Live data from Hacker News

UK has best health system in developed world, US analysis concludes

bmj.com

11–20 of 80 posts

Re: UK has best health system in developed world, US analysis concludes

#11
Unsurprising. We pay more money per capita, to get worse results, BUT at least we get to, in one way or another, exclude people who aren't paying their own way. And that's what red states in this country appear to want, because they keep voting for Republican governors who campaign on sabotaging health care and then succeeding. http://www.latimes.com/opinion/op-ed/la-oe-baker-obamacare-r...

Today on NPR I listened to rural red state folks who lament how far they have to drive to see a doctor. And how many times they've had to change doctors, because their doctor left the area. And most often they leave for cities where they can earn more money. So the red state voter gets conned into this nonsensical "free market" idea of health care as a product, they vote for this, and then when the doctor says "you don't pay me enough, bye" this rural voter is confused. And so now some of these rural areas are looking at forgiving medical school debt if young doctors will do a "tour" (in effect) as a rural doctor. Isn't government paying for school debt socialism?

crickets

And the bureaucracy of middle men and bean counters, it's a major employment sector now. Obliterating it comes with its own economic and policial damage. But that's the way forward, or it just keeps growing bigger until it catastrophically breaks. Medicaid for all. Wipe away Medicare, the VA, and private insurers. Bye.

Apply strong anti-fraud measured funded and mandated by law. And fund it with some variable matching of Federal dollars because, yes, rural areas are going to have to be subsidized, like like we've done with roads, sewers, water, and telephones, since forever, because everything costs more in rural areas. Cities are cheaper in many ways because of economies of scale.

Of course everyone else has a better system.

Re: UK has best health system in developed world, US analysis concludes

#12

This analysis of a report seems pretty bad, even with only the title and abstract available. Firstly, the report doesn't even cover the entire developed world, just 11 countries. Notably, Japan doesn't appear to be included. To be honest, I found that slightly offensive. Secondly the U.K. isn't the overall clear "best" of those 11. It's not bad, and does better on some things, worse on others. In my subjective experi…

As a fellow Brit I'd agree we're proud of the NHS but I don't think people believe it's the best in the world. We complain too much for that.

Re: UK has best health system in developed world, US analysis concludes

#14
This really is a matter of what variables you choose to measure.

For example, the US is by far the world leader in medical research spending - 44% of global medical research is spent in the US. (Until recently it was even higher). [1]

On the same note, many nations regulate the price of prescription drugs - drugs where the initial R&D was done in the states. (Yes, drugs are sold at a huge markup, but that's to recoup the huge initial costs of research). In other words, Americans are taking it in the chin to invest in pharmaceutical innovations, which other countries then treat as a public good.

An additional point that's often obscured: there's no purely capitalistic healthcare system in the world. Even pre-Obamacare, the US system was about 46% funded by the government. (As with the US education system, the availability of government funds has massively pushed up prices). [2]

On a personal note - I'm a brit, but I've lived abroad, and the NHS is one of the reasons I'm considering settling abroad long-term. I simply don't trust the organisation as a whole to take care of my health. If you get assigned a good doctor for your condition, you're OK, but I have my own stories (and I've heard many others) of conditions being ignored or misdiagnosed, even after multiple visits.

In contrast, I went to a hospital in Bangkok that was of far higher quality than the average NHS hospital. (Granted, this was a private hospital, but it puts things into perspective). One Israeli friend said that walking into a UK clinic was like walking into a clinic in a third-world country. It's shabby, the wait is long, the bureaucracy is confusing, etc.

Strange as it may sound, I trust a for-profit entity more with my health, because their livelihood directly depends on taking good care of me. The common argument that healthcare can't be a market because of information asymmetry and doctors being in a position of power doesn't wash: the same holds true for other complex services, like auto repair, and the solution is simple: third party reviews. (On the moral argument, about affordability, I think with a truly private healthcare system entrepreneurs would be able to drive the costs down for people on middle-incomes, and only the bottom 15-20% would be reliant on government or charity spending).

[1] https://www.urmc.rochester.edu/news/story/4233/u.s.-slipping...

