The Moral Healthcare Blog

Measuring the Health of Nations: Updating an Earlier Analysis

Measuring the Health of Nations: Updating an Earlier Analysis:

“U.S. Ranks Last

Between 1997–98 and 2002–03, amenable mortality fell by an average of 16 percent in all countries except the U.S., where the decline was only 4 percent. In 1997–98, the U.S. ranked 15th out of the 19 countries on this measure—ahead of only Finland, Portugal, the United Kingdom, and Ireland—with a rate of 114.7 deaths per 100,000 people. By 2002–03, the U.S. fell to last place, with 109.7 per 100,000. In the leading countries, mortality rates per 100,000 people were 64.8 in France, 71.2 in Japan, and 71.3 in Australia.

The largest reductions in amenable mortality were seen in countries with the highest initial levels, including Portugal, Finland, Ireland, and the U.K, but also in some higher-performing countries, like Australia and Italy. In contrast, the U.S. started from a relatively high level of amenable mortality but experienced smaller reductions.”

Just another collection of damning data to be ignored by the usual suspects…

WSJ.com – Commentary: Edwards and Organ Transplants

Argues that because Americans are more likely than Europeans to get a transplant, and more likely to survive it too, that this would not be possible in an American Single Payer system.

The author argues that, “Organ transplantation, like many areas of medicine, provides a poor basis for his political thesis that single-payer health care offers a more equitable allocation of scarce resources, or better clinical outcomes.”

He is partially correct; a high tech treatment like organ transplant is not a good way to decide how to reform American Health Care. The staunchest advocates for Single Payer Healthcare never, ever, disparage American medicine’s ability to deliver the best care in the world in areas such as organ transplant, trauma, intensive care and other high tech endeavors. But these areas are only a sliver of overall clinical outcomes. Even at the quoted 18.5 liver transplants per million done in the US annually, this is only 5000 or so patients. So, while not being dismissive of these patients, they are not reflective of healthcare outcomes of our population. They only reflect what we already know: We spend tons of money on advancing high tech medicine and we are darn good at it. As I view the transition to single payer, I see no reason, other than “conservatives” wailing about unnecessary spending on healthcare as the system matures, for us to continue to do well in our “American specialty” of bleeding edge healthcare.

Yet, the point about a single payer system not offering a more equitable allocation strikes me as intuitively, obviously false, and I don’t believe the author tries to refute the point other than pointing out that we do more liver transplants in the US than elsewhere. A strange point is also made about the threat of the government deciding who gets the organs. I think most of us would gladly take a standard set of criteria developed by the NIH, UNOS, or other agency, applied fairly and equitably across all socioeconomic and ethnic categories by a Medicare-like agency, rather than the inherently conflicted interests of a private insurer!

And finally, since we spend twice as much on healthcare, shouldn’t we do twice as much of everything, not just liver transplants? Preventive care and prescription drug benefits come to mind immediately, but you can pick your own favorite.

Cheers,

Crooks and Liars » Nataline Sarkisyan passes away. Shame on Cigna!

Crooks and Liars » Nataline Sarkisyan passes away. Shame on Cigna!: “We [Crooks & Liars] posted this story yesterday with an update to the heartbreaking result. While battling CIGNA for a new liver, her family and friends fought and protested until CIGNA finally gave in, but it was too late—the seventeen-year-old Nataline Sarkisyan died.”

Democrats get infusion of campaign money from health care | Dallas Morning News | News for Dallas, Texas | National Politics

Democrats get infusion of campaign money from health care Dallas Morning News News for Dallas, Texas National Politics:

“Depending on who is elected, the role of government and employers could swing dramatically, from Democrat John Edwards’ call to require all employers with five or more workers to provide coverage or contribute 6 percent of payroll toward a public program on one end of the spectrum, to Republican Fred Thompson’s call to ‘divorce [the] complete dependence people have on employment for their insurance.’

In Texas, health care executives have donated almost twice as much to presidential candidates in this campaign as they did in the last election. Doctors and hospitals have a vested interest in increasing the number of people who have insurance, since that ups their chances of getting paid. Meanwhile, insurers want to ensure that people and companies keep purchasing plans from private insurance companies, as opposed to switching to a government-run system.

So, perhaps it should not be surprising that, through September, Texans in areas ranging from surgery to medical supplies donated $934,000, up 75 percent from the $531,000 poured in during the same period of the 2004 campaign.

This time around, about as much of that money went to Democrats as Republicans. Democratic candidates raked in a total of $459,650, versus $474,234 for Republican presidential candidates.
On the national level, the Democrats actually beat the Republicans. Through September, Democratic candidates collected $6.5 million from the health care industry, compared with $4.8 million for Republican candidates, according to the Center for Responsive Politics, a Washington, D.C.-based campaign finance research group.

Mrs. Clinton, the Democratic front-runner, has been the biggest beneficiary from Texas health industry donations, with $237,000 through September; Republican front-runner Rudy Giuliani came in second, with $223,000.

