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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

#71

Post by makomk »

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…

In terms of efficiency, you're right. However because people get fed up of waiting and having to put up with their health issues and pay to go private instead, this reduces demand and the cost to the NHS. Think of it as a softer way of rationing access to some kinds of NHS healthcare to only those who don't have the money to pay for private care instead.

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

#72

Post by makomk »

grey-area wrote: post #58
comstock wrote: post #50

Earlier quoted context omitted.

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…

The problem with using this as a template for solving the US healthcare problem, of course, is that proposing that Americans should have access to less treatments and put up with worse healthcare outcomes in order to improve value for money is a complete political non-starter.

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

#73

Post by _dps »

arethuza wrote: post #67
_dps wrote: post #45

Earlier quoted context omitted.

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 losi…

A couple of years back my son developed an eye infection that didn't respond to the antibiotic drops our GP prescribed. I took him back a couple of days later and we were referred first to a private ophthalmologist (who we didn't have to pay for) and then to the specialist eye department of the local hospital that same day (associated with the medical school of a world top 20 university) where he was regularly seen t…

> It's not perfect, put it is pretty bloody good.

Just to round out my thoughts here, I mainly agree! I lived in London for two years and I was always pleased with the NHS overall.

My main point is that, based on my experience in the USA, advocates of moving to an NHS-style system tend to underplay the fact that there is genuinely a different set of costs, and it is not a magical solution.

I spend lots of time in both the USA and in Greece (which has a mostly-NHS-style system), and I have gotten health treatment in both places throughout my life. Both systems have strengths and weaknesses, and I can totally understand someone advocating for an NHS-style system as the best overall set of tradeoffs available. It's just not without some downsides, and I wanted to point out that waiting times can be a real problem.

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

#74

Post by grey-area »

makomk wrote: post #72
grey-area wrote: post #58

Earlier quoted context omitted.

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…

The problem with using this as a template for solving the US healthcare problem, of course, is that proposing that Americans should have access to less treatments and put up with worse healthcare outcomes in order to improve value for money is a complete political non-starter.

The UK also has private providers, there's no need for a public system to completely replace all care - a single payer system is usually a choice alongside private providers (but one which I think the vast majority of people would recognise as better and cheaper care). If you want slightly better outcomes, pay for private insurance/private care (and you'd pay less because single-payer will drive down demand).

Most countries use a variant of single-payer or mandated insurance for good reasons, the US was an exception, not because it has exceptional requirements, but for historical reasons.

https://truecostblog.com/2009/08/09/countries-with-universal...

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

#75

Post by comstock »

makomk wrote: post #71
2skep wrote: post #57

Earlier quoted context omitted.

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…

In terms of efficiency, you're right. However because people get fed up of waiting and having to put up with their health issues and pay to go private instead, this reduces demand and the cost to the NHS. Think of it as a softer way of rationing access to some kinds of NHS healthcare to only those who don't have the money to pay for private care instead.

Or less charitably... they die...

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

#76

Post by comstock »

DanBC wrote: post #51
comstock wrote: post #50

Earlier quoted context omitted.

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.

Does it show that the NHS provides better value for money than other providers excluding the US? (It doesn't look like it does to me).

The US is a massive outlier globally. They have expensive, poor healthcare in comparison to the rest of the world. Compare any country to the US and that country will likely out-perform the US on most metrics.

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

#77

Post by mikeash »

_dps wrote: post #45
mikeash wrote: post #44

Earlier quoted context omitted.

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 losi…

I find complaints about wait times for minor issues to substantially underplay the incredible waste, suffering, and death which happens in the US system. Yes, the NHS and similar systems are not perfect. But to conclude with "This disabused me of any notion that publicly-provided healthcare is automatically superior" is, to me, trying to put the two on an equal footing which they very much do not deserve.

Maybe I've misunderstood the point they're making, but it sure seems to be saying, well, we could stop bankrupting and killing people for no good reason, but you may want to reconsider, because you might end up waiting several weeks for a non-urgent x-ray.

I realize that even non-urgent conditions can cause great suffering. But how does that suffering compare to dying from an easily treatable condition because you couldn't afford a doctor? If you can fix the latter at the expense of the former, is that not superior?

Especially since the workaround for long wait times seems to be to pay for quicker private care. If you have that option, then is it actually worse at all? You go from "pay to be seen quickly, or die" to "pay to be seen quickly, or wait." Seems like an improvement.

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

#78

Post by oliwarner »

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…

Consider the reason most Brits feel this way is that most Brits understand what the NHS is and isn't. Our expectations aren't that we get CT scans because we paid enough money, we get them when a doctor decides they're medically necessary, in a timeframe based on the urgency of that ailment, again decided by the doctor.

Your post (and your anti-UEA PDF) make it sound like you broke a fingernail, you decided you needed multiple scans so went to the campus doctor (who doesn't have a scanner, can only refer into NNUH), was told there may be a wait while they book you an appointment and you immediately broke out your insurance to get what you wanted, regardless of medical need.

Your insurance is yours to flaunt, but had this been something that "needed" a quick scan, you would have been sent to A&E (it's a 10 minute walk from UEA, 2 minute bus) and you'd have received prompt care.

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

#79

Post by adambj »

zkms wrote: post #3
tehabe wrote: post #2

Is the abstract really shorted and the author is mentioned but as affiliation it only says "London". They really don't want to know much about the paper before you pay for this paid research.

Use sci-hub to avoid paying anything to get full-text PDF.

Hey zkms, this reply isn't about the main thread, but bear with me. I happened upon your comment here (https://news.ycombinator.com/item?id=13454185) asking about the status of Parabix. Granted, that was almost half a year ago, so you may not even remember making the comment. But just in case you're still curious about Parabix, yes it is still very much in development! I've been working on it since about the time you made that comment. The most fully featured application we've built so far is icgrep -- an attempt to rewrite grep from the ground up using Parabix. It's still a bit rough around the edges, but it's usable and exceptionally fast. On large collections of files (10s or hundreds of GBs) it's often orders of magnitude faster than grep, and has more robust Unicode support to boot. We're working on some other pretty neat stuff too, but they aren't quite ready for widespread release yet.

I'll see what I can do about getting our website updated! Thanks for your interest.

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

#80

Post by einpoklum »

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.

In a country with decent health care, you should not wait more than the time it takes to get to the relevant clinic. i.e. the fact that you have to wait at all is ridiculous. There should be - and there typically are - enough X-ray machines so that the line is not 6-8 week long, it's 10 minute long.
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