[2] https://en.wikipedia.org/wiki/List_of_countries_by_health_ex...

Re: UK has best health system in developed world, US analysis concludes

#15
As a resident of the UK and a former resident of Switzerland, I can't understand how they came to this conclusion. Don't get me wrong, the NHS is great and the system works much better than in the US, but health care in Switzerland is just on another level.

Before you say "but in the UK it's free" - considering what I paid for (private, mandatory) insurance in Switzerland, and the National Insurance contribution that gets deducted from my paycheck in the UK, I'm not so sure...

Re: UK has best health system in developed world, US analysis concludes

#16

As a resident of the UK and a former resident of Switzerland, I can't understand how they came to this conclusion. Don't get me wrong, the NHS is great and the system works much better than in the US, but health care in Switzerland is just on another level. Before you say "but in the UK it's free" - considering what I paid for (private, mandatory) insurance in Switzerland, and the National Insurance contribution that…

I don't think anyone, in the UK at least, thinks the NHS is free. Most people in the UK who describe it as "free" really mean "free at the point of use" (i.e. no invoice after treatment), but that's a bit of a mouth full.

Re: UK has best health system in developed world, US analysis concludes

#17
post #6
post #4

The report: http://www.commonwealthfund.org/publications/fund-reports/20... It ranks the UK 10th out of 11 on "Health Care Outcomes".

Good spot. BMJ won't be crowing that one though.

They could, because it also points out the UK had the "fastest reduction in deaths amenable to health care in the past decade" i.e. the most improvement in that category.

If you take a look at the raw data, you can see the basis of comparison (four major diseases: heart attack, stroke, breast cancer, colon cancer, + overall mortality data). The biggest outlier for the UK is clearly the cancer survival rate, where it is more than two standard deviations worse than average and this has been known for some time. The underlying reasons are complex, partly social, mostly ones of late diagnosis, partly due to failure to implement good screening programmes; reports on the topic vary in their tendency to blame patients for presenting late or for comorbidity factors, but here's one of the more measured, from 2011: https://www.kingsfund.org.uk/sites/files/kf/How-to-improve-c...

Most tellingly, with breast cancer, a 2008 report suggested that if you remove all the women who die within a year of diagnosis (whose cancers were likely to have been diagnosed at a very advanced stage), then UK survival rates fall into line with the European average. In other words, the UK has a problem with late diagnosis.

Note that the UK also has a better cancer registry. Germany only captures 1% of the population, the UK captures 80%. Unsure whether the OP report has attempted to detect any resulting skew in the statistics.

Bottom line: if the UK improves the five-year cancer survival rate to OECD standards - and note that the data in this report is from 2015 - then it will flip its position in those rankings and totally cement the #1 position overall.

Re: UK has best health system in developed world, US analysis concludes

#18
post #12

This analysis of a report seems pretty bad, even with only the title and abstract available. Firstly, the report doesn't even cover the entire developed world, just 11 countries. Notably, Japan doesn't appear to be included. To be honest, I found that slightly offensive. Secondly the U.K. isn't the overall clear "best" of those 11. It's not bad, and does better on some things, worse on others. In my subjective experi…

As a fellow Brit I'd agree we're proud of the NHS but I don't think people believe it's the best in the world. We complain too much for that.

well, this is all pretty subjective. But the attitude I often seem to encounter in the U.K. is "it's not great, but everything is bad everywhere and it's the best".

Re: UK has best health system in developed world, US analysis concludes

#19
post #14

This really is a matter of what variables you choose to measure. For example, the US is by far the world leader in medical research spending - 44% of global medical research is spent in the US. (Until recently it was even higher). [1] On the same note, many nations regulate the price of prescription drugs - drugs where the initial R&D was done in the states. (Yes, drugs are sold at a huge markup, but that's to recoup…

> This really is a matter of what variables you choose to measure. > > For example, the US is by far the world leader in medical research spending...

Medical research companies will naturally gravitate to a country where the medical industry is particularly profitable: for example in a country where citizens pay over the odds for healthcare due to disfunction.

If this is the reason that the US spends the most on medical research, is that really something that qualifies as a valid variable for some definition of "best"?

Post reply on HN