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

bmj.com

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

#41

Post by mikeash »

IsaacL wrote: 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…

American medical R&D spending amounts to something around $500 per capita per year. Our total medical spending is $9,000, which is more than $5,000 above the OECD average. Medical R&D spending makes up a mere 10% of our excess costs (and that's only if you assume the entire thing is excess) so I wouldn't describe it as taking it on the chin, nor does it seem reasonable to paint us as altruistic martyrs for paying for so much medical research.

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

#42

Post by dv_dt »

the_watcher wrote: post #32
dv_dt wrote: post #29

Earlier quoted context omitted.

> In other words, Americans are taking it in the chin to invest in pharmaceutical innovations, which other countries then treat as a public good. I completely reject this line of argument. Just because the spending is here, and that a huge profit center is in Ameriica, you can't conclude anything about R&D. A large portion of the marketing spend is also in America too. All the large drug companies are multi-national.…

What he's saying is that drugs are marked up more in the US than other countries that regulate their prices. That necessarily implies that Americans paying for the drug are contributing more to pharma revenues than those in countries that are regulating prescription drug prices.

But that's not necessarily true, and the statement was regarding R&D not general income. The larger income in America part can also be questioned, particularly when the revenue in the US comes also comes a large cost of marketing - which some reports say exceed the cost of R&D. The US is also one of the few nations that allows that expenditure. It seems like we're just paying to much and funding a lot of marketing and doing nothing for R&D of drugs.

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

#43

Post by _dps »

mikeash wrote: post #39
jseliger wrote: post #37

Earlier quoted context omitted.

In my subjective experience (as a Brit) British people often think the NHS is the best health service in the world Having experienced it, I'm surprised that Brits feel that way. When I was studying abroad a while ago (which was not a great experience for other reasons... https://jakeseliger.com/2012/11/18/about-the-university-of-e... ), I needed an x-ray and then a CT scan for what appeared to be a minor issue. So I…

Is it really a big deal to wait 6-8 weeks to get an x-ray for a minor issue? Obviously this is not ideal, but it seems pretty minor compared to the ridiculous stuff we deal with in the US system, especially if you compare to the pre-ACA US system.

Yes, it certainly can be a big deal. You are assuming that there is a reliable way to evaluate "minor" and that the bureaucrats in charge will make that decision well in most cases (even though their incentive structure, parallel to an insurance company's, pushes them to trade bounded-but-not-lethal suffering against the bottom line every day).

I speak from personal experience in a country with an NHS-like "free" system. A close relative of mine flew to the US for short-term treatment of what was considered a "minor" eye problem, because he didn't want to spend 2-3 months functionally blind. It's true that the condition didn't threaten his life, but it did threaten his livelihood and personal autonomy on a daily basis; the bureaucratic process assessing priority decided this was a "minor" problem.

It's easy for us as the general population who isn't suffering to decide "minor, non-life-threatening" medical conditions can be comfortably shoved to the side.

*edited to remove language that could be considered inflammatory in the final paragraph, which was not my intent

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

#44

Post by mikeash »

_dps wrote: post #43
mikeash wrote: post #39

Earlier quoted context omitted.

Is it really a big deal to wait 6-8 weeks to get an x-ray for a minor issue? Obviously this is not ideal, but it seems pretty minor compared to the ridiculous stuff we deal with in the US system, especially if you compare to the pre-ACA US system.

Yes, it certainly can be a big deal. You are assuming that there is a reliable way to evaluate "minor" and that the bureaucrats in charge will make that decision well in most cases (even though their incentive structure, parallel to an insurance company's, pushes them to trade bounded-but-not-lethal suffering against the bottom line every day). I speak from personal experience in a country with an NHS-like "free" sys…

As I said, it's not ideal, but it doesn't seem nearly on the same level as the US system. I'd rather spend 2-3 months functionally blind than be bankrupted because of a pre-existing condition.

Socialized medicine horror stories all seem to be along the lines of, "I had to wait months, it was very inconvenient," possibly with the addition of "I decided to pay extra to get it taken care of sooner." US medical horror stories are more like, "I couldn't afford to see the doctor, so I just hoped it would go away. When the pain became unbearable, I tried self-surgery. It got infected and now I'm dead."

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

#45

Post by _dps »

mikeash wrote: post #44
_dps wrote: post #43

Earlier quoted context omitted.

Yes, it certainly can be a big deal. You are assuming that there is a reliable way to evaluate "minor" and that the bureaucrats in charge will make that decision well in most cases (even though their incentive structure, parallel to an insurance company's, pushes them to trade bounded-but-not-lethal suffering against the bottom line every day). I speak from personal experience in a country with an NHS-like "free" sys…

As I said, it's not ideal, but it doesn't seem nearly on the same level as the US system. I'd rather spend 2-3 months functionally blind than be bankrupted because of a pre-existing condition. Socialized medicine horror stories all seem to be along the lines of, "I had to wait months, it was very inconvenient," possibly with the addition of "I decided to pay extra to get it taken care of sooner." US medical horror st…

To be clear: I'm not suggesting the US system is good or that the NHS-style system is bad. But I do think there is a systematic diminuation of the badness of wait times among advocates of NHS-style systems.

