Problems with UK National Health? Inquiring Yank Wants to Know.

America's economy is predicated on leading the world in healthcare innovations? Pure fiction. Utter rubbish IMO. I can't offer an opinion on social systems because I don't know what a social system is.

Name 10 healthcare innovations entirely developed in america in the last five years. Name 10 leading pharmaceuticals launched in the last five years which were developed entirely in America?

Well, this bit, abstracted from the Guardian report wasn't very reassuring.......

The only serious black mark against the NHS was its poor record on keeping people alive. On a composite "healthy lives" score, which includes deaths among infants and patients who would have survived had they received timely and effective healthcare, the UK came 10th.

Comming 10th out of 11 on keeping people alive is a poor show IMHO.

Hi Plinko,

When you say "healthcare innovation" you refer to the more profitable and corporate aspects as opposed to the social/cultural aspects of healthcare. I am no expert so you may be right. But I think this aspect you bring up is a much more complicated and bigger topic than I can talk about...

But I think to suggest somehow that as a leading nation, using your definition of "healthcare innovation" is the price to pay for having (according to this report) the worst healthcare system out of those 11 countries surveyed, is a slight 'head in sand' response to my post and to the thread.

I thought you might be interested in this interview.

http://www.forbes.com/sites/he...ds-a-paradigm-shift/

Jason.

Jason, I think you are defining "healthcare system" a bit too narrowly.  It's not just how efficiently it is run or delivered (as discussed in the article you offered), how available it is, and how much it costs an end user.  It is also about the products and services that are actually provided.  Last I checked, the US spent $100 billion annually more on healthcare R&D than the entire, larger EU.  The US National Institute of Health is the largest public researcher of health issues in the world.  The US attracts far more private investment in healthcare than any other country or groups or countries (see EU above).  You have to ask yourself why that is the case and why such incentive for investment in healthcare exists in the US as opposed to say, a country like the UK.  Maybe a country like the US should divert that extra $100 billion a year to perfect delivery models and disincentives to innovation?  If we had done this where would we be?  Where would your healthcare system be?

I don't think the US has the best and fairest system by any longshot but when I need that anti-coagulant for a basic surgery, or that statin to lower my cholesterol so I don't have a stroke, or an MRI to examine an over active thyroid (just examples), I will be thankful for where those technologies came from and for the socio-economic environment that allowed it to happen. So you can see that it appears to me that your viewpoint that the UK has the best healthcare system is ironically, "head in sand" as it is simply much too complex an issue.  I did read your earlier links, btw, and I found them equally shortsighted.

So there we have it, Jason....a couple of head-in-sand blokes going at it.  I can take something from your comments and the links you provided.  There is learning to be had most anywhere. 

You think research into statins began in America? Wrong. It was Japan. The first work on anticoagulants began in America in 1914 but it was a Swedish company that bought it to market. You think that without the American health system and the socioeconomic structure of America, the MRI scanner wouldn't have been invented? Vahan Damadian is recognised as the originator, who’s work kicked off worldwide research, not least in Europe, culminating in the first patient body scan being performed in Nottingham, England in 1977.

How much does it cost in America to have your head surgically removed from your own arse? It's certainly not something you can get on the NHS.

For anyone who still thinks yhe American healthcare system doesn't suck (if you're happy to consider the us a 3rd world country, that's a different story)

http://www.nytimes.com/2013/11...can-health-care.html

http://topics.nytimes.com/top/...nline=nyt-classifier

$6000 bill for a small cut due to ER visit

http://www.nytimes.com/2010/08...alth/07patients.html

25000 initial bill - bargained down to about 3000.

http://www.nytimes.com/2014/01...ts-incomes-soar.html

an overnight stay at the hospital following an ER visit - 25000. Mostly covered by insurance,

but guess where they get the money from?

It's easy to berate any healthcare system.

Fourteen years ago, my then 4 year old son contracted tuberculosis. The diagnosis was not readily made, and he underwent numerous tests, a lung biopsy, and spent twelve days in Seattle Children's Hospital. He required 6 months of expensive medication to cure the infection and has been in good health ever since. The bills totalled over $80,000. We had good health insurance and for our part paid about $1,200 of the total cost. Since then, our coverage has remained adequate and fair. I can't complain.

