Daily Number: America’s Health Care is … Fairly Average – Pew Research Center
res ipsa loquitor…
Category: US/World Health Care Comparisons
The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States — Rodwin 93 (1): 31 — American Journal of Public Health
Keepin’ it real. Every system comes with trade-offs…
THE FRENCH HEALTH CARE system has achieved sudden notoriety since it was ranked No. 1 by the World Health Organization in 2000.1 Although the methodology used by this assessment has been criticized in the Journal and elsewhere,2–5 indicators of overall satisfaction and health status support the view that France’s health care system, while not the best according to these criteria, is impressive and deserves attention by anyone interested in rekindling health care reform in the United States (Table 1). French politicians have defended their health system as an ideal synthesis of solidarity and liberalism (a term understood in much of Europe to mean market-based economic systems), lying between Britain’s ‘nationalized’ health service, where there is too much rationing, and the United States’ ‘competitive’ system, where too many people have no health insurance. This view, however, is tempered by more sober analysts who argue that excessive centralization of decisionmaking and chronic deficits incurred by French national health insurance (NHI) require significant reform.
TR Reid Busts International Health Care Myths
This was in my Pittsburgh Post-Gazette, but also in other papers as well. TR Reid, of PBS “Sick Around the World” has done the leg work and homework to become perhaps the most knowledgable journalist in the world on internation health care.
As Americans search for the cure to what ails our health-care system, we’ve overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they’ve found ways to cover everybody — and still spend far less than we do.
I’ve traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as ‘socialist,’ we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:
Myth 1: It’s all socialized medicine out there.
Not so.
Read on about myths 2-5:
MYTH 2: Overseas, care is rationed through limited choices or long lines.
MYTH 3: Foreign health-care systems are inefficient, bloated bureaucracies.
MYTH 4: Cost controls stifle innovation.
MYTH 5: Health insurance has to be cruel.
Do we do better in the US on prostate cancer?
Four Pinocchios for Recidivist Rudy – Fact Checker:
This is not about Rudy Giuliani, he’s irreleveant, but this is about the mythology that remains in the World of Fox about poor outcomes elsewhere. Somebody brought this one up recently (prostate Ca) so I put this here for future reference.
“Let’s begin by deconstructing the original Giuliani claim, featured in a campaign ad in New Hampshire. It rests on a crude statistical calculation by his medical adviser, David Gratzer, on the basis of a 2000 study by a pair of health experts from Johns Hopkins university. According to Gratzer, ’49 Britons per 100,000 were diagnosed with prostate cancer, and 28 per 100,000 died of it. This means that 57 percent of Britons diagnosed with prostate cancer died of it; and consequently, that just 43 percent survived.’
There are several problems with this line of reasoning, according to health experts.
In order to make statistically valid comparisons in epidemiology, it is necessary to track the same population. Because prostate cancer is a slow-developing tumor, it is probable that the Britons who died of prostate cancer in 2000 contracted the disease 15 years earlier. They represent an entirely different cohort of cancer sufferers than those who were diagnosed with the disease in 2000. The number of Britons diagnosed with the disease is itself a subset of the number of Britons with the disease.
‘You would get an F in epidemiology at Johns Hopkins if you did that calculation,’ said Johns Hopkins professor Gerard Anderson, whose 2000 study ‘Multinational Comparisons of Health Systems Data’ has been cited by Gratzer as a source for his statistics. ‘Numerators and denominators have to be the same population.’
Five-year prostate cancer survival rates are higher in the United States than in Britain but, according to Howard Parnes of the National Cancer Institute, this is largely a statistical illusion. Americans are screened for the disease earlier and more systematically than Britons. If you are detected with prostate cancer symptoms at age 58 in year one of a disease that takes fifteen years to kill you, your chances of surviving another five years (until the age of 63) are obviously much higher than if your cancer is detected in year eleven, at the age of 68. Both Anderson and Parnes say that it is impossible, on the basis of the available data, to conclude that Americans have a significantly better chance of surviving prostate cancer than Britons.
Whether or not early screening actually reduces mortality from prostate cancer is the subject of much controversy among researchers, both in the United States and Europe. According to Otis Brawley, chief medical officer for the American Cancer Society, “at least 50 percent of men diagnosed with prostate cancer don’t need to be treated. The problem is that we can’t figure out which men need treatment, and which don’t.”
In an attempt to figure out if screening for prostate cancer does indeed save lives, the National Cancer Institute has been following 70,000 men since 1992, but has yet to a firm conclusion, Brawley said. Half of the men in the sample are being screened and the other half are not being screened. An August 2007 NCI report said it was still unclear whether “earlier detection and consequent earlier treatment” led to “any change in the natural history and outcome of the disease.” Screening can lead to “over-treatment” which can in turn result in undesirable side effects such as erectile dysfunction and incontinence.
