Is the Grass Greener Across the Pond in Healthcare?

 

 

29542433_1496072063855781_546521568945876114_nI was going to continue my discussion regarding a single-payer healthcare system but I was wondering why we wanted to reinvent our healthcare system and which system we wanted to use as a model for our system. So, I will hold off my discussion regarding the single-payer model. As we celebrate the start of spring and Easter and Passover I thought that I would look at the multiple pundits who favor the health care system established in Europe, the systems in other countries, especially England.

As related by a British physician, a mother has blasted her local surgery after a bungling medical practitioner misdiagnosed her five-year-old daughter’s leukemia as a cold.

Kayleigh Chapman, 29, visited their GP when Lily-Mae Filmer’s spluttering cough started to get worse last month.

The mother-of-three also noticed bruise-like rashes appearing on her daughter’s skin, which can be a telltale symptom of some forms of cancer.

But instead of being referred to a GP or hospital, a nurse practitioner sent them on their way, saying she probably just had a virus.

However, Mrs. Chapman, of Pershore, Worcestershire, followed her mother’s intuition and returned just 48 hours later when more rashes started to appear.

Eventually, they were allowed to see a GP and the schoolgirl was referred straight away to Worcestershire Royal Hospital.

Following a series of blood tests, Mrs. Chapman was given the devastating news earlier this month that her daughter had acute lymphoblastic leukemia.

The youngster now faces a grueling two-year chemotherapy battle and has already started losing her hair and experiencing side effects.

Kayleigh Chapman, 29, visited her doctor’s surgery when Lily-Mae Filmer’s spluttering cough started to get worse on April 23 – only to be told that it was just a cold. The pair returned 48 hours later and were referred them to the hospital, where they found she had leukemia

Mrs. Chapman, who runs a gardening business with her husband Craig, said: ‘It was absolutely horrendous.

‘I am quite angry because she should have been referred straight away. I had wanted to see a doctor rather than a nurse, with all due respect.

‘I know they want to keep GPs free for more serious cases but what could be more serious than cancer.

‘I was just made to feel like a paranoid mum, who was over-reacting but I knew there was something wrong with my daughter.

‘We are devastated but we’ve got to stay strong for her. What I want to do is raise awareness of how fast it can all happen.’

The youngster now faces a grueling two-year chemotherapy battle and has already started losing her hair and experiencing side effects (pictured in hospital)

Mrs. Chapman said: ‘I am quite angry because she should have been referred straight away. I had wanted to see a doctor rather than a nurse, with all due respect’ (pictured together at Birmingham Children’s Hospital where a biopsy confirmed the leukemia diagnosis)

It all started with a cold and a cough on April 23, according to Mrs. Chapman.

Lily-Mae was ‘looking a bit off’ so she decided to keep her off of school as her symptoms worsened the next day.

Red spots started to appear on her skin alongside bruises, like that of a rash.

“I am quite angry because she should have been referred straight away. I had wanted to see a doctor rather than a nurse, with all due respect.”

So my question is, as we discuss health care and the virtues of the European system, is, is the Grass Greener on the other side of the pond?

“… I have never seen such a symbiotic relationship between a country’s health system [NHS] and its national identity. It runs very deep and every politician knows it.

However, he related statistics, such as that their continental neighbors can boast better health outcomes in some cases, such as cancer. Survival rates in England are around 10% lower than the EU average, particularly for colon, ovarian and lung tumors. We are catching up in some areas, including breast and stomach cancer but too many people are still being diagnosed too late.

Some European systems have a different way of financing, funding and providing healthcare. For example, Germany created the first social insurance sickness funds under Bismarck in 1883, which are still based on the principles of solidarity, subsidiarity and corporatism. Similarly, the widely admired French system is founded on the concept of “médecine libérale”, offering a greater choice of doctor and clinical freedom. The Dutch are consistently lauded for patient focus, their system is based on the principles of both competition and social solidarity. Switzerland is similar and is the least distressed health service I have worked in. A case of “you get what you pay for”.

But it’s glaringly obvious that these countries spend much more than the UK. We, i.e. England, commit 9.1% of our GDP to health while Germany spends 11.3%, Switzerland 11.5%, France 11.7% and the Netherlands 12.9%. Having worked in 60 countries over the last six years, he came to the conclusion that a single – or dominant – funder as in the UK offers their best hope for improved population health, patient care and taxpayer value. Germany and France have many health insurers, which pushes costs up. So does Japan, but the government sets a single price so, effectively, it is the dominant payer.

