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Comment by comstock | Hacker News Reader

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.

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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.

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

> 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.

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).

Demand is increasing. Supply is falling.

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...

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?

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.

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.

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

'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.

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.

The original report is better. This report is really about saying "the US system could be a lot better" rather than an overall ranking of healthcare.

The way it's being used here, to say the NHS is wonderful, doesn't work very well in my opinion.

From my friends' stories, Japan healthcare experiences were pretty bad:

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").

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?

http://www.photius.com/rankings/healthranks.html

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.

As a fellow Brit I'd agree we're proud of the NHS but I don't think people believe it's the best in the world. We complain too much for that.

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".

France ranks higher in some studies. I did a lot of personal research after "Sicko" the movie was released.

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