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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

#51

Post by DanBC »

comstock wrote: post #50
grey-area wrote: post #48

Earlier quoted context omitted.

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-...

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

I'm not sure how your link supports your point. the US spends far more on healthcare than the UK, but has lower life expectancy. Even if you remove private spending and only include government spending the US spends more on healthcare.

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

#52

Post by warsharks »

having had a fair amount of experience of the british healthcare system i find this very hard to believe, ive been treated like shit by them many times, been talked into an operation i didnt really want (i think they were extra keen because its a rare condition) which they then managed to screw up and cripple me.

another little gem is my current insurance claim, i was knocked off my motorbike over a year ago, yet i still havent received a payout from my insurance, id assumed their lawyers were dragging the process out but by this point she has been convicted, my insurance company have been paid by hers but i still havent had anything back, when i asked my lawyer what was holding it up he said it was just one thing they need, they are still awaiting the medical records from my GP which were requested and paid for back in September but despite monthly attempts to get them to send it they still havent done so and every time i try and contact them to ask why im told that the medical secretary isnt in at the moment and only she can deal with it, but they will tell her to call me as soon as she gets back in, i have yet to receive a single call from them.

i could go on to site a ton of other various reports of shit service that i have personally experienced let alone that of others i know. if i was insurable id have taken private medical insurance long ago and still strongly advise any healthy person in the UK to get private medical insurance ASAP, sure its an extra cost no one wants to pay but if you ever do get sick youll be damn glad you have it

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

#53

Post by DanBC »

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.

Some people in UK have very long waits (over 6 months) for treatment that should be relatively easy to provide and for things that are not minor.

One example would be 'community based psychological therapies' - long form talking therapies.

these are an alternative to far more expensive inpatient hospital stays. Without it people are subjected to increased detentions under S136 of the MHA; they use A&E more often; they use crisis teams more often. And those are all more expensive than a talking therapy.

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

#54

Post by DanBC »

jseliger wrote: post #38
ggambetta wrote: post #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…

the NHS is great and the system works much better than in the US, I'm not so sure about that: https://news.ycombinator.com/item?id=14774718

You know the rapid access to multiple forms of scanning is something that causes harm and death in the US, right?

Over testing, over diagnosis, and over treatment are not good things.

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

#55

Post by DanBC »

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…

> If you get assigned a good doctor for your condition

You can chose your doctor. You can change your GP at any time and you don't need to give a reason. You can choose and book your consultants.

About the only time you don't get to chose is for mental health treatment.

> because their livelihood directly depends on taking good care of me.

their livelihood directly depends on them giving the appearance of taking good care of you, and avoiding you suing them. this means they make much more use of testing and scanning which results in a lot of overtesting, overdiagnosis, and overtreatment, which all cause harm.

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

#56

Post by DanBC »

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.

We could say that the medication advertising budgets in the US are huge, and that Americans experience that in increased prices.

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

#57

Post by 2skep »

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.

Actually, I never understood this. Is demand and supply matched and this is just the lag in the system (ie 6-8 weeks remains 6-8 weeks forever) or demand is greater than supply and this number will grow. If it is the former then there doesn't seem to be a cost advantage for the wait. A temporary increase in supply could bring this waiting time to zero with just the cost of 6-8 weeks worth of x-rays outsourced. And then you have a steady state system with zero waiting.

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

#58

Post by grey-area »

comstock wrote: post #50
grey-area wrote: post #48

Earlier quoted context omitted.

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-...

I wouldn't make a claim as strong as that, but it wouldn't surprise me that it's among the best value for money - it's a tradeoff - you could spend more for better outcomes but at some point it's not worth it any more. The important thing is universal coverage free at the point of use. The NHS is under severe demographic and funding pressure right now, but even that doesn't negate a clear advantage over US healthcare in terms of value for money as shown in the very chart you linked.

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

#59

Post by Boothroid »

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…

'an x-ray typically takes 6 - 8 weeks to be done!' - this is one clinic, and they always prioritise on clinical need (as they gauge it). If your arm's hanging off you will be x rayed very swiftly.

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

#60

Post by Boothroid »

2skep wrote: post #57
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.

Actually, I never understood this. Is demand and supply matched and this is just the lag in the system (ie 6-8 weeks remains 6-8 weeks forever) or demand is greater than supply and this number will grow. If it is the former then there doesn't seem to be a cost advantage for the wait. A temporary increase in supply could bring this waiting time to zero with just the cost of 6-8 weeks worth of x-rays outsourced. And th…

x-rays are generally pretty quick in the UK in my personal experience - I'm not sure the 6-8 weeks is representative. x ray technology is widespread and the procedure usually very simple and non-invasive. It's the more exotic scans that take longer to wait for as there are not as many machines, and if you need a gadolinium contrast for example that requires someone to pump the stuff into you during the procedure thus skilled staff requirement, thus bottleneck. I suspect the temporary increase in supply you mention is not realistic for the NHS budget and there simply may not be the skilled staff available to step up resourcing, and there's a fair chance that some of the people requiring the x-ray will recover during the wait! This last point is I think one of the tactics the NHS has been forced to rely on due to lack of budget. It's sad really. Not to grind a political axe but I suspect the NHS's status as provider of healthcare to all migrants free of charge hasn't helped, and may even have been a factor behind Brexit. I have a manageable condition for which I'm seen in a hospital in London every 6 months or so, and every time I vist it's apparent that most of the people at the clinic do not appear to have been born in Britain. I'm guessing this based on their physical appearance, the clothes they wear, and the fact that often they do not appear to have English as their first language. It doesn't seem fair to me that people that have probably paid little into the system are getting some of the finest care in the world out of it (at this particular clinic I mean. It's a world class research centre) free of charge. How am I supposed to feel about this when I have paid in for decades and have to wait months to be seen for things?

I'm hoping the pressure on the NHS budget will eventually force a change to something like the Dutch system, where insurance is compulsory but reasonably priced at the bottom end and everyone is ensured at least a minimum level of treatment, but has scope to buy a better level of treatment within the same system. If that were the case I wouldn't feel so bad about migrants bringing over their grandad for a heart bypass, or pregnant foreign women turning up at British hospitals in labour (there are documented examples).

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