I returned to England from India only to learn that the NHS was already overspent [see link below] by almost £1bn. Soon, there will be siren voices that either scorn the lack of efficiency in the NHS or question its long-term sustainability. Either position is too simplistic…”

“Ministers are under growing pressure to give the NHS a multibillion-pound emergency cash injection after official figures showed hospitals overspent by £930m in three months and are on course to rack up an unprecedented £2bn deficit by the end of the year…

Heidi Alexander, the shadow health secretary, said ministers were in denial about the gravity of the NHS’s deepening black hole, which their policies had created.

“It is now clear why these figures weren’t released ahead of Tory party conference – they show an NHS in crisis. The alarming deterioration in NHS finances is a direct result of actions this government has taken. Cuts to nurse training places has left the NHS with a shortage of nurses, forcing hospitals to hire expensive agency staff. With a difficult winter approaching, hospitals are facing a stark choice between balancing the books and delivering safe care,” she said.”

“…I want junior doctors to know that their bosses aren’t going to be angry with them when they strike. I want them to know that they are going to be supported. I want them to know that we are shoulder to shoulder with them in what they are planning to do and we will help keep our patients safe. We are joined by the nursing staff. The nurses I have spoken to and work with want to lend their support and have similar concerns.

This solidarity exists because everyone in healthcare is anxious about how junior doctors are feeling. There are a large number who are deciding whether or not they want to continue to work as a doctor in this country. Many have traditionally worked overseas for a year or 18 months, and return having seen a different healthcare system, which often enriches their career. But now a lot of them are starting to talk about not coming back…”

He goes on to state that nurses and docs – frustrated by Ireland’s HSE and Britain’s NHS – are emigrating in larger and larger numbers.  If you’re in the minority that purchase private health insurance (as we do) and are willing to advocate for yourself and your family, you can sometimes bypass queues, minimize though not eliminate delays, and generally access care.  Our small county of Leitrim, for example, has no pediatrician or plastic surgeon; but the girls receive good care from local GPs and there’s an excellent plastic surgeon in neighboring Roscommon County (trained at NYU and Cornell) who, with a requisite letter of introduction, accepts referrals. Notably, Ireland’s healthcare is both implicitly and explicitly rationed and is a two-tier system of private and public sectors.  Public patients (the majority of Irish) experience difficulties accessing basic care, waiting times to see a consultant (specialist) can be anywhere from months to a year or more, and A&Es (ERs) are a “slow coach” where overcrowding and long stays in chairs and/or on gurneys, rather than beds, are commonly decried in the news.

“Waiting lists in the State’s public hospitals are continuing to rise with the numbers waiting for an out-patient appointment now close to 400,000, figures published [December last] by the HSE show.

The figures reveal increases in numbers on waiting lists for out-patient appointments, as well as in-patient and day-case procedures in hospitals…”

“…[A] study in May found young Irish doctors and nurses are not choosing to go abroad only for financial reasons, but because of poor working conditions, training and career opportunities here.

The survey of more than 500 junior doctors and nurses, by the Royal College of Surgeons in Ireland (RCSI), reported a feeling of “general disrespect” for health professionals in Ireland from the media and HSE.  Many said they had “rediscovered the joy” of practicing their profession in Australia, the UK and US…”

Without anyone noticing, doctors are leaving the NHS in droves

“Increased paperwork, increased hours, and ever more pressure are forcing GPs out of the NHS – either to the private sector, or abroad…”

“Almost half of all junior doctors are opting not to continue their training in the NHS, threatening a “disaster” that senior medics fear will worsen the service’s shortage of frontline clinicians.

This year only 52% of junior doctors who finished the two-year foundation training after medical school chose to stay in the NHS and work towards becoming a GP or specialist – the lowest proportion in the health service’s history and down from 71.3% as recently as 2011.

The official figures reveal sharp rises in the number of junior doctors shunning the NHS and opting instead to work in academia, as a locum medic or simply taking a career break…”

So you might ask, “What country has the world’s best health system?”

“…The problem with these exercises is that no one can really agree on what should be measured and, even when they do settle on measures, data are not always reliable and comparable.

“Of course, there is no such thing as a perfect health system and it certainly doesn’t reside in any one country,” Mark Britnell, global chairman for health at the consulting giant KPMG, writes in his new book, In Search of the Perfect Health System. [published Sept 2015, might be worth a read]

“But there are fantastic examples of great health and health care from around the world which can offer inspiration.”