“This is getting completely ridiculous,” e-mailed Giuliani spokesman Jason Miller. “You are still not getting it. The point the mayor has made is that privatized medicine is better than socialized medicine. If you can find one person who said they’d rather be treated for prostate cancer in the UK instead of the US, we’d like to meet them.”
UPDATE WEDNESDAY 4:30 P.M.: Reader Jim Crowder asked an interesting question this morning, in response to Dr. Brawley’s statement that at least 50 per cent of men diagnosed with prostate cancer “don’t need to be treated.” Crowder asked, “OK, If I am in the 1/2 group that would benefit by earlier treatment, wouldn’t I rather be in the US and receive it? In fact I have received treatment.”
I [Fact Checker] asked Dr Brawley to respond. Here is what he says:
We know that at least half of the screened and detected do not need treatment and any treatment they get can only give them side effects of treatment, including a 0.5% to 1% chance of death from treatment.We do not know that we benefit the other half who have a disease that is destined to disrupt their life by causing symptoms and in many death. Indeed some of our clinical treatment studies are designed to figure out whether we cure those who need to be cured.
Connecticut versus Washinginton State comparisons show that men in Washington State have a much higher risk of prostate cancer diagnosis and treatment and side effects of treatment, but have the same risk of death as men in Connecticut. In several papers, [including] one by me, this has been attributed to the higher rates of screening in Washington compared to Connecticut. Both have had the same decline in mortality rates.
Health at a glance: OECD indicators 2005 – Google Book Search
Health at a glance: OECD indicators 2005 – Google Book Search
I was looking to find the prevelance of Nurse Practitioners elsewhere in the world and found the entire OECD “Health at a glance 2005”
Very interesting.
Who has the highest paid specialists? The Netherlands.
Where do PCPs and specialists get paid the same? Portugal.
Most MRIs? Japan. CTs? Japan.
And who pays the most? Oh, you know this one!
Senate Finance Committee Hearing on Expanding Health Care Coverage
“Roundtable Discussion on “Expanding Health Care Coverage”
May 5 , 2009, at 10:00 a.m., in 106 Dirksen Senate Office Building
Over at the PNHP Blog, Don McCanne points out that the voices for single payer are being stifled and excluded because of the view of most in the Congress that it is a politically unviable proposition, though he “respects” their views.
Even more problematic was an exchange later in the hearings between Sen. Pat Roberts and Scott Serota, CEO of the Blue Cross and Blue Shield Association.
Sen. Roberts told the tale of how a group of surgeons and anesthesiologists surrounded him after his knee surgery and told him and said they’d all quit if we went to a national health plan or even, I believe, to a public option and their reimbursements were to be decreased.
I don’t have the transcript, but he went on to say something along the lines of how there was no way to control costs in a national health system and then asked Serota what he thought.
Of course, Serota explained in that patrician way of so many how there was no way in the world to produce high quality and lower costs than we have in the US now with private insurance.
Now, if Sen. Baucus doesn’t want single payer advocates around because he doesn’t think it is politically viable, that is one thing. But what he doesn’t seem to realize is that having a knowledgeable single payer advocate and someone knowledgeable about international comparative health care in the room would have resulted in the particular line of BS that Roberts and Serota were peddling to be swatted down without breaking a sweat.
That is why it is so critical to have a broader range of views at the table. There was no one there willing to point out the obvious: Reducing future surgeons’ income from $500 K to $400 K, for example, will not bring the world to a halt. Essentially every country in the world controls costs and maintains quality at massive savings compared to the disastrously inefficient US private insurance industry.
But there was no one at the table willing to tell them that.
OECD Waiting Times Study Executive Summary
I realized that while I have a link to this study elsewhere, it is rather a pain to get to the information because the document is in pdf.
Now, this is from 2003, and so the UK/NHS data is now happily out of date. And leaders in Canada have seen the results in the UK and are pushing to end the bloc financing of hospitals that helped so much in the UK. But anyway, here is the summary:
- Waiting times for elective surgery are a significant health policy concern in approximately half of all OECD countries.
- This report is devoted to [analyzing waiting times]. An interesting feature of OECD countries is that while some countries report significant waiting, others do not.
- Waiting times are a serious health policy issue in the 12 countries involved in this project (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom).
- Waiting times are not recorded administratively in a second group of countries (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States) but are anecdotally (informally) reported to be low.
- This paper contains a comparative analysis of these two groups of countries and addresses what factors may explain the absence of waiting times in the second group. It suggests that there is a clear negative association between waiting times and capacity, either measured in terms of number of beds or number of practising physicians. Analogously, a higher level of health spending is also systematically associated with lower waiting times, all other things equal.
