by frog
In a cautionary tale the New Yorker explores the effect of organising health care around making money. “It finds that costlier care is often worse care….”
This article looks at why some towns have much higher health care costs than others. It finds that higher costs are driven by health providers seeking to make a profit rather than making the needs of the patient the priority.
The U.S health system relies heavily on private hospitals and insurance- and is the most expensive health care system in the world with it costing a whooping 13.7 % of America’s massive GDP (and 18.7 % of total Government spending).
But does it provide the best health care in the world for its people? Not by a long shot ….. In 2000 a World Health Organisation report – found that the U.S spent the most on healthcare but ranked only 37th in terms of performance.
So is making money out of sick people efficient? Does it make for a better health system which looks after people?
Draw your own conclusions but I reckon that health care systems that are run to make profit at the expense of the patient create perverse incentives, do not save money and do not promote health outcomes (but try telling that to Roger Douglas…..).
Published in Health & Wellbeing by frog on Tue, June 23rd, 2009
Tags: health, private hospitals, privatisation
on the trolls and those who are unable to keep on topic
...
Singapore has got it pretty well right.
Good care and their nurses and doctors don’t go to the US or elsewhere because they are so well paid in Singapore.
Like or Dislike:
0 
0 (0)
The USA is such an easy target. It is almost impossible to come up with a worse system than they have there.
So what do they do in Singapore? Besides having more money.
I don’t reckon we’re SO far wrong… but we’re stuck for bux here. We tied it all up in houses and interest payments.
…and I only have the USA for a comparison.
respectfully
BJ
Like or Dislike:
0 
0 (0)
Yeah the US system sounds like a pretty creaky non-free market one that most sane people (right and left) would want to stay away from. Rock star surgeons of course, but not a hell of a lot else…
Singapore:
http://en.wikipedia.org/wiki/Universal_health_care#Singapore
Like or Dislike:
0 
0 (0)
Everyone pays into a Government operated Health insurance Account rather than a Super Account. It has their name on it and insures them.
The government provides some services but there is private competition for most.
You take your choice. The Government service provision is quite basic but takes less of your Account. So you can go into a shared ward with basic food and your policy pays a basic rate but if you decide you want a private room with wine with great food then you can go to a private provider and a bigger chunk comes out of your account.
This provides an incentive to keep yourself well. If you look after yourself you will have more in your account to give you elective surgery etc when you really need it.
Singapore is becoming a health provider to the region because of its high quality services and competitive pricing.
Like or Dislike:
0 
0 (0)
Does your opening line suggest that the Green Party is against all the health foods and organic foods claiming health benefits being sold for profit.
I suppose you can argue that most of those products are sold to the worried well.
Like or Dislike:
0 
0 (0)
France & Germany have excellent health systems that seem to operate in a fairly similar way to that of Singapore. Basically everyone pays a dedicated part of their tax as health insurance, and then a highly regulated a non-profit sector provides the health service.
From what I know it’s a slightly less “government involved” system than what we have in New Zealand or what the UK has. Which is interesting.
Like or Dislike:
0 
0 (0)
The big issue with the American health system is the fact that you have a culture of litigation there – an American surgeon has to pay $200,000 a year just for insurance in case they get sued and the judge gives a massive payout – indeed, it is so ridiculous that an American can fly to New Zealand, get treated in one of our private hospitals all for a cost less than being treated in their home country.
Obama should have really started off by fixing the Tort Laws in the United States rather than having nationalised health care. Cutting the culture of litigation would be a good thing for the good ole U S of A.
Like or Dislike:
0 
0 (0)
Beuocracy. Ultimatly its all about the costs incured in beurocracy. Talking to afew doctors apparently the reason france is so good is because they treat everyone. Almost no money wasted on paper work. I know a doctor whom i shall not identify whom, when working the night shift, doesint prescribe morphine because of all the paper work but its much more expensive alternative which is, ironically, free of such paper work. Its funny that in excluding people and only providing care in some circumstances we actually increase the costs incurred.
