Table 1:
Top 50 Countries Ranked by Maternal Mortality Rates and Showing Health
Expenditure
Rank
|
Country
|
Deaths/100,000 births
|
Heath expenditure %/GDP &
world rank
|
1
|
Estonia
|
2
|
6%, 85
|
2
|
Singapore
|
3
|
4%, 24
|
3
|
Greece
|
3
|
10.3%, 173
|
4
|
Italy
|
4
|
9.5%, 158
|
5
|
Austria
|
4
|
11%, 179
|
6
|
Sweden
|
4
|
9.6%, 161
|
7
|
Finland
|
5
|
9%, 149
|
8
|
Iceland
|
5
|
9.4%, 155
|
9
|
Poland
|
5
|
7.5%, 119
|
10
|
Czech Republic
|
5
|
7.9%, 130
|
11
|
Japan
|
5
|
9.5%, 157
|
12
|
Spain
|
6
|
9.5%, 159
|
13
|
Slovakia
|
6
|
8.8%, 145
|
14
|
Netherlands
|
6
|
11.9%, 193
|
15
|
Ireland
|
6
|
9.2%, 153
|
16
|
Norway
|
7
|
9.5%, 156
|
17
|
Qatar
|
7
|
1.8%, 1
|
18
|
Australia
|
7
|
8.7%, 144
|
19
|
Germany
|
7
|
11.6%, 189
|
20
|
Israel
|
7
|
7.6%, 123
|
21
|
Portugal
|
8
|
11%, 180
|
22
|
Montenegro
|
8
|
9.1%, 152
|
23
|
Lithuania
|
8
|
7%, 112
|
24
|
Switzerland
|
8
|
11.5%, 187
|
25
|
Malta
|
8
|
8.7%, 142
|
26
|
Belgium
|
8
|
10.7%. 177
|
27
|
France
|
8
|
11.9%, 182
|
28
|
Bosnia/Herzegovina
|
8
|
11.1%, 181
|
29
|
Kiribati
|
9
|
11.3%, 184
|
30
|
Cyprus
|
10
|
6%, 86
|
31
|
Macedonia
|
10
|
7.1%, 113
|
32
|
Bulgaria
|
11
|
6.9% 108
|
33
|
Denmark
|
12
|
11.4%, 186
|
34
|
Canada
|
12
|
11.3%, 185
|
35
|
Serbia
|
12
|
10.4%, 174
|
36
|
United Arab Emirates
|
12
|
3.7%, 20
|
37
|
Slovenia
|
12
|
9.4%, 154
|
38
|
United Kingdom
|
12
|
9.6%, 160
|
39
|
Kuwait
|
14
|
2.6%, 7
|
40
|
New Zealand
|
15
|
10.1%, 170
|
41
|
South Korea
|
16
|
6.9%, 107
|
42
|
Croatia
|
17
|
7.8%, 127
|
43
|
Luxembourg
|
20
|
7.8%, 126
|
44
|
Turkey
|
20
|
6.7%, 99
|
45
|
Bahrain
|
20
|
5%, 50
|
46
|
Puerto Rico
|
20
|
N/A
|
47
|
Hungary
|
21
|
7.3%, 117
|
48
|
United States
|
21
|
17.9%, 190
|
49
|
Iran
|
21
|
5.6%, 72
|
Additionally, the WHO Health Statistics Report shows that,
since 1990, maternal mortality rates have nearly doubled going from 12/100,000
live births in 1990 to 21/100,000 live births in 2010. This abysmal ranking is in spite of the fact
that in 2010 the US spent a higher percentage of its GDP in health care (17.9%)
than every other country in the entire
world except for the Marshall Islands (18.1%, well at least we aren’t the
worst right?).
While it does not appear that money spent = lower rates, the
majority of the top 20 countries spend between 8-11% of their GDP on health
care, with the exceptions of Estonia (6%), Singapore (4%) and Qatar (1.8%). This seems to indicate that spending between
8-11% of GDP is the optimum amount to spend on health care. Much more (like the US) and there seem to be
issues with efficiency and overuse of expensive procedures, and much less
(Somalia, Chad) and there are not enough services to help every woman. Some countries, especially in the Middle East
show low percentages due to very high GDPs and smaller populations (United Arab
Emirates, Qatar)
According to an article done by Frontline ((http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html),
there are basically four ways of paying for health care: The Beveridge Model,
the Bismarck Model, The National Health Model and the Out-of-Pocket Model. The majority of the countries in the top 46
have one of the Beveridge Model, the Bismarck Model or the National Health
Model. All three of these models require
the involvement of government to either provide health care or provide
regulation on health care so that prices stay low and affordable. The Beveridge Model is government controlled
health care where all health care professionals either work for the government
or receive their payment directly from the government. This model is used in countries like the UK,
Scandinavia, Spain, and New Zealand. The
Bizmark model uses private insurance and health care providers funded by
employers etc (similar to the US), but the government is responsible for
regulating the industry to make sure that everyone is insured and prices stay
low. Countries like Germany, France,
Belgium, Japan, the Netherlands, Switzerland and much of Latin America. The National Health Model uses private health
care providers, but bills are paid for by the government, which is funded
through taxes. In all three sections, health
care providers and insurance companies are non-profit, which keeps prices low
and ensures that the patient will get preference not the procedure.
So here is the thing, almost all of the countries that are
doing better than us in maternal mortality rate use one of those three
systems. The United States has pieces of
all four systems (including the
out-of-pocket system, which means rich people get health care and the poor do
not). This makes our system completely
disjointed, inefficient and means that the systems values practices that cost
the most money rather than save the most lives.
The US C-section rate is 33% and growing; that is worse than
175 other countries in the world and more than twice the WHO recommendation for
15%. A C-section is a costly procedure
that benefits both doctors and for-profit insurance companies. Delivery of mediations (epidurals, spinals,
Pitocin), running fetal monitors, these are all things that hospitals get to
charge people for, which increase the bills and gets more money for them and
the insurance companies. C-sections and
medications are necessary in some cases
and o help some women, but these
rates show that there is too much unnecessary intervention going on.
These “standard” procedures are also what cause most of the complications that
women face during labor, which leads to higher death rates. In countries that use one of the 3 primary
health care models, the government is able to control the use of these procedures
because they end up costing tax payers and people more money (which they do
here too, even if you have health insurance, don’t kid yourself you are paying
for these expensive procedures!). For
instance, in Canada, doctors are now trained to deliver breech babies vaginally
in order to lower the rate of C-sections and keep rates and prices low for the
people.
In many of these countries (Canada, Scandinavia, the UK,
Germany, etc.), midwives are also an integral part of the health care
systems. Their services are less
expensive and since they promote natural birth, the births themselves cost
less. For the majority of low-risk
mothers, this is the best way to have a baby, and it is the cheapest. The systems of doctors and midwives work
together in these countries to insure that the majority of mothers who do not
need interventions have healthy babies, but when the mothers come in that do
need help to save their lives and those of their babies, doctors and hospitals
are necessary as well.
While acceptance of midwives is growing in the US, there are
still many states where the practice is illegal, or midwives are so strictly
regulated that they can’t perform their duties to the best of their abilities
and it actually causes problems.
The US health care system is so disjointed that we cannot
effectively treat women. Too much depends on expensive procedures, expensive
medicines and not enough on the health of the woman (or anyone for
that mater). I’m not saying that there
is a perfect system out there (because that isn’t possible, we are human after
all and gloriously imperfect), however we need to streamline this system, pick one, and move forward. Pick a system that promotes the health and
wellness of the people and not the pocket books of the insurance companies and
health care professionals.
