Disparities in health care spending and numbers of doctors

Differences in access to health care can have far-reaching consequences. Those denied access to basic health care may live shorter and more constrained lives. A dramatic example of this is that inadequate access to health care is thought to be the primary cause of the premature deaths of 100 million "missing women" worldwide. Sen estimated (1990) that 100 million more women would be alive today, primarily in China, South Asia and North Africa, if women and girls had equal access to health care and nutrition across the globe.

Here we examine two aspects of access to health care: spending and the number of physicians.

The page on health care spending makes two points. First, a graph of global population, ranked by average country spending, shows that there are enormous differences in health care spending across the globe. Health care spending per head for the top 5% of world population is nearly 4,500 times spending in the lowest 20%.

Second, two graphs examine the relationship between health care spending and life expectancy. These graphs show that there is a correlation but there are also some striking anomalies. Countries which spend little on health care mostly have low life expectancies, and countries with high health care spending generally have high life expectancies. But there are anomalies in both directions. Some countries with high health care expenditure, such as the United States, have surprisingly low average life expectancy.

The page on physicians provides a map illustrating the density of physicians across the globe in 1998. It shows that the industrialized countries have more physicians per 100,000 people than the non-industrialized. However, within those categories there are some striking differences. For example, some formerly socialist countries have a high density of physicians.

These two indices, health care spending and density of doctors, suffer from at least two limitations as measures of access to health care. First, they provide national average measures, and therefore do not illuminate differences in access within each country, such as between rich and poor, and urban and rural populations. Second, even at the national level, these indices provide only a crude metric of health care. For example, paramedics, "barefoot" doctors, nurses and midwives may be more significant health care providers than physicians for much of the world's population.

In addition, several other factors influence life expectancy, including access to safe water, and adequate nutrition. There is much to be done to provide better global health statistics.

Nevertheless, these indicators provide a rough guide to some of the glaring global disparities in access to health care.