File talk:Universal health care.svg
Map based on unreliable ILO source: response
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Revision as of 20:58, 18 March 2013
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This Wikipedia map was altered from the 2010 Stuckler et al. paper map to include an additional 17 countries that the paper (dubiously) says have passed health legislation that explicitly states that the entire population is covered by a health plan that grants them access to a core set of services, but have not achieved >90% skilled birth attendance (4 countries) or >90% health insurance coverage (12 countries + the United States which the ILO says has achieved 100% health insurance coverage but has not). This Wikipedia map highlights these 17 additional countries as: "Nations with legislated mandate for Universal health coverage, but which have not yet reached thresholds above." It is not credible to highlight El Salvador (ILO 59.6%), Bolivia (ILO 66.9%), and the Congo (ILO …%) as being closer to providing universal health care than Poland (OECD 97.5%), Lithuania (ILO …%), and Lebanon (ILO 95.1%).[[User:Apatens|Apatens]] ([[User talk:Apatens|talk]]) 16:53, 14 March 2013 (UTC)
This Wikipedia map was altered from the 2010 Stuckler et al. paper map to include an additional 17 countries that the paper (dubiously) says have passed health legislation that explicitly states that the entire population is covered by a health plan that grants them access to a core set of services, but have not achieved >90% skilled birth attendance (4 countries) or >90% health insurance coverage (12 countries + the United States which the ILO says has achieved 100% health insurance coverage but has not). This Wikipedia map highlights these 17 additional countries as: "Nations with legislated mandate for Universal health coverage, but which have not yet reached thresholds above." It is not credible to highlight El Salvador (ILO 59.6%), Bolivia (ILO 66.9%), and the Congo (ILO …%) as being closer to providing universal health care than Poland (OECD 97.5%), Lithuania (ILO …%), and Lebanon (ILO 95.1%).[[User:Apatens|Apatens]] ([[User talk:Apatens|talk]]) 16:53, 14 March 2013 (UTC)
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=== Response to Apatens ===
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Apatens makes some interesting points. However, I cannot agree with his discounting of ILO data, nor of the Stuckler paper. ILO is a major intergovernmental organization, and they take their data very seriously. If there are discrepancies between old OECD data and more recent ILO data, the only explanation is that ILO statisticians found their numbers to be more accurate. Now, you can disagree with ILO methodology, or dispute their findings, but unfortunately that all adds up to original research - in order for such findings to make their way into wikipedia, you need to write them up and publish them and get them cited and then they can become a more "true" version of the truth.
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As for Stuckler et. al., that paper is the best one I have been able to find that actually draws a line in the sand and attempts to set a workable threshold for UHC. Some countries that we feel "should be" there aren't, and others that don't look right, are. So, is it perfect? No. Is it a global study (eg looking at most countries in the world), published in a peer reviewed forum? Yes. Their data is from 2009 so of course people will complain about it, but unfortunately we don't have any other *clear* definition of achievement of UHC, nor do we have any other published papers that lay out a threshold and then do the math in the way this paper does. So, what I suggest is that if we want to improve these maps, we find another published source, which is more recent, and has "better" data or a more agreeable threshhold, and then use that to iteratively improve the map. People are working on this as we speak - but I haven't see the papers yet.
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You should have seen the map before this most recent one - it was terrible, based on, well, I don't know what it was based on - no sources were given - but that wildly inaccurate map was replicated across the blogosphere and even ended up in the pages of the WSJ or something similar - and when I deleted it there was an outcry and people want a colored map on this page.
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So, this current map is better than any other I've found, and I of course welcome ever better and more up to date sources. Until those are found, this map should remain, with proper notation explaining what it means, and where the data comes from, and how old it is. Too many wikipedia chloropleth maps like this are generated based on specious data - this one at least has a paper and research behind it.
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To respond to a few specific points:
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# "the United States which the ILO says has achieved 100% health insurance coverage but has not" - You will really have to debate this with the ILO. It's all about definitions - and per their definition the US have 100% social health protection (probably due to the fact that someone can show up at an emergency room and receive treatment without having to pay right away). Again, it's all about definitions.
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# "it equates 90% health insurance coverage with universal (100%) health insurance coverage" - no, the paper sets a threshold for achievement of UHC, and it uses 90% coverage + 90% skilled birth attendance + legislated mandate as a proxy for same. There is no such thing as 100% - even countries which we consider fully there (e.g. Thailand, France, etc) still have people who slip through the cracks. UHC is not a destination, it's a journey. Is your package of services sufficient? Should you also cover dialysis? If you don't, do you have UHC? The WHO UHC paper lays this out nicely, showing 3 dimensions of coverage - reach, out of pocket expenses, and depth of services covered. In theory, reach can go to 100%, but you're not done - what about migrants, or stateless people in your borders, or tourists, or ... As for payment/financial protection, some systems have high levels of co-pays even at ~100% coverage (eg. Japan) which other countries would disagree with - so one goal is to bring those OOP down. As far as benefit packages/depth of services, you can keep on adding and adding. So in a sense, you're never done. That's why I think a practical way forward is to have a threshold, a line in the sand. Otherwise, it's meaningless to say "X country has UHC and Y country doesn't" - if we're not all using the same measuring stick it's a useless argument.
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# "It is not credible to highlight El Salvador (ILO 59.6%), Bolivia (ILO 66.9%), and the Congo (ILO …%) as being closer to providing universal health care than Poland (OECD 97.5%), Lithuania (ILO …%), and Lebanon (ILO 95.1%)." - again, I was just following the methodology of the paper. The other map (based on pure ILO figures) was placed below, for exactly this reason, to highlight different levels of ILO-determined social health protection. But the pure ILO figures, on their own, are disputed in other literature, which is why Stuckler et. al. added other criteria for UHC, at least that's how I understood their approach. There are other ways to color the map based on the Stuckler paper, but I actually hope we will just find a better paper with more recent data and move forward with that.--[[User:Obiwankenobi|KarlB]] ([[User talk:Obiwankenobi|talk]]) 20:58, 18 March 2013 (UTC)
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