Most of the complaints about U.S. healthcare are on the billing side - horrifically high medical bills, perverse incentives, the insurance industry, lack of transparency, the fact that we spend 17% of GDP on healthcare, etc.
But looking only at the quality aspect of healthcare - technology, skill, cleanliness, etc. - is America in the Top 20? Top 50?
I think it would be accurate to say that for all the dosh the collective “you” spend on healthcare that you don’t get the bang for your buck you should.
How does the quality of the U.S. healthcare system compare to other countries?
Of course there is the argument that the US averages are weighed down by those with poorer health outcomes through not being able to access the US healthcare system.
Which is counterbalanced by the argument that if the US had universal healthcare at similar funding levels to present then it couldn’t afford to provide the top quality health cover it does to those who currently access it.
No. Most complaints are about a large segment of people who have zero coverage.
As a nation, it’s not a high quality system if it leaves out millions of people. Even though a CEO can buy access to any procedure, new or current, the latest drug, whatever.
Or was that the premise? Based entirely upon the quality of any individual service that the 1% can access. That’s an odd metric though.
If you can only access a Dr when you’re in peril of death that’s pretty bad quality health care.
Whereas the 1%, in any nation on earth can always access the finest quality care. So what’s that prove about that nations healthcare quality?
OK, maybe I should clarify:
“Quality” in terms of things like - cleanliness of hospitals, likelihood of secondary infections, the quality of the drugs, the sanitation (or unsanitary-ness) of the tools, the sophistication of the technology, the skill and education/knowledge of the doctors and nurses, etc.
This large PDF from The Commonwealth Fund compares around twenty healthcare systems. It is from 2017. It has specific costs, outcomes, quality etc.
It convinced me of the need for UHC in the US.
My US doc suspected protein in my urine. I said Do you want a sample, to check with a lab-stik. Lab-stiks cost about 20c each and you read the color. He said No, we don’t do that anymore, and sent me for lab work, where urinalysis is billed at about $50. The result? Protein present. A result he could have had for 20c. Next stop, ultrasound.
More costly, yes, by 2 or 3 orders of magnitude. Better diagnosis? No, He’d have callled for the ustrasound in either case, lab-stik or lab analysis. But insurance demands the more costly justification.
And as we’re being reminded this month, health care isn’t just a matter for individuals. You can have the best possible health care for yourself and you still gain something more by other people also having good health care. It’s the opposite of a zero-sum game.
dupe
It might seem that American healthcare must be good — why else would it cost so much? But this isn’t so.
I recall a study that some American hospitals could improve outcomes by requiring doctors to practice better sanitation, i.e. wash hands more often. The hospitals refused to make changes for fear that a rule change would open them up to malpractice suits for results before the rule change! But anecdotes about financing may be off-topic in this thread; I’ll mention another in a spoiler.[spoiler]
A friend just paid $90 for a strep throat culture. That seemed high — Old-fashioned doctors can sometimes diagnose strep in two seconds after saying “Say ‘ahh’.” But when I Googled I found that one woman was billed $28,395.50 for strep culture and antibiotics. The “normal” price should have been $600. (I don’t have insurance so strep throat would set me back about $4 in Thailand.)
Most of that $28,395.50 was paid by the woman’s insurance company. The American system leads to a reversal of normal economics. Buyers of most products want to pay LESS, so supply-demand curves produce a low price. But insurance companies “get a share of the pie.” Although eager to deny coverage in specific cases when they can, they are happy to see overall prices soar — that increases the pie they’re taking a bite of![/spoiler]
I think there is general agreement that US healthcare is massively inefficient - for the amount that they are prepared to spend, as a society, on healthcare the US could get much, much better health outcomes than the outcomes they actually get. Or, if you prefer, they could get the current heallth outcomes at a much lower cost, if they cared to.
But that’s not what the OP asks about. Ignore the cost. Ignore the limited coverage. Purely in terms of clinical standards, how does the healthcare actually delivered to an individual in the US compare with the healthcare actually delivered to individuals in other countries?
The answer is going to be, of course, that clinical standards vary according to the kind of cover you have. This will also be true in other countries, so we are really looking for some kind of average or typical level of care in the US and comparator countries.
I don’t have a comprehensive answer - just a semi-anecdotal data point about a comparative study which I saw some years ago and now cannot find. The US measured very well on some matters, in particular the “hotel” side of hospital care - the quality of the food, the comfort, the ambience, the privacy - and also on the amount of time patients got to spend with their doctors and patients’ perception of how well they were informed and how well they were supported in making medical choices. On other metrics the US fared less well, but some of this may have been to do with uneven levels of coverage.
