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.
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.
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.
"In general, the U.K. achieves superior performance compared to other countries in all areas except Health Care Outcomes, where it ranks 10th despite experiencing the fastest reduction in deaths amenable to health care in the past decade."
If you look at the graph Exhibit 4. Mortality Amenable to Health Care, 2004 and 2014[1] it shows that for 2014 the UK wasn't 10th. They have taken an average for the decade leading to 2014. So it isn't as clear cut as just being 10th.
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 experience (as a Brit) British people often think the NHS is the best health service in the world. It's not bad, and it's free. Waiting times are often long, particularly for non-urgent conditions. Compared to the U.S. system I prefer the NHS, but there are other options, and the NHS could provide a better service than it does.
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".
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.
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?
I work in Japan, actually. I have sick days, never waited more than about 15 min at the hospital (without an appointment!), and the care was excellent. YMMV - I recon sick days are indeed unusual.
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 went to the clinic and signed up for one, only to discover a week later that an x-ray typically takes 6 - 8 weeks to be done! I asked around and was told to go to Bupa facility (https://en.wikipedia.org/wiki/Bupa). To the Brits this seemed like an obvious solution, and paying in cash is in fact a good way to get things done quickly. It turns out that when people have something really wrong with them, the solution is often to just pay out of pocket!
This disabused me of any notion that publicly-provided healthcare is automatically superior.
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
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."
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.
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 twice a week until the condition cleared up.
I know the NHS isn't perfect, and I don't really care whether it is #1 or #10 in some ranking. But what I do know that over the last 20+ years of having a family with multiple serious accidents (rugby, climbing etc.), childbirths etc. they've provided excellent and timely care.
Did I have to wait three weeks to get an MRI scan for a sinus infection that was recurring? Yes I did. Did I care if it was being used for properly ill people in the meantime? No I didn't.
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.
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.
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.
I don't think the gatekeeper GP system helps. What are GPs for? Hugely overpaid generalists supported by a powerful lobby (BMA) that cares little about patients and overwhelmingly about increasing doctors' pay and conditions. I'm hoping technology undermines their position over time.
The trend seems to be towards giving GPs more responsibility. My surgery seems to do a lot more than they did twenty years ago. You are right about the BMA though.
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.
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).
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.
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.
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
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.
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.
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.
'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.
I was in an NHS hospital last week for an infected bite on my arm.
Time waiting for X-ray - maybe 30 seconds, mostly taken by the time for me to get to the X-ray room.
Doctor in A&E said I needed an X-ray, I walk next door to X-ray department where they X-ray me immediately and I walk back to the A&E department where the doctor has already looked at the X-rays by the time I got back there (i.e. within a couple of minutes of them being taken).
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.
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.
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).
> 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"?
Interesting thought regarding the r&d spending in the US versus the rest of the world and hence subsidizing global health care. I did look at some numbers in a more recent publication [1](page 21) where the latest r&d numbers for both healthcare and biotech are listed. Germany‘s spending seems to be on average a little less than 1/3 of the US which would make them equal on a per capita level. The UK seems to be a little below those levels. Do you have any data to support your claim?
> 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. Once the income arrives from various nations, that money is fungible within the accounting of the company. One really can't say a pound coming in from the UK isn't funding R&D in America, any more than you could say a dollar is.
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.
I like how you mentioned there's no purely capitalistic healthcare system in the world, even in the U.S. there is massive government involvement in Health Care (120 millions Americans are on medicare/medicaid for instance which is twice the population of the UK if i'm not mistaken), additionally Switzerland which seems to have the best healthcare in the world also has very strict government regulation. When it comes to drug pricing there's another caveat which is a lot of the incredible R&D breakthroughs aren't even done in the states but rather they are done by British and Canadian companies that then markup the prices in the US because it's the only place they can charge people lots of $ (and even in the US they have to sell at a reduced cost to the third of the population that is on medicare/medicaid as stated earlier). So in short the U.S. healthcare system isn't entirely capitalist and the pharmaceutical companies in countries with national health insurance are very capitalist when it comes to selling their drugs in the U.S...basically nothing is what it seems.
Expat American here now living in Thailand for many years and have been treated numerous time to the outstanding medical care at both private and public hospitals here.
Question: As far as you know, do the private hospitals here in Thailand receive any government money? Because it sure seems like a real market here with private hospitals competing on services and prices. And they advertise those services and prices in the media regularly.
I plan to never return to my home country and one of the main reasons is the health care debacle in the U.S. It's so much better and affordable here.
It's true that America's higher drug prices ultimately subsidize the world. But this certainly isn't the only thing driving up costs. Administration costs in healthcare are significantly higher in the US than other countries, and heroic end-of-life care is a sort of religion that sucks money down a black hole. Some chronic health issues like obesity are more common in the US. And there's this:
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.
> 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.
> As with the US education system, the availability of government funds has massively pushed up prices
Although people on here keep saying one reason insured people are overpaying for treatment is because Medicare/Medicaid generally underpay for services rendered and hospitals have to make up the difference on other paying patients?
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...
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.
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 received proper treatment in an early stage.
Instead, the 'cost' of billing that is 'outsourced' to the government's tax collectors, which are going to be the /very/ last thing removed if ever.
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.
Basically UK spends less overall, 9.9% of GDP vs SWIZ's 11.1%. While UK ranks higher than SWIZ on the report's definitions of Care Process, Access, Efficiency and Equity. SWIZ ranks higher on Health Care Outcomes.