We should provide healthcare to everyone. If it is self infliced give them the health care up front and then charge them afterwards through a low interest government loan, if they have insurance the insurance can pay it back. If it is something that is not self induced or through their own stupidity or somethign that is accounted for in the purchase of the tool (e.g. tabacco should be taxed to the extent that it covers all health externalities and as such treatment for tabbaco induced lung cancer would be free) of infliction then it is free.
Like or Dislike:
0 
0 (0)
The thing is though, that in the US they don’t make money out of the sick people – they make it out of their insurers. Higher cost states tend to be states with higher levels of insurance coverage, and the reason is that if the insurance covers it, patients tend to choose costlier, more elective procedures, doctors tend to run up costs more, and so on. The only ones with the incentives to keep costs down are insurers, and they consistently lose court battles to deny treatments, compensation, etc.
Like or Dislike:
0 
0 (0)
The problems in the USA several. First we look at the “black box” aspect of this.
Who in the system is making lots of money.
A. Lawyers.
B. Insurance companies.
C. Doctors.
Pretty much in that order. The Lawyers feed on both the Doctors and the Insurance companies. The Doctors tend to be pretty beaten up in comparison, but they do well enough.
Those insurance companies are large enough to have tax lawyers as well, and despite their claims, they have the some of the largest office buildings and wealthiest executives outside the banking industry. With 55000 pages and counting, in the rulings and regulations, the tax code is well able to provide them with a forest to hide in.
http://www.medicalnewstoday.com/articles/112710.php
The obvious problem is that health care is a lot like nuclear safety.
IT CANNOT BE ADMINISTERED TO MAKE A PROFIT IF THE SOCIETY IS TO BE PROPERLY PROTECTED.
That’s so simple as to be almost self-evident but someone can be counted on to argue otherwise in the USA. Usually a lawyer. They get a cut on just about every transaction in the system.
Funny how that works when some 40% of the people elected to Congress are/were lawyers… and it used to be higher.
It isn’t just the fact that the legal system in the USA is a sort of lawsuit lottery. Forty+ million Americans have NO insurance. The hospitals are required to treat them by law, once they are sufficiently ill. The bulk of medical costs are expended in the last few weeks of life, staving off the inevitable. Americans in general aren’t such wimps… but the system turns them into vegetables towards the end. Then there’s the drugs problem, as the MDs are constrained as to the amount and type of painkiller they are allowed to give even a terminally ill patient. It is bizarre. It is unconscionable. It is “the American Way” in ways that most Americans abhor.
I suggest as a result of what I know of that system, that it not be used as any sort of standard for comparison to what we do or should do, and that we restrict ourselves to trying to look at systems that work BETTER than ours and how we might make ours work better.
respectfully
BJ
Like or Dislike:
0 
0 (0)
I suggest as a result of what I know of that system, that it not be used as any sort of standard for comparison to what we do or should do, and that we restrict ourselves to trying to look at systems that work BETTER than ours and how we might make ours work better
Yup. Too often people assume the mention of ‘alternatives’ mean ‘OMG US system fully privatized profit b4 people!!’ and the conversation descends into arguing about how the US system could be better, rather than um something a little more constructive.
Like or Dislike:
0 
0 (0)
john-ston – Tort reform is not the cure-all you claim it to be. It is an excuse to remove the last vestige of protection that real people have against the fake people – corporations – in this world. I agree that it is out of control in the USA. It would be out of control here too if we didn’t have the no-fault ACC system.
Fake “persons”, usually corporates, don’t get sent to jail. They don’t get executed, and can re-incorporate themselves with another name if their reputation suffers, and start their antics over again. They can file from bankruptcy and re-invent themselves overnight. Humans don’t have such recourse to hide from the law.
Tort reform seeks to eliminate the last real tool that real humans have within the legal system to punish fake persons. Health law suits need reform, control, or something, agreed. tort reform ain’t it.
Like or Dislike:
0 
0 (0)
But bj there are huge numbers of people contributing to the health system who make a profit.
Medical centres, pharmacists, nursing homes, the people who make medical aids, the pharmaceutical companies, the people who make ambulances and operating equipment and the people who make heart valves.
And the people who train nurses and doctors and so on.
Then there are the medical laborotories and the people who make X ray machines and the people who make sticking plaster.
So who and what are you talking about?