As a consultant who has worked in 60 countries – and who receives in-depth briefings on the health systems of each before meeting clients – Mr. Britnell has a unique perspective and, in the book, offers up a subjective and insightful list of the traits that are important to creating good health systems.

If the world had a perfect health system, he [Mark Britnell] writes, it would have the following qualities: the values and universal access of the U.K.; the primary care of Israel; the community services of Brazil; the mental-health system of Australia; the health promotion philosophy of the Nordic countries; the patient and community empowerment in parts of Africa; the research and development infrastructure of the United States; the innovation, flair and speed of India; the information, communications and technology of Singapore; the choice offered to patients in France; the funding model of Switzerland; and the care for the aged of Japan…”

In my humble opinion, Kate, at its core this usually reverts to each individual’s willingness to pay – an unsurprising conclusion considering the Western world’s widely divergent theories of justice.

So what’s fair?  What’s morally right?  In a democracy, it may simply reflect majority rule; but an individual might readily argue the “tyranny of the majority”.  Enough for today.

It brings up the statement that the Grass Is Not Always Greener: A Look at National Health Care Systems Around the World.

Michael Tanner of the No. 613 Policy Analysis back in 2008 wrote that critics of the U.S. health care system frequently point to other countries as models for reform. They point out that many countries spend far less on health care than the United States yet seem to enjoy better health outcomes. The United States should follow the lead of those countries, the critics say, and adopt a government- run, national health care system.

However, a closer look shows that nearly all health care systems worldwide are wrestling with problems of rising costs and lack of access to care. There is no single international model for national health care, of course. Countries vary dramatically in the degree of central control, regulation, and cost sharing they impose, and in the role of private insurance. Still, overall trends from national health care systems around the world suggest the following:

  • Health insurance does not mean universal access to health care. In practice, many countries promise universal coverage but ration care or have long waiting lists for treatment.
  • Rising health care costs are not a uniquely American phenomenon. Although other countries spend considerably less than the United States on health care, both as a percentage of GDP and per capita, costs are rising almost everywhere, leading to budget deficits, tax increases, and benefit reductions.
  • In countries weighted heavily toward government control, people are most likely to face waiting lists, rationing, restrictions on physician choice, and other obstacles to care.
  • Countries with more effective national health care systems are successful to the degree that they incorporate market mechanisms such as competition, cost sharing, market prices, and consumer choice, and eschew centralized government control.

Although no country with a national health care system is contemplating abandoning universal coverage, the broad and growing trend is to move away from centralized government control and to introduce more market-oriented features.

The answer then to America’s health care problems lies not in heading down the road to national health care but in learning from the experiences of other countries, which demonstrate the failure of centralized command and control and the benefits of increasing consumer incentives and choice.

And now look at the latest announcement regarding the British health care system.    U.K. Hospitals Are Overburdened, But The British Love Their Universal Health Care!                                                                                                                                            Lauren Frayer wrote that when Erich McElroy takes the stage at comedy clubs in London, his routine includes a joke about the first time he went to see a doctor in Britain. Originally from Seattle, McElroy, 45, has lived in London for almost 20 years. A stand-up comedian, he’s made a career out of poking fun at the differences in the ways Americans versus Britons see the world — and one of the biggest differences is their outlook on health care.                                                                                                                                            “I saw a doctor, who gave me a couple pills and sent me on my way. But I still hadn’t really done any paperwork. I was like, ‘This isn’t right!’ ” McElroy says onstage, to giggles from the crowd. “So I went back to the same woman, and I said, ‘What do I do now?’ And she said, ‘You go home!’ ”                                                                                                                 The mostly British audience erupts into laughter. McElroy acknowledges it doesn’t sound like much of a joke. He’s just recounting his first experience at a U.K. public hospital. But Britons find it hilarious, he says, that an American would be searching for a cash register, trying to find how to pay for treatment at a doctor’s office or hospital. It’s a foreign concept here, McElroy explains.

Onstage, McElroy recounts how, when the hospital receptionist instructed him to go home, he turned to her and exclaimed, “This is amazing!”

Amazing, he says, because he didn’t have to pay — at least not at the point of service. In Britain, there’s a state-funded system called the National Health Service, or NHS, which guarantees care for all. That means everything from ambulance rides and emergency room visits to long hospital stays, complex surgery, radiation, and chemotherapy — are all free. They’re paid for with payroll taxes and the Value Added Tax, which is like a National Sales Tax. In addition, any medication you get during a hospital visit is free, and the cost of most prescription drugs at a pharmacy are cheap — a few dollars. (Private health care also exists in the U.K., paid out-of-pocket or through private insurance coverage, but only a small minority of residents opt for it.)