Purely anecdotally, I get the impression from this and other largely US-based forums that a fair number of Americans are indeed more likely to feel, or to want/feel obliged to be, more proactively involved in their medical care than would be usual in the UK. The flip side of this is that, from our perspective, such people seem to be doing a lot more running around (metaphorically) between providers and insurers and generally doing admin that we would leave to our GPs and specialist services. Clearly there’s an interaction there between what’s systemic, and what’s culturally-determined expectations, which is hard to disentangle.
The truism about our NHS is that it’s as good as any at dealing with the immediately life-threatening, variable when it comes to chronic but not dangerous conditions, but a reasonable level of basic care for everyone. Nothing is perfect, because doctors and nurses are only human.
I suppose any system is like Longfellow’s little girl with the curl:
*
When she was good,
She was very good indeed,
But when she was bad she was horrid.*
Of all the stats that show just how second-rate US health care is (while costing more than countries with first-rate care), the one that really gets to me is infant mortality.
Here’s the CIA World Factbook chart. The US is at 170 of the 225 places listed. (Bigger is better.) Look at the nearby states. That’s the company we keep, medically speaking.
Comments like “The US has the best health care in the world.” defy facts, logic, etc.
The technology at Zap Surgical is leading-edge. They’re in California and they treat brain cancer with non-invasive laser surgery.
Video ZAP-X. First-In-Kind. Vault-Free. Cobalt-Free. - YouTube
News story of brain surgery patient — ZAP-X® Gyroscopic Radiosurgery™ Platform - YouTube
This is pretty fantastic, Star Wars type of technology!
I think it’s fair to say that your top end is better than most; certainly it’s common to hear of people from the UK going to specialists in the US for treatments unavailable here, especially for rarer conditions, but the lower end also seems far worse, not just the lack of availability, but even the ER wait times often sound extremely high. In the UK, I’ve never had to wait more than 4 hours, and being accident prone and for some years the only one in a house full of silly people with a car, I’ve been rather a lot, and that’s always been for very low priority things; usually cuts that need a few stitches.
The joined-up system also helps; this Christmas I went to the emergency doctor, having just had a bad eczema flare up and realising I didn’t have enough ointment to see me through my holiday. I got seen within 2 hours and, having given my name and address, they could look my medical records up on the system, including all prescriptions I’ve had. That should reduce the chance of errors like prescribing something inappropriate, as well as meaning long-term trends might be a bit easier to spot. There are security concerns with the NHS medical records system, but the concept surely does sound a lot easier than everything I’ve heard about the US system.
In the US the very rich get the best care and the not-rich follow the GOP health plan: don’t get sick. We “self-insured” i.e. lacked coverage during our years between retirement and Medicare + Blue Shield, and fortunately survived, though I had to use part of dead Mom’s inheritance to pay for orthopedic surgery. Our premiums, co-pays, and drug and dental costs would begger us if we’d been unable to save during our worklives.
We receive superb care from a large hospital chain known for high billings that pay for medical superstars. The many millions who can’t afford such services are a big disease vector pool. Some private interests benefit from a weak, sick nation. Watch how this plays out.
I’m not sure if this is accurate, but I’ve heard that if physicians think insurance will refuse to cover tests or treatment for a rare disease, the physicians basically blow you off or tell you your illness is psychosomatic since they don’t want to deal with insurance companies refusing to pay.
Not sure if that is true, or if it happens in other nations.
But I’ve heard several stories of people having rare diseases and having doctors tell them its all in their head, then they go overseas and get quality care pretty quickly. But no idea if that is a systemic problem with the US health care system.
On average, what percentage of Americans can access this Star Wars technology?
It’s a minuscule percentage now because they only have one hospital with their machine. They are a startup, just getting underway. But from what I know of what they want to do it will eventually be a large percentage of the people who have brain cancer (which is the true population, statistically speaking), because the cost to treat them will be significantly lower than competing methods.
I work in an industry closely related to theirs, and former coworkers have gone on to work for them. That’s why I can make these educated guesses.
But on that basis, this is unlikely to be an advantage available only to Americans. If this is both cheaper and more effective than competing methods, then presumably healthcare provides outside the US will be as quick to adopt it as those within.