HONG KONG (BLOOMBERG) – As a pandemic ravaged the world, Asian economies led by Singapore, Hong Kong and Taiwan 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 healthcare 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 United States 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 prioritise policies that rely on people potential,” said Dr 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 gross domestic product 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 per cent 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 US ranks among the bottom 10per cent 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 tops the list, followed by Hong Kong, 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 Dr Poonam Khetrapal Singh, the World Health Organisation’s South-east Asia director, in a Dec 12 report.

“In ordinary times, every dollar invested in health yields an average return of between US$2 and US$4 (between S$2.65 and S$5.31), which can be up to 20 times higher in low- and middle-income countries,” Dr 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 US$5,000 and a minimum population of five million.

India does not 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.

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The epicentre 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 US is 78.5 years, having decreased for several consecutive years, according to the latest data. That is at near-parity with those in the United Arab Emirates and Cuba, where per-capita spending on health care is less than a tenth of the US’ US$10,246.

Only Switzerland’s US$9,956 expenditure is close – yet the average Swiss lives five years longer than their American peers.

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