Since the 2008 financial crisis, the U.K., like many countries, has been taking in less tax revenue — so it’s had to cut spending. Its expenditure on the National Health Service has still grown, but at a slower pace than before. That means drugs are now being rationed. Tens of thousands of operations have been postponed this winter. Wait times at the emergency room are up, says Richard Murray, policy director at the King’s Fund, a health care think tank.

“If the ER is really busy, it makes the ambulances queue outside the front door — not great,” Murray says. “And in some cases, the hospital is simply full.”

In recent months, there have been several “Save the NHS” marches across Britain, where thousands have demonstrated to demand improved care and more funding for the health system. One such march, on Feb. 3 on Downing Street in central London, caught President Trump’s attention.

Two days later, Trump tweeted that the NHS is “going broke and not working.” He accused Democrats of pushing for a similar system of universal health care in the United States. “Dems want to greatly raise taxes for really bad and non-personal medical care. No thanks!” the president wrote on Twitter.

The Democrats are pushing for Universal HealthCare while thousands of people are marching in the UK because their U system is going broke and not working. Dems want to greatly raise taxes for really bad and non-personal medical care. No thanks!

That tweet offended many in Britain. It prompted Prime Minister Theresa May’s office to issue a statement saying the U.K. premier is “proud” of her country’s system. The U.K. health secretary, Jeremy Hunt, tweeted back at Trump, saying he may disagree with some of the claims of those attending “Save the NHS” marches, but that “not ONE of them wants to live in a system where 28m people have no cover” — a dig at the uninsured in America. Hunt wrote that he’s proud that Britons “all get care no matter the size of their bank balance.”

I may disagree with claims made on that march but not ONE of them wants to live in a system where 28m people have no cover. NHS may have challenges but I’m proud to be from the country that invented universal coverage – where all get care no matter the size of their bank balance

The National Health Service spends less than half of what Americans spend per person on health care, and yet life expectancy is higher in Britain.

Defense of the NHS runs straight across the British political spectrum.

“You wouldn’t find a single leading politician on either the left wing the Labour Party or the right wing in the Conservative Party that would talk about privatizing the NHS,” Murray says. “That would be electoral poison.”

The NHS polls better than the queen. U.K. politician Nigel Lawson once said, “the NHS is the closest thing the English people have to a religion.” It featured prominently in the opening ceremony of the 2012 London Olympics, with doctors dancing to swing music and hospital beds arranged to spell out the letters N-H-S in aerial views from above.

Britain’s National Health Service celebrates its 70th birthday this summer. It was founded on July 5, 1948.

After the pain of World War II, Britons decided to provide health care for all, and they’re still very proud and protective of that choice, says Roberta Bivins, a historian of medicine at the University of Warwick.

“The war was barely over. The rubble was still smoking,” Bivins says. (She is also an American expatriate who’s lived in the U.K. since the 1990s, when she arrived to study for a Ph.D. She, too, describes being in disbelief the first time she went to a doctor and wasn’t asked to pay anything.)

“People here are very, very uncomfortable that companies should profit from someone getting sick,” she says. “In the U.S., we’re much more comfortable with the idea that the market will provide services.”

McElroy, the comedian, says state-funded health care means his family doesn’t have to worry about needing coverage through an employer. He and his wife Erin McGuigan are both self-employed. McGuigan works as a birth and postnatal doula, alongside NHS midwives. She gave birth to the couple’s two children, in the NHS system, for free.

“You get follow-up care, where the midwives and health visitors come to your home, for a number of days after you give birth, to do checks and ensure breastfeeding is established and [the] baby is well — just to get new parents on their way,” McGuigan says. “I’ve had excellent care.”

She says she has had to wait four to six weeks for a doctor’s appointment if it’s not something urgent.

McElroy says there is one thing he would like to change about the NHS. His comedy routine includes another joke about what happened after he had minor surgery in Britain.

“The first thing they gave me when I came out of surgery was a fish pie — which I say in the routine, put me straight back into the hospital, because it was so disgusting!” he says.

“They might give us health care,” he jokes, “but the food is still terrible in this country.”

So, is universal health care the answer? Based on other countries experience maybe it isn’t. Then what is the answer?

Happy Easter and Best wishes for those of my friends who celebrate Passover.

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