UK has best health system in developed world, US analysis concludes
bmj.com
bmj.com
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?
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.
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.
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...
I'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...
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?
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