On cost (which is under the Access category), Swiss seem to self-report having at least somewhat more problems even with the health insurance. For example: 22% of Swiss self-report having had a "cost-related access problem to health care in the past year" (UK 7%, US 33%), and 21% of Swiss report skipping dental care or check up in the past year because of cost (UK 11%, US 32%). Also, 46% of Swiss report having paid more than US$1000 for out-of-pocket medical expenses in the past year, which was the highest of any country in the study (UK 4%, US 36%).
> the National Insurance contribution that gets deducted from my paycheck in the UK
National Insurance nominally covers state pension and unemployment benefits, not the health service.
Of course, it all goes into one pot of money, but your entitlement to the above goes up the more years of NI you have paid in, whereas your entitlement to NHS does not change.
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
As a swede living in London, I was shocked to find the NHS still uses paper prescriptions that are consumed upon use, at least in my limited experience. In Sweden, every prescription I have is digital and tied to my ID, accessible from any pharmacy or hospital in the country and is not necessarily consumed upon use, I can easily reuse it and renew it.
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[ 2.6 ms ] story [ 91.8 ms ] threadI'll see what I can do about getting our website updated! Thanks for your interest.
http://www.commonwealthfund.org/~/media/files/publications/f...
http://www.commonwealthfund.org/publications/fund-reports/20...
It ranks the UK 10th out of 11 on "Health Care Outcomes".
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.
If you look at the graph Exhibit 4. Mortality Amenable to Health Care, 2004 and 2014[1] it shows that for 2014 the UK wasn't 10th. They have taken an average for the decade leading to 2014. So it isn't as clear cut as just being 10th.
http://www.commonwealthfund.org/interactives/2017/july/mirro...
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 experience (as a Brit) British people often think the NHS is the best health service in the world. It's not bad, and it's free. Waiting times are often long, particularly for non-urgent conditions. Compared to the U.S. system I prefer the NHS, but there are other options, and the NHS could provide a better service than it does.
The way it's being used here, to say the NHS is wonderful, doesn't work very well in my opinion.
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").
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
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 went to the clinic and signed up for one, only to discover a week later that an x-ray typically takes 6 - 8 weeks to be done! I asked around and was told to go to Bupa facility (https://en.wikipedia.org/wiki/Bupa). To the Brits this seemed like an obvious solution, and paying in cash is in fact a good way to get things done quickly. It turns out that when people have something really wrong with them, the solution is often to just pay out of pocket!
This disabused me of any notion that publicly-provided healthcare is automatically superior.
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
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."
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.
I know the NHS isn't perfect, and I don't really care whether it is #1 or #10 in some ranking. But what I do know that over the last 20+ years of having a family with multiple serious accidents (rugby, climbing etc.), childbirths etc. they've provided excellent and timely care.
Did I have to wait three weeks to get an MRI scan for a sinus infection that was recurring? Yes I did. Did I care if it was being used for properly ill people in the meantime? No I didn'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.
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.
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.
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).
Because the data I've seen [1] doesn't suggest that.
[1] http://wjmc.blogspot.jp/2011/03/us-healthcare-costs-vs-life-...
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.
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.
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...
Time waiting for X-ray - maybe 30 seconds, mostly taken by the time for me to get to the X-ray room.
Doctor in A&E said I needed an X-ray, I walk next door to X-ray department where they X-ray me immediately and I walk back to the A&E department where the doctor has already looked at the X-rays by the time I got back there (i.e. within a couple of minutes of them being taken).
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.
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.
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...
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"?
[1] https://www.iriweb.org/sites/default/files/2016GlobalR%26DFu...
And R&D is very hard to compare due to different incentives to categorize R&D depending upon taxation laws and charity institutions.
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. Once the income arrives from various nations, that money is fungible within the accounting of the company. One really can't say a pound coming in from the UK isn't funding R&D in America, any more than you could say a dollar is.
Question: As far as you know, do the private hospitals here in Thailand receive any government money? Because it sure seems like a real market here with private hospitals competing on services and prices. And they advertise those services and prices in the media regularly.
I plan to never return to my home country and one of the main reasons is the health care debacle in the U.S. It's so much better and affordable here.
http://johnhcochrane.blogspot.com/2017/04/the-second-origina...
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.
Although people on here keep saying one reason insured people are overpaying for treatment is because Medicare/Medicaid generally underpay for services rendered and hospitals have to make up the difference on other paying patients?
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...
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 received proper treatment in an early stage.
Instead, the 'cost' of billing that is 'outsourced' to the government's tax collectors, which are going to be the /very/ last thing removed if ever.
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.
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.
But for some reason any time it's used in the context of health care, people just have to point out that it's not really free.
Basically UK spends less overall, 9.9% of GDP vs SWIZ's 11.1%. While UK ranks higher than SWIZ on the report's definitions of Care Process, Access, Efficiency and Equity. SWIZ ranks higher on Health Care Outcomes.
On cost (which is under the Access category), Swiss seem to self-report having at least somewhat more problems even with the health insurance. For example: 22% of Swiss self-report having had a "cost-related access problem to health care in the past year" (UK 7%, US 33%), and 21% of Swiss report skipping dental care or check up in the past year because of cost (UK 11%, US 32%). Also, 46% of Swiss report having paid more than US$1000 for out-of-pocket medical expenses in the past year, which was the highest of any country in the study (UK 4%, US 36%).
I'm not so sure about that: https://news.ycombinator.com/item?id=14774718
Over testing, over diagnosis, and over treatment are not good things.
National Insurance nominally covers state pension and unemployment benefits, not the health service.
Of course, it all goes into one pot of money, but your entitlement to the above goes up the more years of NI you have paid in, whereas your entitlement to NHS does not change.
Some of the data from the Appendix on Equality pulled out. The difference between countries is quite astounding!
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