I, personally, find descriptions like "it's not ideal" to substantially underplay the human suffering involved. And "it's very inconvenient" is, again in my opinion, a gross understatement of the suffering of losing your vision for a few months.

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

#46

Post by deepsun »

ramchip wrote: post #24
comstock wrote: post #10

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…

I'm also really puzzled by the omission of Japan. It has the highest life expectancy in the world, I would expect a comparison of health systems in the developed world to include it.

From my friends' stories, Japan healthcare experiences were pretty bad:

1. Extremely long lines in small rooms, so people cram together to get a better chance of coughing on each other.

2. For any illness doctors listen to you and prescribe exactly three drugs: antibiotic, pain reducer, and "something for stomach". For any symptoms.

3. There is no "sick leave" thing, so if you're sick -- you are absent.

4. Because of #3, people always come to work being acutely sick (so if it's flu, they cough on each other, obviously).

Although labor traditions are the horror story of its own, no one worked there recommens to ever do that (just youtube for "working in japan").

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

#47

Post by deepsun »

HarryHirsch wrote: post #28
mjevans wrote: post #25

Earlier quoted context omitted.

It removes an entire department and source of variable from a 'company' that doesn't need it. Ultimately you aren't going to deny someone coverage based on cost*, they're going to end up in an ER and 'written off' which will then be billed in to everyone else's costs. Worse, the outcome for the individual is often less good and frequently means they will be, overall, more of a burden on society than if they had recei…

Ultimately you aren't going to deny someone coverage based on cost For acute conditions, yes, but in the American ER they do not treat chronic conditions, like cancer, depression and substance addiction. That's a public health issue.

And even for sub-acute thing, for example if you've broken ankle, it needs a surgery to bring your bones together and put a metallic screws and a plate. But the only thing they'll do in ER is put a cast on your leg (for ~$7,000 bill to your insurance). For the surgery you'll need to look for a surgeon yourself (and, there's HUGE shortage of surgeons everywhere in US, seems like the system wants it that way).

Then your surgeon's hospital will pre-agree on the surgery cost with your insurance. If you don't have insurance or money -- welcome to limpers.

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

#48

Post by grey-area »

jseliger wrote: post #37
comstock wrote: post #10

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…

In my subjective experience (as a Brit) British people often think the NHS is the best health service in the world Having experienced it, I'm surprised that Brits feel that way. When I was studying abroad a while ago (which was not a great experience for other reasons... https://jakeseliger.com/2012/11/18/about-the-university-of-e... ), I needed an x-ray and then a CT scan for what appeared to be a minor issue. So I…

It's superior because of outcomes for a given cost, not customer experience. The suggestion if Bupa was probably made because of your expectations of prompt service.

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

#49

Post by comstock »

deepsun wrote: post #46
ramchip wrote: post #24

Earlier quoted context omitted.

I'm also really puzzled by the omission of Japan. It has the highest life expectancy in the world, I would expect a comparison of health systems in the developed world to include it.

From my friends' stories, Japan healthcare experiences were pretty bad: 1. Extremely long lines in small rooms, so people cram together to get a better chance of coughing on each other. 2. For any illness doctors listen to you and prescribe exactly three drugs: antibiotic, pain reducer, and "something for stomach". For any symptoms. 3. There is no "sick leave" thing, so if you're sick -- you are absent. 4. Because of…

I mean, I guess I could also provide counter anicdotes (such as it taking 1 week to get adequate medication for a chronic condition in Japan, which in 15 years I'd been unable to obtain in the U.K.).

But I'm not sure it would be helpful. Instead maybe the WHO World Health Care report ranking is a useful datapoint?

http://www.photius.com/rankings/healthranks.html

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

#50

Post by comstock »

grey-area wrote: post #48
jseliger wrote: post #37

Earlier quoted context omitted.

In my subjective experience (as a Brit) British people often think the NHS is the best health service in the world Having experienced it, I'm surprised that Brits feel that way. When I was studying abroad a while ago (which was not a great experience for other reasons... https://jakeseliger.com/2012/11/18/about-the-university-of-e... ), I needed an x-ray and then a CT scan for what appeared to be a minor issue. So I…

It's superior because of outcomes for a given cost , not customer experience. The suggestion if Bupa was probably made because of your expectations of prompt service.

Do you have data that shows that the NHS is better value for money than most/all other providers?

Because the data I've seen [1] doesn't suggest that.

[1] http://wjmc.blogspot.jp/2011/03/us-healthcare-costs-vs-life-...

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