Asia trounces US in Health-Efficiency Index amid pandemic

Health workers check a coronavirus disease (COVID-19) patient at Hallym Sacred Heart Hospital ECMO Center in Anyang, South Korea, March 5, 2020. — Hallym Sacred Heart Hospital ECMO Center/Handout via REUTERS

As a pandemic ravaged the world, Asian economies led by Hong Kong and Singapore topped a ranking of most-efficient health care systems.

The Bloomberg Health-Efficiency Index, first conducted in 2013, tracks life expectancy and medical spending to determine which health-care systems have the best outcomes. This year’s results include the impact of COVID-19 on mortality and gross domestic product in 57 of the world’s largest economies.

These measures helped many Asian territories improve their standing on the list since their generally aggressive coronavirus responses kept cases and deaths relatively low. Brazil and Russia joined the U.S. in the bottom tier, reflecting relatively low life expectancies along with high COVID-19 mortality and weaker economic outlooks.

“Efficient health systems are often in places that have limited natural resources and therefore prioritize policies that rely on people potential,” said Pisonthi Chongtrakul, a professor in the Faculty of Medicine at Chulalongkorn University in Bangkok.

“Success in combating COVID-19 has come in places that coordinated among government bodies and were willing to let health experts call the shots, which helped create a clarity of public messaging,” he said.


To measure efficiency during the pandemic, two adjustments were made to the original ranking formula: the 2020 table includes the one-year change in GDP based on an October forecast by the International Monetary Fund, as well as the COVID-19 toll on each economy.

For example, a 2020 GDP contraction of 6% led to a 6 point subtraction from the total score, while a death toll or new confirmed cases of 100,000 deducted 11.5 points.

The U.S. ranks among the bottom 10% under this method as well as the formula used before COVID-19, which simply measured spending against life expectancy. America’s low scores reflect a middling average lifespan, the world’s biggest outlays on medical care along with the largest COVID-19 caseload.

Using the formula adjusted for the pandemic, eight of the world’s 10 most-efficient health systems are in Asia Pacific. Singapore and Hong Kong top the list, while Taiwan, New Zealand, South Korea and Thailand leapfrogged many territories based on their COVID-19 statistics.

“The pandemic has underscored the fact that economic health is dependent on public health, which is in turn dependent on adequate public spending on health,” said Poonam Khetrapal Singh, the World Health Organization’s South-East Asia director, in a Dec. 12 report.

“In ordinary times, every dollar invested in health yields an average return of between $2 to $4, which can be up to 20 times higher in low- and middle-income countries,” Singh said.

The rankings of France, Spain and Peru tumbled most among the 57 economies in Bloomberg’s 2020 adjusted-formula survey, which includes only those with average lifespans of at least 70 years, GDP per-capita exceeding $5,000 and a minimum population of 5 million. India doesn’t meet the minimum metrics, though it is among the nations hardest hit by the pandemic.

China, the world’s most-populous territory, ranked 25th using the pre-pandemic formula, but jumped to No. 12 when adjustments for COVID-19 were incorporated. The epicenter of the virus was also the place that used some of the most draconian measures — ranging from controlling peoples’ movements to mandatory testing — to limit cases and mortality.

All but two of the 57 economies in this index are expected to shrink in 2020, according to forecasts by the International Monetary Fund, with only China and Taiwan projected to post year-on-year growth.

The average lifespan in the U.S. is 78.5 years, having decreased for several consecutive years, according to the latest data. That is at near-parity with those in the U.A.E. and Cuba, where per-capita spending on health care is less than a tenth of the U.S.’s $10,246. Only Switzerland’s $9,956 expenditure is close — yet the average Swiss lives five years longer than their American peers. — Bloomberg


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