Like or Dislike:
0 
0 (0)
I think he was talking about those managing the system itself, rather than those providing products to it. having spent some time in that system, I echo his comments.
Like or Dislike:
0 
0 (0)
I think there are issues around the economics of hospitals that make privatisation a bad idea, but which don’t really apply to sticking plaster manufacturers.
Like or Dislike:
0 
0 (0)
The best health care available anywhere is in the USA.
But, because the system is based on ability to pay, and the average Amercian cant afford the world’s best health care (and many Americans cant afford any health care at all) when you apply the statistics to that the numbers come out pretty appalingly.
So the commonly quoted statistic that the USA has the 37th placed health care system is as valid as the old definition of a statistician with one hand in a bucket of boiling water and the other in iced water and declaring the temperature is fine. The extremes are so far apart there is no meaningful average. America has both the Number one, and the number 101 in the same country.
Like or Dislike:
0 
0 (0)
This is the statement I was responding to.
The obvious problem is that health care is a lot like nuclear safety.
IT CANNOT BE ADMINISTERED TO MAKE A PROFIT IF THE SOCIETY IS TO BE PROPERLY PROTECTED.
Like or Dislike:
0 
0 (0)
dbuckley – if what you say is true, which I believe is only marginally true in very narrow circumstances, why are so many Americans taking holidays for quality healthcare? It’s not just price that drives them away!
I think the yanks lead the world in some medical procedures/practices, but I don’t believe for a minute that it is the best care anywhere.
Like or Dislike:
0 
0 (0)
I would respectfully add that it’s completely possible in NZ to have ACC funding for injury and not get adequate treatment …
Get into a situation where you have to deal with both MSD and ACC, (due to Invalid’s Benefit), and you’ll have an almost completely tautological journey through the bureaucracy.
One of the things we are doing right is terminal disease care, however.
I was appalled to hear from an acquaintance, whose mother was dying painfully of cancer in the USA (and not diagnosed correctly until very nearly terminal), that there is no system like our hospice associations there, and that the use of morphine for palliative care was not common.
Having assisted nursing my grand-mother-in-law through terminal liver cancer, I was very appreciative of the care, both respite and in the terminal fortnight, that she received from Te Omanga Hospice in the Hutt Valley.
Two of the family held her hands at the end, as the final dose of morphine administered took hold. This was a much finer way to see her drift off, than that which I have heard recounted to me of cancer treatment in the USA.
She began to get care early in the terminal phase (secondary cancer in liver, primary kidney cancer 20 years earlier had metastased, there was no surgery option) and was quite pleased herself that it was cancer, and not a dicky heart or lung disfunction, which would not have seen her receive such marvelous care.
What we don’t do well is stuff like emphysemia, diabetes, congestive heart failure, etc, which are known to be terminal, eventually, but get treated as discrete medical events, without any ongoing checkup of the patients’ increasing state of disability.
Hospitals and GP’s don’t liase well, due to the gates within the system, and opportunities to effect daily care improvements are often lost in the shuffle.
The other area where patient advocacy groups have had an effect is in treatment and care of terminal AIDS patients – HIV/AIDS care and protocols were lobbied for by the NZ Aids Foundation, and the survival rates in NZ, while not a reason for complacency, are indicative of the amount of work done by what is essentially a voluntary body (although some paid positions are held these days) over the past 25 years or so.
AIDS research has also significantly contributed to the body of knowledge on immune dysfunction disorders, which in the congenital (non-acquired) forms are reasonably prevalent in the NZ population.
There’s still room for improvement – but I see that coming from increased R & D funding, and enabling hospital staff to actually get on with doing their jobs, mostly by increasing staffing levels and reducing administrative tasks per patient to be done by attending medical staff.
Like or Dislike:
0 
0 (0)
Owen
The principle is basically relating to the “insurance” aspect of it.
Fundamentally nobody can afford to pay for care when the sh!t really hits the fan. The need exceeds the resources of the individual. There may be a few exceptions on the planet, but we’re talking about the wholes society. As a result we have, one way or another, insurance which spreads the burden and shares the risk.
As for the rest, they make their crust by earning it and there’s no problem with that. I take your point though… there is room for misunderstanding.
respectfully
BJ
Like or Dislike:
0 
0 (0)