Thursday, August 27, 2009

How the NHS rates against American Health Care

72% of NHS patients complain that the stethoscope is too cold

The inimitable Siger forwarded an article to me about a recent report by the UK's Patient's Association - which claims that hundreds of thousands of patients have suffered 'neglectful, demeaning, painful and sometimes downright cruel' treatment at the hands of the NHS doctors and nurses.
"The report disclosed a horrifying catalogue of elderly people left in pain, in soiled bed clothes, denied adequate food and drink, and suffering from repeatedly cancelled operations, missed diagnoses and dismissive staff."
It's a fascinating article and one that will no-doubt yield bundles of ammunition for American conservatives intent on criticizing Obama's much-lauded 'public' health care option (even though what he's proposing is very far from the almost Soviet-style National Health Service in the UK.)

But what interested me was in the conclusion of the article.

Chris Beasley, Chief Nursing Officer at the Department of Health, is quoted in defending the NHS, citing that: "...recent patient experience surveys show that 93 percent of patients rate their overall care as good or excellent."

Why is this so interesting?

Because Fox News, that bastion of 'fair and balanced' reporting, recently cited that 89% percent of Americans had been similarly satisfied with the most recent treatment they'd received. This actually increased to 93% for those patients who'd recently suffered a serious illness.

Which is, somewhat coincidentally, the same percentage as those satisfied with their treatment from the NHS.

You can take that observation how you will - either as an indication that both systems are comparably successful, or to allege that both the NHS and Fox News are using conspicuously slanted statistics to support their agenda!

But what's really interesting is looking at the other end of these much-touted facts and figures - like the Fox News analysis which concludes that 'only' five million Americans are both uninsured and 'very dissatisfied' with the quality of health care they receive - roughly around 2% of the population.

According to the NHS article, the patients receiving what they determined as 'poor' care extrapolated to over one million people - also roughly about 2% of the population.

The same figure. Again.

To my mind, it just goes to reinforce the fact that there isn't a right and a wrong answer to providing health care for a nation's citizens. The best and worth of both seem comparable - whereas we really know they're not.

On the one hand, the American system can be criticized for being monstrously expensive and not covering enough of its citizens. Per capita, it costs twice as much to offer health care to the population of the United States - yet Fox News reports that 13.4% of Americans are still left without coverage.

The World Health Organization rank the United States as having the 37th best coverage in the world; not exactly a figure to boast about.

The United Kingdom, on the other hand, is ranked 18. Britain also has a lower rate of infant mortality and a longer average life expectancy. The cost of giving medical coverage to Britain's citizens is several thousand dollars less per person than in America (and, of course, covers everybody and costs its citizens nothing.)

But in many ways, such statistics tell us nothing.

Because while Britain's health care is cheaper and covers more people, many people argue that this is an indirect benefit of America's privately funded health care system.

It's a fact that many of the worlds leading pharmaceutical companies are based in the United States - and most of the new and exciting drugs and treatments emerge from the American health care system. The US system absorbs the related costs of researching and developing these new treatments (perhaps explaining why their health care costs so much more.)

And without having to pay for 'inventing' them, British patients do eventually benefit from these new drugs and treatments - just not immediately. The NHS generally offers only 'generic' medication, the copyrights of which have expired, meaning that most commonly prescribed medication is as much as a decade 'behind' the new and exciting drugs available in America.

But at least they don't have to pay for that development - or the research, marketing or related bumf. That cuts a huge chunk out of the related costs of running a universal health care system.

Perhaps that's not a fair analysis - in many way, it makes the NHS seem like a parasite, sucking drugs, treatments and developments from better funded health care systems - but it does offer an explanation for the gross disparity between the costs of running universal health care in Britain and the price of America's privately funded system.

America's race to develop new treatments also explains why some areas of medicine - like the treatment of cancer - are notably 'better' in America than in the UK.

So there's a truth we don't discuss much in the health care debate - that no nation's policy towards medicine exists entirely in a vacuum.

Some British people have to come to America to get the medical treatment that's simply not available to them at home. Meanwhile, drugs developed in America make a huge impact when they're eventually adopted by the NHS.

Because of that, the two systems are inextricably linked - as are the health care systems of Canada and other nations with a publicly funded system that benefits from America's private one.

This means that the discussion about changing the way America looks after the health of her 300 million citizens in reality affects far more people than just those with a US passport.


Eve said...

Hmm. I've had a few unpleasant experiences with medical care in the US, mostly with surly doctors or doctors who didn't take me seriously. However, the absolute worst medical experience I've ever had was in Edinbugh, Scotland (though I'm sure other people have had worse).

I went into the emergency room for mysterious stabbing pains in my chest. First off, reception completely butchered my address. Instead of a street address and a city, they put down two different streets. I've never heard of an address that was simultaneously on two different streets and in no city. Anyway, After taking a couple blood samples, the doctor left the needle in my arm in case they needed more later (it had an off valve, so not perhaps the most horrifying thing, but it's important later). An hour after my EKG, a nurse came in to do another one. As she was explaining what it was, I said I'd already had one. She was surprised, and said the doctor must have lost the first one. (obviously some kind of disorganization or lack of communication here, with a potential for harm if certain procedures are accidentally performed twice) Eventually they decided I just had back problems and gave me some kind of pain pills (they wouldn't tell me what they were, they just handed me a cup and said "take these"). Now the fun part. After 4 hours, they decided they needed the bed, so I could leave. But they wouldn't take that needle out of my arm. I've always had a huge dislike of needles, almost to the point of phobia (the thought makes me dizzy if I dwell on it), and I suffer from post traumatic stress disorder, so the invasive feeling of a needle for more than a few minutes is rather distressing. It was already quite a feat that I could lay there for 4 hours with a large needle in the crook of my elbow. And now they expected me to get dressed with that thing in my arm (of course, the placement meant that I couldn't bend my arm with out a lot of pain). I'm not sure how I managed, but I did get dressed. At that point it was all I could do to keep from sobbing (yes, the needle was that bad after 4 hours). I then had to pester the doctor to take the needle out. I got the impression he expected me to do it myself! To this day hospitals freak me out. The only positive thing about that whole experience is that I didn't have to pay for it, but with care like that I would much rather have not gone in the first place.

Whee. I suppose it could have been worse, but I don't think it should even have gotten to the point it did. Of course, I don't assume that all or most care in the UK is that upsetting, but it certainly trumps any of the disappointing hospital experiences I've had in the US. This is just my two cents, so draw whatever conclusions you like.

Eve said...

Also, I apologize for how long that story ended up. I can be a bit verbose at times.

Roland Hulme said...

Don't apologize for a thing, Eve!

After my experiences with the NHS - like my wife's ectopic pregnancy being misdiagnosed as a UTI - I have totally lost my faith in the NHS, too.

From a statistical standpoint, the NHS appears better. From a personal one, based on my experiences of both, America has treated my family a lot, lot better.

Thanks so much for your input!