Next in line for Democratic contributions was Illinois Sen. Barack Obama, with $110,000 from Texas health care donors. Mr. Obama also collected the state’s single-largest such donation, with $24,000 from the Dallas-based medical technology company T-System Inc., according to a study prepared for The Dallas Morning News by the Center for Responsive Politics. “

Doctors endorse single-payer | Philadelphia Inquirer | 12/04/2007

Doctors endorse single-payer Philadelphia Inquirer 12/04/2007:
“Because much of the growth in expense in the current system is in procedures performed by specialists or in increased use of technology like MRIs, doctors who work in those areas have the most to fear from a single-payer system, Getzen said. Internists, who serve as primary-care doctors for many people, have less to fear.

The ACP also called for better payments for primary-care doctors to help avert a shortage and for the creation of a uniform billing system and greater use of electronic health records to reduce administrative costs.

Dale said that some U.S. doctors and hospitals were better than their counterparts in other nations, but that this country’s health system compares poorly. ‘Part of our call is, ‘Look around, guys, and see how other people are doing,’ ‘ he said, ‘and they’re doing better than us.’ “

Nicely done summary of where most of the tension in advocating for single payer lays.

The ACP position paper is here, and I believe free to anyone.

Cheers,

Draft Proposal for a Single Payer, Comparative Healthcare Wiki

Comparative Healthcare: Economic, Policy, Provider and Public Perspectives

Nation: General description/overview of system
Economics
Macroeconomic view
Per capita, GDP spending
Financing system
Cost to taxpayers
Cost to employers/employees
Efficiency
Microeconomic view
Business evaluation of efficiency
Citizen evaluation of efficiency
Provider evaluation of efficiency
Hospitals
Other facilities (SNF, surgery centers, testing/imaging)
Providers
Physicians
Nurses
Others: extenders/PT/OT/RT/ Pharmacists

Policy Considerations
Socialized/Single Payer/Hybrid
Private insurers/providers
Federal Perspectives
Perceived shortcomings
Percieved efficiencies
Things to include
Things to avoid
Political pitfalls
Funding
Administration

State/Province/Other Perspectives
Local Administration
Local Governanace

Provider Perspectives
Hospitals
Adminstrators
Nurses and allied healthcare
Physicans
Physicians
Perspectives of Physicians
Timeliness
Effectiveness
Practice Variation
Quality data
Fairness
Access
Research
“High Tech” health care
End-of-Life Care
Reimbursemnet
Bureacracy
Autonomy of decision making
Access to data (quality)
Access to data (EHR)
Mental Health/substance abuse care

Nurses
Physician Extenders
Utilization
Role
Income
Other Allied healthworkers
Pharmacists
Dentists
Optometrists
Psychologists

Public Perspectives
Timeliness
Effectiveness
Access
Out-of-Pocket Costs
Rationing
Spending/Cost to nation
Value

Although U.S. Spends Twice as Much…- Kaisernetwork.org

Coverage & Access Although U.S. Spends Twice as Much as Other Industrialized Nations on Health Care, More in This Country Have Access Problems, Survey Finds – Kaisernetwork.org:

“The article notes that the U.S. spent $6,697 per capita, or about 16% gross domestic product, on health care in 2005. Other nations in 2005 spent less than half that amount per person on health care. The survey found that respondents in Canada and the U.S. often visit emergency departments for routine care and that those in the U.S. ‘were most likely to have gone without care because of cost and to have high out-of-pocket costs.’

In addition, the survey found that 37% of all respondents in the U.S. and 42% of those with chronic diseases ‘had skipped medications, not seen a doctor when sick, or forgone recommended care in the past year because of costs — rates well above all other countries.’ In contrast, respondents in Britain, Canada and the Netherlands ‘rarely report having to forgo needed medical care because of costs,’ according to the survey. Respondents in New Zealand and Britain had the least confidence in the quality of care that they received, and those in Germany and the U.S. had the most access to elective surgeries, the survey found.

Commonwealth Fund President Karen Davis said, ‘The survey shows that in the U.S., we pay the price for having a fragmented health care system,’ adding, ‘The thing that struck me in this survey is the trouble that Americans have in getting to see their own doctors'”

Exhausted

From a note on my patient’s chart today:

Dr. _______
Mrs. ________ has exhausted her SNF [Skilled Nursing Facility] coverage. She has used her full 100 days and does not qualify for Medical Assistance [Medicaid]. She would have to privately pay for an SNF and she cannot afford this.

Doctor’s Reply: What can I do about this?

Response: The patient and family are aware and husband says he will hire help but cannot afford private pay at SNF.

Joint Canada/United States Survey of Health: Findings and public-use microdata file: Analytical report

Joint Canada/United States Survey of Health: Findings and public-use microdata file: Analytical report:

“Overall, most Canadians (88%) and Americans (85%) reported being in good, very good or excellent health. However, the range of health status was more polarized in the United States. More Americans reported being at either end of the health status spectrum – in excellent health (26%) and in fair and poor health (15%) – compared with Canadians (24% and 12% respectively).”

I saw a post arguing that this data proved the US system is better, and I just wanted to post the summary report for reference. Follow the link for the rest of it. It’s worth remembering how much more we spend here than there as you review the numbers, and it’s worth restating that we want to build an American system that is the best in the world in its totality, not just in niches of high tech and procedural related care.