (2008). Health policy: Crisis and reform in the U. S. health care delivery system (5th ed.). Sudbury, MA: Jones and Bartlett Publishers. Hogberg, D. (2006). Don’t fall prey to propaganda: Life expectancy and infant mortality are unreliable measures for comparing the U.S. health care system to others. National Policy Analysis, 101, 1-10. Reidpath, D. D., & Allotey, P. (2003). Infant mortality rate as an indicator of population health. Journal Epidemiology Community Health, 57,344–6. U.S. Department of Health & Human Service (2012). Understanding health indicators. Retrieved from http://www.hhs.gov/open/datasets/healthindicator.html Wenger, R. D. (2009). Does the U. S. have the best health care system in the world? Bulletin of the American College Surgeons, 94(7), 8-15. World Health Organization (2010). The world health report 2000– Health system: Improving performance. Retrieved from http://www.who.int/whr/2000/en/whr00_en.pdf

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