- Among the group of countries with waiting times, it is the availability of doctors that has the most significant negative association with waiting times. Econometric estimates suggest that a marginal increase of 0.1 practising physicians and specialists (per 1 000 population) is associated respectively with a marginal reduction of mean waiting times of 8.3 and 6.4 days (at the sample mean) and a marginal reduction of median waiting times of 7.6 and 8.9 days, across all procedures included in the study.
- Analogously, an increase in total health expenditure per capita of $100 is associated with a reduction of mean waiting times of 6.6 days and of median waiting times of 6.1 days.
- In the comparison between countries with and without waiting times, low availability of acute care beds is significantly associated with the presence of waiting times. Also, evidence from this and other studies suggests that fee-for-service remuneration for specialists, as opposed to salaried remuneration, is negatively associated with the presence of waiting times. Fee-for-service systems may induce specialists to increase productivity and may also discourage the formation of visible queues because of competitive pressures. In addition, evidence from this and other studies suggests that activity-based funding for hospitals may also help reduce waiting times.
Kaiser Family Foundation Health Policy Tutorials and Compendia
KaiserEDU’s tutorials are multimedia presentations on health policy issues, research methodology or the workings of government.
Here are a few to get started (I haven’t yet, but put them here for reference and eventual use!)
Health policy experts provide overviews of current topics in health policy. Watch and download slides from these and other tutorials:
The Public and Health Care Reform
A Primer on Tax Subsides for Health Care
Expanding Health Coverage to the Uninsured
They also have Compendiums:
These modules include background summaries along with links to academic literature, policy research and data sets on current health policy issues, such as:
U.S. Health Care Costs
Health Information Technology
Addressing the Nursing Shortage
The Uninsured
International Health Systems
Candian Medical Association Looks to Europe to Improve Health System
Letter to members kicks off CMA debate:
The Canadian Medical Association is looking at European health systems for ways to improve.
The CMA won’t launch its online consultation about transforming Canada’s health care system until April 6, but if the initial response to President Robert Ouellet’s March 6 letter announcing the endeavour is any indication, the consultation website should be a busy place.
Within five days of emailing the letter to members and posting it on cma.ca, the CMA had received 149 emails, many containing lengthy comments.
In his letter, entitled Status quo, or transformation?, Ouellet suggested that if Canada wants ‘a sustainable, universal health care system, we have to transform the one we have.’ It was first emailed to 45,000 members and posted on cma.ca, and then sent by regular mail to a further 25,000 members.
The link the the letter is at their website, and a few choice comments are there, and here:
- “I kindly disagree with you. The problems in our system will not be solved by privatizing the most lucrative parts of it. Canadian doctors want to practise medicine, not run businesses.”
- “I was delighted with your comments. The constant arguments that any changes in our system will make us like the US have been misleading and frustrating.”
- “It is about time care and money be patient based. Bring on the new system you suggest – it cannot come soon enough for me.”
- “I’m baffled how we are like sheep and accept the wait times in our country when other countries far surpass our achievements.”
It’s funny, isn’t it? Canada has the sense to look past the end of its collective nose for solutions, while we continue to try to tweak our system as it continues on its glide-path into the mountain.
RAND | (Technical) Reports | Possibility or Utopia?: Consumer Choice in Health Care: A Literature Review
RAND (Technical) Reports Possibility or Utopia?: Consumer Choice in Health Care: A Literature Review:
This literature review examines consumer choice in health insurance plans against the background of the German health system in order to inform the questions: What are models of consumer choice and their effects?, and: If consumers want lower cost health care, what instruments can insurers use to provide it and what are the likely effects of those instruments? The review looked at experiences in other industrialized countries, especially the United States, for consumer choice options such as co-payments, reimbursement/bonuses, and deductibles, as well as organizational designs such as gatekeeper systems and selective contracting. In addition to cost-containment measures, the review also examined what was known about effects on health status, satisfaction, fairness and the macro-economic situation. The review describes the health economics theory of consumer choice, the methodology for the literature review, the German health system, and studies on consumer choice of insurers and providers, and reflects on their relevance on the German system. This literature review examines consumer choice in health insurance plans against the background of the German health system in order to inform the questions: What are models of consumer choice and their effects?, and: If consumers want lower cost health care, what instruments can insurers use to provide it and what are the likely effects of those instruments? The review looked at experiences in other industrialized countries, especially the United States, for consumer choice options such as co-payments, reimbursement/bonuses, and deductibles, as well as organizational designs such as gatekeeper systems and selective contracting.