Comment by yummyfajitas | Hacker News Reader

Comment by yummyfajitas | Hacker News Reader

Parent Full thread

Only one of those measures is even remotely related to the factors I asked for data on (working hours, health care or luxuries), namely the WHO rankings of health care. Unfortunately, the WHO rankings of health care are not actually rankings of health care. They rank a weighted average of health (25%), health inequality (25%), responsiveness (12.5%), responsiveness inequality (12.5%), and financial inequality (25%).

Go read the actual report: http://www.who.int/whr/2000/en/whr00_en.pdf

Only 37.5% of the ranking is even peripherally related to health care, namely health outcomes (measured by DALE, Disability Adjusted Life Expectancy) and responsiveness (how satisfied patients are). The US is #1 in responsiveness and #24 in DALE (4.5 years behind Japan at #1 and 0.5 years behind Germany at #22).

It's unclear how significant the gap in DALE is, since lifestyle and genetics strongly affect DALE. Fun fact: life expectancy for Japanese Americans is higher than for Japanese (84.5 in the US [1], 82.6 in Japan). Within the US, life expectancy varies from 44 (Lakota Men) to 86 (Chinese American Women), a gap of 42 years.

To actually rank health care, one would need to measure medical outcomes for specific medical diagnoses, adjusted for patient quality. E.g., it would need to answer questions like "given a group of non-overweight white males aged 45-55 with prostate cancer, how many survive at least 5 years?".

[1] http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2...

(mini-rant: Well, to be honest I found your attitude a bit annoying. The poster mentioned three things. You asked for data. He provided one and your reply was: "Not sceptic of that", without specifying much. I provide different measures, including one covering one more of the three original points, and you complain that some of them are off topic. So yeah, if one gives you on topic data you are not sceptic of that, if one gives you partially on topic partially off topic, then you complain too. Not very polite, if you ask me. Anyway, on with the actual reply.)

Your definition of health care is who got the best doctor. But the point is that there's a lot more than that to good health care. If a country has better diet, or a less polluted environment, or people are less stressed (which itself can cause further problems, including physical problems), then I think all of that should be included.

Why shouldn't the average health be counted? Is preventing an illness less effective than curing it? And what's the point of measuring how good are your doctors or facilities if a lot of people cannot afford those?

(edited for grammar.)

You are correct, I should have originally specified that I was only skeptical of the claims on health care and luxuries (since working hours are easy to look up). That was my mistake, and I offer my apologies.

You provided more data unrelated to health care and luxuries. One of your data points looked (at first glance) to be directly on point, but on further examination it turned out not to be. I pointed this out. I'm sorry that you consider disputing your facts is impolite.

Preventing an illness is great, and I'm strongly in favor of it. However, you are expanding the term "health care" beyond it's normal use. A quick google search finds definitions for "health care" similar to the following: "The prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions."

Being ethnically Japanese, visiting the gym or living in a less polluted environment is not health care by the usual definition, even though it affects health. If you want to define health care as "anything which improves health", be my guest. With that definition in mind, I agree that the US has a poor health care system. But when you use a non-standard definition of terms, it's helpful to clarify that.

I was simply arguing against the idea that the WHO rankings provide strong evidence that the US has poor health care, with health care defined as per the definition I quoted. The WHO rankings don't even attempt to study that question.

I didn't say you were impolite because you disputed the facts. But because you were giving very vague definitions of what you were exactly looking for, and instead just turned down people who offered numerical evidence. Had you been more clear what exactly you were after, I'd wouldn't have had a problem (disputing the relevance of facts I think it's alright).

I agree health care is a badly defined word. And if you want to restrict yourself to services offered by medical professionals then I am fine.

Then I can argue with you that yeah, the USA is not so bad on the actual services provided. Although given the quality of the service changes with how much you can pay, we should really look at the average health care offered (hence those who can't pay and are not insured would count as horrible service). Also having universal health care helps simply because people can take much more advantage without worrying if it's worth the money. For example screening for diseases or cancer. And where I live now (UK) doctors will also check your weight, discuss how you can improve your diet and so on. Not sure then if these would count in your definition or not.

I think anyway that the guy you replied to meant a broader concept of health care. When the government subsidises screening or healthy food at schools then I would have counted those under health care.

Incidentally I guess that's why the WHO used those other data that you disliked. Financial inequality matters because richer people can afford better health care.

Financial inequality measures inequality in spending, not affordability.

The way they calculate it is to take sum |marginal_spending[i] - avg_marginal_spending|^a (I think a is 3, but I'd have to double check, I do recall that a > 1). So if 50% of people pay $1000 out of pocket for health care and 50% pay $0, you are penalized for being unequal. If everyone pays $2000 in taxes, the inequality penalty is zero. That's nothing but a penalty for non-socialized medicine and for copayments.

It's such a screwed up measure that increasing health or responsiveness for some of the population (or lowering costs for some, but not all) can reduce your score (if the magnitude is large enough)!

If you want to measure the baseline level of healthcare in a country (e.g., the bottom fifth percentile, or something), go ahead and do it. The WHO didn't do that. They ranked nations in order of how closely their health care systems resembled what some WHO bureaucrats thought an ideal health care system would look like.

Reply on news.ycombinator.com