US/World Health Care Comparisons – Page 4

Britain’s health care amounts to malpractice – BostonHerald.com

I don’t know of a person who advocates for universal health care in the US who advocates for a nationalized system such as Britain’s that the author holds up as his bogeyman. The discussion is about which type of single payer system or universal insurance coverage scheme we should adapt to the US. As Michael Moore has stated, we aren’t talking about blindly adopting another contry’s system wholesale, we are talking about having a policy discussion and creating a uniquely American system, emphasizing our strengths and remedying our weaknesses.

But what really prompted me to write this were a couple of absurd statements by the author.

First, “No one can complain that the NHS is underfinanced. This year’s budget is $210 billion – about $1.05 trillion if adjusted to match America’s population.” Really, no one? The Internets have this thing called “Google” and if you search for “NHS underfunded” you might find out that at least a few people (Tony Blair, for one) who believe it is underfunded. But more importantly, is there anyone who doesn’t get that we spend roughly twice as much per person on healthcare and get terribly shaky outcomes for it? Specifically, is there anyone writing a piece for a major newspaper who doesn’t know this?

And this: “A September 2007 Lancet Oncology article found 66.3 percent of American men alive five years after cancer diagnosis. Only 44.8 percent of Englishmen survived after five years. Across the European Union, 20.1 females per 100,000 under 65 died prematurely of circulatory disease. Among British women, that number was 23.6.”

Here’s an interesting table from that study, showing the UK NHS as the worst, except for Slovenia, Iceland, Poland and the Czech Republic. And I’ll say it again, nobody wants to replicate the British system here. And for more comparisons on US versus other countries healthcare outcomes, go here.

And, finally, my favorite, “Within this maze, patient needs often yield to the wants of pols and medicrats.” Go see Sicko, man! Are you kidding? You think we don’t have pols in the hands of Pharma and the health insurance and health care industries and “medicrats” at our insurers? Who do you think draws those multi-million dollar salaries at the Blues and Aetna and the rest?
Aren’t these people getting tired of flogging this dead dog? Probably not, because apparently that dog still hunts in the imaginations of some.

Cheers,

Boston herald:

Britain’s health care amounts to malpractice – BostonHerald.com

But what really prompted me to write this were a couple of absurd statements by the author.

Aren’t these people getting tired of flogging this dead dog? Probably not, because apparently that dog still hunts in the imaginations of some.

Cheers,

A satisfying update to WSJ Editorial on US/UK liver transplantation results..

Thanks to Maggie Mahar for doing the work on this. I was willing to accept Dr. Gottlieb’s facts at face value and make my case, but Mahar went the extra mile to show that, not only is the argument bogus, so are the facts! Here’s the prime of the post:

But what Gottlieb omits is the crucial fact that, when the researchers went back and looked at “patients who survived the first post-transplant year,” they discovered that “patients who had suffered from chronic liver disease in the U.K. and Ireland had a lower overall risk-adjusted mortality” than patients in the U.S. In other words, survival rates for patients who had a chronic disease before the transplant were better in the U.K. and Ireland. As for patients suffering from acute liver disease, longer-term survival rates past one year were just as good in the U.K. and Ireland as in the U.S. Moreover, if you checked patients in the interval between 90 days and one year, outcomes were similar in the two health care systems.

So “equilibrated” wasn’t just a dodgy piece of jargon; it was inaccurate. When researchers checked on patients more than a year after they had the transplant, outcomes in the U.K/Ireland and the U.S. weren’t in perfect balance (or in equilibrium) with results in the U.S. Outcomes in the U.K./Ireland were just as good for one group and decidedly better for the second —assuming that if you go through the trauma of a liver transplant, the outcome you are hoping for is to live more than a year, rather than just 90 days.

Why is chronic care better in the U.K. in the years following surgery? Because the “primary care infrastructure” is stronger in the U.K. and Ireland, the article explains. Add in the fact that patients have “equal access” to health care and that the cost of care is “lower,” and this helps explain superior long-term results. As the researchers point out, “the 2002 Commonwealth Fund International Health Policy Survey found that sicker adults in the US are far more likely than those in the UK to forgo medical care and fail to comply with recommended follow-up and treatment because of costs. In the U.S., it seems, outcomes tend to turn on whether the patient has money.

Finally, what about outcomes after five years? What Gottlieb forgot to mention is that survival rates for patients who had originally suffered from chronic liver disease were similar in the two countries, while mortality rates for patients suffering from acute liver disease were higher in the U.K. and Ireland.

Thanks, Maggie!

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…

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'”

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.

First world results on a third world budget | Special reports | Guardian Unlimited

First world results on a third world budget Special reports Guardian Unlimited:

A nice, evenhanded piece on the Cuban system, with some comparison with the UK’s NHS at the end. Clearly not the be-all-and-end-all of healthcare, but, really, can’t we do better than Cuba?

“But how good, exactly? And how does Cuba do it given such limited
means? Neither question is easy to answer. The communist government is not
transparent, some statistics are questionable and citizens have reason to muffle
complaints lest they be jailed as political dissidents. According to the World
Health Organisation a Cuban man can expect to live to 75 and a woman to 79. The
probability of a child dying aged under five is five per 1,000 live births. That
is better than the US and on a par with the UK.

Yet these world-class results are delivered by a shoestring annual per capita health expenditure of $260 (£130) – less than a 10th of Britain’s $3,065 and a fraction of America’s $6,543. There is no mystery about Cuba’s core strategy: prevention. From promoting exercise, hygiene and regular check-ups, the system is geared towards averting illnesses and treating them before they become advanced and
costly.”

More on US Health Care and Health Insurance cost

Two new bits in the Inbox today regarding US spending on health care and consumers spending on insurance:

From Health Affairs:
Health Spending In OECD Countries In 2004: An UpdateGerard F. Anderson, Bianca K. Frogner and Uwe E. Reinhardt
In 2004, U.S. health care spending per capita was 2.5 times greater than health spending in the median Organization for Economic Cooperation and Development (OECD) country and much higher than health spending in any other OECD country. The United States had fewer physicians, nurses, hospital beds, doctor visits, and hospital days per capita than the median OECD country. Health care prices and higher per capita incomes continued to be the major reasons for the higher U.S. health spending. One possible explanation is higher prevalence of obesity-related chronic disease in the United States relative to other OECD countries.

From The Kaiser Family Foundation:
Premiums for employer-sponsored health insurance rose an average of 6.1 percent in 2007, less than the 7.7 percent increase reported last year but still higher than the increase in workers’ wages (3.7 percent) or the overall inflation rate (2.6 percent), according to the 2007 Employer Health Benefits Survey released today by the Kaiser Family Foundation and Health Research and Educational Trust. Key findings from the survey were also published today in the journal Health Affairs.The 6.1 percent average increase this year was the slowest rate of premium growth since 1999, when premiums rose 5.3 percent. Since 2001, premiums for family coverage have increased 78 percent, while wages have gone up 19 percent and inflation has gone up 17 percent.