Which countries have the best healthcare systems?
The overall health and wellbeing of the world’s population is critically impacted by the healthcare systems that serve them. Prior to the COVID-19 pandemic, which exposed systemic and underlying fragilities of various health systems, there have existed significant disparities in their performance. Global health systems – what they offer, who can access them, and how effective they are – are not universal. Even amongst nations who share similar levels of health expenditure and gross domestic product (GDP), care differs dramatically.
It is critical that global population health is improved as the quality, efficiency and availability of healthcare has a substantial, and direct impact on quality of life. Hospitals and clinics across the world suffer from capacity constraints, overstretched workforces, failure to harness appropriate technologies, funding issues, budget cuts, political instability and a wealth of other barriers to adequate primary care.
How are healthcare systems measured?
There are numerous ways in which to measure how effective a country’s healthcare system is. High-level measures include: quality of care and efficiency of patient care; access to care, including cost of healthcare services; disparities in performance; care equity; overall care outcomes; safety levels; and adherence to government-mandated standards.
Collecting data on how health providers in various countries perform helps to identify where improvements can be made. It offers insights into whether a clinic is meeting given benchmarks, highlights gaps in care where remediation is required, and provides continuous data about changes in care over time.
IBM refer to a number of essential measurements that can be used to assess how healthcare services are performing:
- length of stay
- readmission rates
- patient satisfaction
- mortality rates
- bed utilization/bed occupation rate
- hospital/clinic incidents
- average cost per discharge
- operating margin
- bad debt.
Which countries perform best – and why?
In 2000, the WHO conducted a pioneering study into the performance of global health systems across its 191 member states.
The 10 countries judged as having the most advanced medicine and healthcare services were:
- San Marino
Of course, more than two decades have passed since the report was published – and a variety of other studies have published differing results.
William Russell – a leading provider of international health insurance – list the following countries as their top 10 for health systems in 2022:
- United Kingdom
- United Arab Emirates
Clearly, some countries who were performing well then are still performing well now. France, which tops both lists, has a healthcare system characterized by universal coverage, good health outcomes and some of the highest-quality medical care. Statutory health insurance (SHI), decreed by the government, covers every French citizen; while some medical appointments may be paid for by an individual, the French government refunds most fees.
Singapore is consistently ranked as providing some of the highest quality care outside Europe. Financed via a combination of statutory public health insurance – MediShield Life – and private systems that citizens pay for – MediSave and MediFund – the country’s healthcare is highly efficient.
In Japan, life expectancy is among the highest in the world. More than 98% of its population is covered by SHI – with a separate system supporting those living in poverty – with insurance extending to most medical care, including mental health services, dental care and hospice care. Most Japanese healthcare takes place in specialist, privately owned clinics.
While it does not feature on both lists, Luxembourg serves as an example of how countries with large health technology sectors, and tech-literate populations, are more likely to prioritise e-health and increase care standards as a result. As one of the richest of the European countries, over 5% of all employees’ gross income is deducted and spent on healthcare.
Characteristics prevalent in other top-performing health systems across the world include:
- mostly government-funded/single-payer healthcare, such as Medicare (Australia) or the National Health Service (NHS) (United Kingdom)
- universal healthcare via mandatory private health insurance (Switzerland)
- state-of-the-art medical centres and hospitals (United Arab Emirates).
What can be done to improve global health systems?
Governments, healthcare leaders and decision makers must analyse the root causes behind health system inequalities and variations and take meaningful action to address them.
The World Economic Forum, in partnership with others, is passionate about developing greater health system resilience and health system sustainability. Resilience efforts focus on “the ability of systems to prevent, mitigate, overcome and rebound stronger from crises”, for example COVID-19, the climate crisis and natural disasters. In terms of sustainability, efforts focus on “the ability of systems to continually deliver their key functions of stewardship, generating resources, providing services, learning and improving in their ability to do so, in pursuit of improved population health.”
The World Health Organization (WHO) outline the following characteristics of well-functioning healthcare systems:
- steady financing mechanism
- a properly trained, adequately paid workforce
- well-maintained facilities
- access to reliable information to base decisions on.
In addition to this, policy changes and practical solutions are required for each country in order to be successful, as well as funding that reflects the real value of human health. Systems require methods for earlier detection, a shift towards human-centered, preventative care, strategic use of the latest technologies and medicines, less reliance on ‘out-of-pocket’ medical models most often seen in less-developed countries, and a healthy workforce that feels valued and motivated.
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