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November 04, 2005

Our Care vs. Their Care

Interesting study out from Health Affairs comparing the care experiences of patients in six countries.  The lucky lab rats are Australia, America, Canada, Germany, England, and New Zealand.  The results, for Americans, are not comforting.  I'll quote you the interesting parts:

"Concerns about transition care extended to medications. Patients in all countries   were often given a new medication when discharged, with U.S. patients the most   likely to report new medications. Yet in all but Germany, at least one in four   patients said that nobody had reviewed the medications they were taking before   their hospitalization.[...]

  On a composite variable including three types of errors—medication or   medical mistakes or lab errors—U.S. patients were the most likely and   U.K patients the least likely to report errors. Driven up by relatively high   medication and lab or test errors, at 34 percent, the spread between the United   States and the countries with the lowest error rates was wide as well as statistically   significant. Yet in all countries, more than one of five sicker adults reported   at least one of the three types of errors, with patients often reporting more   than one type of error.[...]

Asked about waits to see their doctors when sick, sicker adults in Canada   and the United States were significantly less likely to report rapid access   and more likely to wait six days or longer for an appointment than patients   in the other countries. The percentage receiving same- or next-day appointments   ranged from a high of 70 percent or more in Germany and New Zealand to below   half in Canada and the United States.

  Ease of access to care after hours or on weekends also varied widely, with 70   percent or more New Zealand and German patients and more than half of U.K. patients   saying that access is “easy.” In contrast, more than half of sicker   adults in the United States, Canada, and Australia said that it is difficult   to get after-hours care.

  Canadian and U.S. patients were the most likely and German patients the least   likely to report emergency room (ER) visits in the past two years, with rates   notably low in Germany. Moreover, one-fifth of Canadian and one-fourth of U.S.   sicker adults said that they went to an ER for a condition that could have been   treated by their regular doctor if available—rates significantly higher   than reported in other countries. Also, Canadians stood out for long ER waiting   times.[...]

  As found in past surveys, the United States is an outlier for financial burdens   on patients and patients forgoing care because of costs. Half of sicker adults   in the United States said that they did not see a doctor when sick, did not   get recommended treatment, or did not fill a prescription because of cost. On   each access/ cost question, the U.S. rate was 1.5 to double the forgone care   rates reported in the next-highest country. Moreover, the percentage of U.S.   sicker adults forgoing care because of costs was much higher on all three indicators   compared with the 2002 survey of sicker adults.12   Despite these high rates of care forgone, one-third of U.S. patients spent more   than $1,000 out of pocket in the past year, a level rare in the other countries.   Insured and uninsured U.S. patients were about equally likely to report expenditures   this high (34 percent insured and 32 percent uninsured; data not shown). U.S.   patients were also the most likely to pay $100 or more each month for medications[...]

Asked to rate their country’s care system overall, the majority of sicker   adults (66–85 percent) in all countries saw room for major improvement.   Sicker adults in Germany and the United States were the most negative, followed   by Australia.[...]

Our findings also indicate that insurance and delivery systems affect patients’   experiences beyond basic access and waiting times. Symptoms of inadequate insurance   coverage and more fragmented care in the United States emerged throughout the   survey. The United States outspends the other countries, spending 14.6 percent   of national income compared with Germany’s 10.9 percent, Canada’s   9.6 percent, Australia’s 9.1 percent, New Zealand’s 8.5 percent,   and the United Kingdom’s 7.7 percent.25 Yet   the United States often ranks last or tied for last for safety, efficiency,   and access. With one-third of U.S. patients reporting medical, medication, or   lab errors and a similar share citing duplicate tests or medical record delays,   our findings indicate widespread performance deficiencies that put patients   at risk and undermine care. Moreover, a recent study finds that the United States   is not systematically a leader in clinical outcomes.26
 
  Confirming spending data from the Organization for Economic Cooperation and   Development (OECD), the United States also stands out for its patient cost burdens,   with consequences for access.27 U.S. physician   visit rates are already low by OECD standards.28   To the extent that U.S. insurance continues to move toward higher front-end   patient deductibles, these rates could go up, as increasing numbers of insured   patients become “underinsured,” lacking access or adequate financial   protection.29 Contrasts between the United States   and Germany, in particular, indicate that it is possible to organize care and   insurance to achieve timely access without queues, while ensuring that care   is affordable at the point of service. There are clear opportunities for the   United States to learn from other countries’ insurance systems."

It's not, to say the least, a comforting picture.  It's Friday afternoon, so I'm not feeling in-depth analysis.  For that, you should go to Matt Holt.  But if you've read the excerpts, there's really not much explanation required.  We get worse care that's less convenient and leaves us less satisfied than most everyone else, meanwhile, we pay much more than anyone else for the priviledge.  Keep in mind, here, that we're dealing with five single-payer systems, not only Canada.  ClintonCare, by the way, was modeled after Germany.  Sure glad we decided against that boondoggle of efficiency.

November 4, 2005 in Health Care | Permalink

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Comments

The part I found most interesting was comparing wait times between the US and Canada (because of course that's the party line on Canadian care--you have to wait forever for everything). It does provide some basis for that (in particular, where specialists and elective surgery are concerned); on the other hand, off-hour access to doctors seems to be significantly better in Canada. And even where we beat Canada on wait times, that's like beating the Jamaican bobsled team; every other country in the survey is a lot better than we are (in other words, socialized medicine does not inherently mean waiting longer for care).

Posted by: Tom Hilton | Nov 4, 2005 7:43:25 PM

On each access/cost question, the U.S. rate was 1.5 to double the forgone care rates reported in the next-highest country.

