The WHO conducts this study using five weighted metrics. Health Level: 25 percent, Health Distribution: 25 percent, Responsiveness: 12.5 percent, Responsiveness Distribution: 12.5 percent, Financial Fairness: 25 percent.
*Health Level is figured by the countries Disability Adjusted Life Expectancy. This statistic for the purpose of the WHO includes homicide and accidental death. Remove those, and the United States actually has a life expectancy that is higher than countries listed above it on the list. Also many countries will cite babies that are born, but die after attempts to keep them alive, as 'stillborn'. It's common practice in America to list them as death after birth, which skews America's statistic for infant mortality.
*Responsiveness is figured out by rating things like system features, speed of service, protection of privacy, choice of doctors, happiness with care and quality of amenities. America actually rated fairly higher than most other countries on the happiness statistic.
*Financial Fairness is determined by the percentage of household income, beyond subsistance, that is spent on health care. This statistic is heavily skewed against any country that does not mandate it's health care. It subjectively determines a percentage of income that is 'acceptable' for each family in a country to spend. For countries that tax everyone, this number appears very low compared to that subjective number because the cost is spread over every family. For countries that rely on patients to pay through insurance of out of pocket, this number appears very high.
*Distribution Responsiveness refers to the disparity of health care available in a country. This is a misleading statistic also. It is possible for a country to have a majority of it's population to have 'excellent' health care, and a minority to have 'good' health care, and this country will be rated lower than a country that has 'good' health care across it's entire population.
The study is conducted using random sampling, which gives an uncited margin of error to the WHO studies. It also has as much as 80% uncertainty intervals in it's numbers. This means that on Overall Attainment (OA) of healthcare goals, the United States could be anywhere from 7th to 24th. France could be 3rd to 11th. Canada could be from 4th to 14th.
The study also ranks countries by the quality of health care received, but only in light of the amount of money spent. When Costa Rica ranks higher than the United States in the OP (Overall Performance) ranking (36 versus 37), that does not mean Costa Ricans get better health care than Americans. If the question is health outcomes alone, without reference to how much has been spent, the more appropriate measure is the OA ranking, where the United States is 15 and Costa Rica is 45.
The study also heavily weights factors that give preference to government subsidized medical systems. It only takes into account the health care system involved, and not other important factors such as nutrition and exercise habits of the studied populations. An earlier paper laying out the WHO methodological framework asserts, “Problems such as tobacco consumption, diet, and unsafe sexual activity must be included in an assessment of health system performance.” However that methodology was rejected as being irrelevant to a countries health. In other words, the WHO approach holds health systems responsible not just for treating lung cancer, but for preventing smoking in the first place; not just for treating heart disease, but for getting people to exercise and lay off the fatty foods.
In other words, the WHO studies that people love to quote are constructed using a methodology that favors government subsidized systems. It makes assumptions about what should be happening, and then compares countries systems against that. The study says very little about the actual quality of care received, and more about how people pay, if there is a perceived disparity, features, amenities, choice of who you can see.