Don't judge a health care system on anecdote and personal experience, not least when the latter is hardly likely to encompass great age/social range.

Although the USA is one of the leaders in innovation and healthcare R+D that is not wholly a good thing. The US has a profit-led system (rather then primarily an evidence based one). Building a big scanner is more profitable than providing community mental health care to a small town. Which is more important if you are not going to have both? Doctors too are guilty of being allowed to practice too much medicine, litigation fears push that along too. 'Too much medicine' may be an alien concept to some but believe me the risks of over-diagnosis, over-investigation and over-treatment are manifest.

The US fails on tests of equity, access, community care and preventative healthcare.  Some people get great care, some get too much care, many get fragmented or indeed too little care. A comparison can be made at the other extreme with Cuba which has systematically invested in primary care, community staff and preventative care with some very interesting results, and for very little money.

We need innovation, and we need healthcare companies to be motivated by profit to do that but we also need to ensure that healthcare priorities are addressed by their work. For example; where is the next generation of antibiotics coming from? High value hospital only drugs are occasionally being developed but low-value low-profit general use ones are way more urgent probably. Ensuring R+D concentrates on what is valuable as well as what is exciting and or expensive is a tough problem.

The NHS battles with the same problems as all healthcare systems. none have solved the puzzle; and none will because healthcare is a bottomless pit. We could always do more, for more people, in better ways. The NHS has financial and political constraints that in part demand it examines issues of access, equity and value in a way that is more transparent than many systems. It has a well developed (although now significantly under-resourced) universal Primary Care system that has been the key to the value for money it has delivered in the last 50+ years. Far from perfect (and the horizon is looking stormy) but I'd prefer to live and work with our system than the US one any day.

Bruce

My personal health care experience is not limited to just my immediate family, but my grandmother's, parent's, sibling's and their children as well. Granted, that's a limited social range, but an expansive age range. We've all been working middle class types that have paid rather extensively into various health care plans over time. Aside from tuberculosis, my family members have been or are being treated for ailments such as prostate cancer, enlarged prostates, several heart attacks, dementia, macular degeneration, polythycemia vera, and numerous routine surgeries. None of us has been overburdened with related copayments. It may be just mine, and my relatives own interests I am concerned with, but overall I can't complain about the healthcare benefits we've been provided throughout those various treatments.

You can certainly judge a national health care system by any number of macro-metrics, but what is more relevant than personal experience?

Your experience is valuable to you, and combined patient experiences are valuable and sought after to plan healthcare. As a GP commissioner I work far more with patient feedback than we have ever done before in the NHS.

However the inverse care law also applies to patient feedback. Basically it is the nature of most healthcare systems that the greatest access, the greatest resource and the greatest spend tends to favour those with the least need-and vice versa. The dis-enfranchsied, dis-advantaged, inarticulate, poor and the sick tend not to contribute to feedback. Their personal experiences of healthcare tend to be the poorest too.

Bruce

Update on my current if rare engagement with the NHS.

I have an appointment with the same surgeon who was seeing ten years ago about Centrel Serous [Chorio-] Retinopathy set for the 18th August. They invited me on the 28th July, but unfortunately I shall be away on that day, so a nice telepjone-call to the appointment desk and a lovely lady found me the next suitable free time.

The NHS knows how to pull its finger out when required and take it easy when it is just a watching brief. There last time the CSR appeared I saw the same consultant I shall see this time within 36 hours.

Superb service like that would be very expensive to pay for at the point of contact, rather than general taxation, I would think.

ATB from George

How much we spend as a nation compared to others is well worth considering.

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

UK spent 9.4 GDP on health 2012/13 compared to say the US which spent 17.9. The US has the the worst health care outcomes of all the developed nations. As Bruce has pointed out mainly because they are focused on a certain aspects of health, mainly the higher profit ones and not so on preventative.

Germany and France spend roughly the same 11.3 and 11.7 and have a good balanced systems but they do not score as highly overall as the NHS.

The reality is that we pay for a bronze service and get gold, mostly!