Insight
March 4, 2025
Quality Care in Perspective: Children’s Hospitals
Executive Summary
- The importance of access to quality care for children is a key point of agreement between proponents of single-payer health care and those for a robust private insurance market.
- Because both private and single-payer systems prioritize access for children, differences in the quality of those care systems is a useful metric in measuring which is more effective.
- One aspect of such care is the number of, and access to, top-quality children’s hospitals, an area in which the United States prevails over single-payer countries.
Introduction
If there is one point of agreement in health policy – across countries, health care systems, ideologies, and political persuasions – it is the importance of access to quality care for children. As the American Action Forum recently documented, wait times in single-payer systems tend to be longer, including for children. Because both private and single-payer systems prioritize access for children, differences in the quality of those care systems is a useful metric in measuring which is more effective. One aspect of such care is the number of, and access to, top-quality children’s hospitals, an area in which the United States prevails over single-payer countries.
This study analyzes recently collected data on specialized children’s hospitals to shed some light on these quality issues. These data show that, by most measures, the United States outpaces single-payer countries in terms of the quality of its pediatric care.
Data and Discussion
The data for this discussion are drawn from a ranking of the top 250 pediatric hospitals developed by Newsweek. The ranking was based on a worldwide online survey by experts, information in accreditation and certification data (where available), and Patient Reported Outcome Measures (PROMs). In the final ranking, the survey of experts received a 90-percent weight; the accreditation/certification data were weighted 6.5 percent, and the PROMs data were assigned a 3.5 percent weight.
It should be acknowledged that any single ranking is likely a noisy measure of the underlying reality of quality hospitals and that additional research would be invaluable. Yet it is useful for providing some insight into the quality of hospitals around the globe. The data are summarized in the table (below).
| Number of
Top Hospitals |
Percent of
Top Hospitals |
Hospitals
Per Million Children |
Hospitals in
Top 10 |
Median
Rank Hospitals |
|
| Australia | 8 | 3.2% | 1.63 | 75 | |
| Austria | 1 | 0.4% | 0.77 | 72 | |
| Brazil | 13 | 5.2% | 0.30 | 151 | |
| Canada | 10 | 4.0% | 1.69 | 1 | 61.5 |
| Colombia | 2 | 0.8% | 0.18 | 229 | |
| Denmark | 1 | 0.4% | 1.06 | 50 | |
| France | 7 | 2.8% | 0.60 | 1 | 174 |
| Germany | 31 | 12.4% | 2.66 | 165 | |
| India | 18 | 7.2% | 0.05 | 203.5 | |
| Israel | 1 | 0.4% | 0.38 | 234 | |
| Italy | 14 | 5.6% | 1.97 | 1 | 149.5 |
| Japan | 10 | 4.0% | 0.68 | 126.5 | |
| Norway | 1 | 0.4% | 1.12 | 116 | |
| Singapore | 1 | 0.4% | 1.14 | 213 | |
| South Korea | 25 | 10.0% | 4.78 | 1 | 148 |
| Spain | 12 | 4.8% | 1.99 | 141.5 | |
| Sweden | 1 | 0.4% | 0.55 | 97 | |
| Switzerland | 8 | 3.2% | 5.94 | 216.5 | |
| Thailand | 1 | 0.4% | 0.09 | 249 | |
| United Kingdom | 15 | 6.0% | 1.32 | 1 | 75 |
| United States | 70 | 28.0% | 1.21 | 5 | 72 |
There are three lessons that fall out of the data:
- High-quality hospitals are very unevenly distributed across the globe. There are only 21 countries represented in the data – essentially a handful of nations. Even within this group, the distribution is uneven. Instead of each country having 12 premier hospitals – a condition under which the represented countries shared the 250 premier hospitals evenly – a majority of countries fell in the single digits. The United States has far and away the most high-quality children’s hospitals: 70 total, or 28 percent of the 250. It is followed by Germany (31) and South Korea (28).
- The sheer number of U.S. pediatric hospitals is, in part, a reflection of the size of the country. Scaled by the size of the population under the age of 15, South Korea is even more of an outlier, exceeded only by Switzerland. The United States falls closer to the middle of the pack. While this number has some bearing on the level of access to pediatric hospitals, it does not capture the United States’ absolute advantage in health care quality for children.
- Among the elite hospitals, the United States stands out. Of the top 10 children’s hospitals, one-half are in the United States. No other country has more than one. Looking at quality more generally, the median rank (within the 250) of a U.S. hospital is 72, the best performance of any country with a large number of children’s hospitals.
Conclusions
Countries with single-payer health care lag far behind the United States in the number of high-quality pediatric hospitals. Of the world’s top pediatric hospitals, the United States claims 28 percent – more than a quarter. Even among the top 10 hospitals, one-half belong to the United States, and no other country claims more than one. Finally, the median rank (within the 250) of a U.S. hospital is 72, the best performance of any country with a large number of children’s hospitals. In short, by most measures the United States outpaces single-payer countries in terms of the quality of its pediatric care.