The Triumph of Capitalist Medicine!

Reverse Robin Hood in action!

Aren't we PROUD?

Posted by: JimPortandOR | Nov 4, 2005 8:15:12 PM

Well, if we had accepted that "boondoggle of efficiency" we would have extended our nightmare of peace and prosperity and that would have simply been wrong. Thank god for our Godly President.

I'm not sure how much confidence I have in errors, waiting times, etc. as reported by patients. Recollection is a notoriously poor way to collect data. However, IMHO the repetition of lab tests and failure to follow up is largely a result of the the continuous flux of patients and doctors. People change docs whenever they change jobs or their employers change plans or their plans change providers. They don't or can't coordinate transferring records. It's a mess.

Posted by: J Bean | Nov 4, 2005 11:11:28 PM

If end result is the only guiding factor, then let's get social medicine. Say, and why we are at it, wouldn't a centrally planned economy be just that much more efficient? Couldn't you make a case for the government also delivering a palatable religion, one more to your liking without all of the "hate" and stuff? Hey, here's an idea! Let's put all of the public schools under the control of the federal government as well!

What? You think maybe federally controlled schools would lead to politicization and indoctrination? and you say that a centrally planned economy has already been tried by several communist states and hasn't worked out well? Politicization of the process? Bad idea to have the government deliver religious services? You say it would lead to the politicization and oppression? So why would government delivered health care be immune to the same forces?

Posted by: Fred Jones | Nov 5, 2005 10:20:17 AM

Fred, because centrally-planned economies have proven to not work worth anything. OTOH, single-payer or socialized medicine has been proven to work better than the present US system.

Posted by: Barry | Nov 5, 2005 11:02:53 AM

Fred can't make fine distinctions like that, Barry. Because we have a government controlled military, he's sure we're already on the way to communism. It's kind of a sad affliction. Funny, though.

Posted by: Ezra Klein | Nov 5, 2005 12:17:23 PM

Ezra, I understand that you are a young pup, but the millions and millions of self-described communists didn't just disappear overnight along with the East Berlin wall and the demise of the Soviet Union.
They now call themselves by other softer names to hide their identity. In every anti-war and anti-government rally, you will find them only now they call themselves A.N.S.W.E.R or the ACLU or a myriad of other names. However, the goals are the same. Show me some goals of the "progressive" movement and I will show you the same goals strived for by those who were honest enough to tell others who they really are.

Posted by: Fred Jones | Nov 5, 2005 8:58:32 PM

Oh, and one more thing. There are millions and millions of those just like me that stop the wacko left. I hold the mainstream views. Yours are not.

Posted by: Fred Jones | Nov 5, 2005 8:59:58 PM

That depends, on what you mean by mainstream Fred. Universal healthcare is, in the entrenched political system (Congress, for instance), a fringe view, not mainstream. Among ordinary people, though, it's a popular view -- more popular than our current system.

Posted by: Julian Elson | Nov 6, 2005 12:13:14 AM

That depends, on what you mean by mainstream Fred. Universal healthcare is, in the entrenched political system (Congress, for instance), a fringe view, not mainstream. Among ordinary people, though, it's a popular view -- more popular than our current system.

Posted by: Julian Elson | Nov 6, 2005 12:15:10 AM

That depends on your definition of mainstream, Fred. By the standards of the current congress, no, support for universal healthcare is not a mainstream position. By the standards of ordinary people like you and me, support for universal healthcare is a more mainstream position than support for the current system.

The ACLU, by the way, was founded in 1920, somewhat before the collapse of the Berlin Wall. None of Australia, America, Canada, Germany, England, and New Zealand are centrally planned economies, though northeastern quarter of Germany was centrally planned until 1990 and the British economy made extensive use of central planning from the end of World War 2 until the late 1970s.

Posted by: Julian Elson | Nov 6, 2005 3:11:46 AM

Bugger: I apparently posted successfully at 9:15 when I thought that typepad was having problems and hadn't posted. If you don't mind, Ezra, delete my 9:13-15 posts and this one.

Posted by: Julian Elson | Nov 6, 2005 3:23:40 AM

In every anti-war and anti-government rally, you will find them only now they call themselves A.N.S.W.E.R or the ACLU or a myriad of other names.

You forgot MoveOn Dot Org--they're big fat gay commies too. Oh, and George Soros--he's the reddest of the red (all that stuff about trying to democratize the Eastern Bloc was just a smokescreen for his incredibly far-reaching plans to turn the whole world into Gay Commieland).

Also, you forgot to mention that Michael Moore is fat.

Posted by: Tom Hilton | Nov 6, 2005 7:10:05 PM

And you'll find nearly as many undercover security as "communists" Fred. Bye the bye : only the Marxists advocate violent overthrow of the state. As for the rest ; name-calling is a cheap way to discredit another's opinions and dehumanize them. That's fascism.

Posted by: opit | Nov 7, 2005 12:19:08 AM

If end result is the only guiding factor, then let's get social medicine.

A very telling remark. "Oh, sure, if you just want a system that works better, then have social medicine. But I am concerned with more important things than reality, and I oppose it!"
And I rather doubt that the US ever had millions and millions of self-described communists.

And I hate to say it, but the UK has had state religion basically forever, and the current status is:

SIMILARITIES BETWEEN THE UK AND TALIBAN AFGHANISTAN
1. Mullah Mohammed Omar has a beard. Archbishop of Canterbury Rowan Williams has a beard.
2. Err...
3. That's it.

Posted by: ajay | Nov 7, 2005 8:50:46 AM

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